The long-distance psychiatric patient in the emergency room. Insights regarding travel and mental illness

Abstract

This paper deals with the motivational, demographic and clinical characteristics of individuals who seek psychiatric help at facilities located a great distance from their places of residence. The study identifies two subgroups within this category. The first (Intentional or Type A) group is constituted by persons who, owing to their concerns with the social stigma of mental illness, or driven by the desire for a magical solution to their problems, purposely undertake the journey to a distantly located psychiatric center. The second (Incidental or Type B) group consists of vacationers, hitch-hikers and skid-row individuals. While these "long distance patients" (LDP) did not show any differences when compared with the remainder of clinic attendance on demographic variables, distinct clinical features differentiated the two populations. Most significantly the LDP had a higher incidence of schizophrenia and alcohol related problems. The difference was entirely accounted for by the Type B subgroup ((LDP less than 0.01; Type A, NS; Type B less than 0.001). Implications of this finding have been discussed in view of the suggested relationships between travel and mental illness. Administrative problems of the LDP have been briefly commented upon.