Continuity of Care in Mental Health

Abstract

Background: Individuals who make multiple visits to EDs for mental health complaints are a highly visible and challenging group. Recent healthcare priorities aimed at reducing inappropriate or unnecessary service use call for improved continuity of care. Implementing effective continuity interventions is contingent on sound foundational knowledge including population profiling and conceptual understanding. A deficit in these key elements is apparent in existing literature. These gaps in knowledge must be addressed to ensure quality continuity research targeting frequent presenters. Furthermore, there is a paucity of research available that implements evidence-informed methods and theory-driven measurement strategies. Objective: To strengthen the knowledge base on frequent mental health-related ED use and continuity in mental healthcare by addressing existing gaps in foundational knowledge and examining the phenomena at a regional tertiary healthcare centre. Method: This was a three-phase emergent study design using mixed methods. Phase 1 was an integrative study to synthesize research on frequent presenters to the ED for mental health complaints. Phase 2 was a theory analysis to explore the conceptual understanding of continuity in mental healthcare. Phase 3 was an observational case-control study of an exemplar population at a regional tertiary healthcare centre using the evidence-informed methods emerging from the first two phases. Results: From this enquiry, I proposed an evidence-informed profile for frequent presenters to the ED for mental health complaints, summarized parameters used to identify the frequent presenter population, highlighted existing areas of theoretical consensus not yet recognized in continuity research, and provided a global understanding of continuity in mental healthcare and an approach for selecting measurement strategies for continuity research. The observational study strengthened the emerging frequent presenter profile and explored CoC using a comprehensive tool. Conclusion: This doctoral thesis addresses important gaps in foundational knowledge by providing an evidence-informed frequent presenter population profile and global theoretical summary of continuity in mental healthcare. The observational study appears to be the first to use a theory-driven measurement tool and results differ from previous studies in which simple measurement approaches are used. Given this, new hypotheses/questions about the focus and role of CoC with frequent ED use need to be explored.