An analysis of mental health referrals from public health centres to the Emergency Department of Mater Dei Hospital, Malta

Abstract

INTRODUCTION: Fifty per cent of the population experiences at least one mental disorder in their lifetime with 25% suffering one in the previous year. Recognition, diagnosis, treatment and referral depend on general practitioners (GPs). Prevalence of psychiatric problems in local primary care was 8% in 2017.

AIM: To evaluate the number of patients with a psychiatric complaint referred to the Emergency Department at Mater Dei Hospital (MDH), Malta, the reason for referral and whether these referrals were associated with certain factors, including time of day.

METHOD: Data of all patients with a psychiatric complaint referred to the Emergency Department from one of the primary health care centres in Malta was collected retrospectively using Excel. Referrals during the months of November and December 2019 were considered.

RESULTS: Sixty-nine patients inputted were equally distributed between November and December. Forty-two percent were females, the commonest age group was 19-30 years and most were triaged as Emergency Severity Index-2 upon arrival to the Emergency Department. Most patients were referred from the South region (Kirkop, Paola and Bormla). Most patients were referred between 09:01 and 17:00 hours. Twenty-seven point per cent were referred due to suicidal ideation closely followed by severe anxiety (21.7%). Forty-three percent were discharged on the same day with an urgent psychiatric appointment being given, 20% were kept at MDH, 7.2% required care at Psychiatric Unit and 5% admitted to the psychiatric Mount Carmel Hospital (MCH).

CONCLUSION: Suicidal ideation and severe anxiety are common complaints from government primary care to the Emergency Department. The majority of patients referred were given urgent psychiatric follow-up appointments in the community. The role of an onsite community psychiatrist would be twofold; immediate review for certain patients (such as a walk-in system) and further follow up by the same person in the community to improve the continuity of care.