More Than Suicide: Mortality After Emergency Psychiatric Care and Implications for Practice

Abstract

Background: Emergency departments (EDs) provide vital mental health services. ED patients with behavioral health presentations, particularly suicidal ideation, are at increased risk of death by suicide, medical illness, trauma, or overdose. Causes of death for patients who receive specialty emergency psychiatric services remain undescribed.

Objective: We describe the incidence and cause of death after care in a psychiatric emergency service (PES).

Methods: Mortality data were obtained for all adult patients treated in a safety net ED from April 2016 to June 2020. Causes of death were categorized as medical, external (accidents, overdoses, and homicide), or suicide and compared between PES patients and ED patients who were not treated in the PES. Correlates of mortality were described for PES patients.

Results: We analyzed 164,422 encounters including 6063 PES visits. Mortality in the 30 days after discharge was 0.3% among PES patients and 0.6% among medical ED patients. At both 30 and 365 days, PES patients were more likely to die by suicide than medical ED patients, and ED patients were more likely to die by medical causes. Among PES patients who died within 365 days, 46% died by medical causes, 32% by external causes, and 23% by suicide. In multivariable analyses, age was associated with all-cause, medical, and external mortality after a PES visit; opioid and stimulant use disorders were associated with all-cause and external mortality.

Conclusions: Most patients who die after receiving emergency psychiatric care die by medical and external causes such as accidents, overdose, and homicide. Patients who are older and have opioid or stimulant use disorders are at higher risk of nonsuicide mortality. We propose interventions to reimagine emergency psychiatric care and address nonsuicide mortality among psychiatric patients treated in emergency and crisis settings.

Keywords: emergency psychiatry; integrated behavioral health; mortality; public health; social emergency medicine.