{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T14:05:55Z","timestamp":1790863555438,"version":"4.1.0"},"reference-count":88,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2024,6,30]],"date-time":"2024-06-30T00:00:00Z","timestamp":1719705600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["8400997"],"award-info":[{"award-number":["8400997"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Patients with mental health (MH) problems are known to use emergency departments (EDs) frequently. This study identified profiles of ED users and associated these profiles with patient characteristics and outpatient service use, and with subsequent adverse outcomes. A 5-year cohort of 11,682 ED users was investigated (2012\u20132017), using Quebec (Canada) administrative databases. ED user profiles were identified through latent class analysis, and multinomial logistic regression used to associate patients\u2019 characteristics and their outpatient service use. Cox regressions were conducted to assess adverse outcomes 12 months after the last ED use. Four ED user profiles were identified: \u201cPatients mostly using EDs for accessing MH services\u201d (Profile 1, incident MDs); \u201cRepeat ED users\u201d (Profile 2); \u201cHigh ED users\u201d (Profile 3); \u201cVery high and recurrent high ED users\u201d (Profile 4). Profile 4 and 3 patients exhibited the highest ED use along with severe conditions yet received the most outpatient care. The risk of hospitalization and death was higher in these profiles. Their frequent ED use and adverse outcomes might stem from unmet needs and suboptimal care. Assertive community treatments and intensive case management could be recommended for Profiles 4 and 3, and more extensive team-based GP care for Profiles 2 and 1.<\/jats:p>","DOI":"10.3390\/ijerph21070864","type":"journal-article","created":{"date-parts":[[2024,7,3]],"date-time":"2024-07-03T06:04:18Z","timestamp":1719986658000},"page":"864","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Emergency Department Use among Patients with Mental Health Problems: Profiles, Correlates, and Outcomes"],"prefix":"10.3390","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4743-8611","authenticated-orcid":false,"given":"Marie-Jos\u00e9e","family":"Fleury","sequence":"first","affiliation":[{"name":"Department of Psychiatry, McGill University, 1033, Pine Avenue West, Montreal, QC H3A 1A1, Canada"},{"name":"Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Blvd., Montreal, QC H4H 1R3, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhirong","family":"Cao","sequence":"additional","affiliation":[{"name":"Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Blvd., Montreal, QC H4H 1R3, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2445-0060","authenticated-orcid":false,"given":"Guy","family":"Grenier","sequence":"additional","affiliation":[{"name":"Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Blvd., Montreal, QC H4H 1R3, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,6,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Barratt, H., Rojas-Garcia, A., Clarke, K., Moore, A., Whittington, C., Stockton, S., Thomas, J., Pilling, S., and Raine, R. (2016). Epidemiology of Mental Health Attendances at Emergency Departments: Systematic Review and Meta-Analysis. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0154449"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Santo, L., Peters, Z.J., and De Frances, C.J. (2021). Emergency Department Visits among Adults with Mental Health Disorders: United States, 2017\u20132019, National Center for Health Statistics.","DOI":"10.15620\/cdc:112081"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Fleury, M.J., Fortin, M., Rochette, L., Grenier, G., Hu\u1ef3nh, C., Pelletier, E., and Vasiliadis, H.M. (2019). Assessing quality indicators related to mental health emergency room utilization. BMC Emerg. Med., 19.","DOI":"10.1186\/s12873-019-0223-8"},{"key":"ref_4","unstructured":"Fleury, M.-J., Fortin, M., Rochette, L., Lesage, A., Vasiliadis, H.-M., Hu\u1ef3n, C., Grenier, G., and Pelletier, E. (2019). Surveillance de L\u2019utilisation des Urgences au Qu\u00e9bec par Les Patients Ayant des Troubles Mentaux, Institut National de Sant\u00e9 Publique du Qu\u00e9bec (INSPQ)."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"E724","DOI":"10.1503\/cmaj.181712","article-title":"Combined impacts of multimorbidity and mental disorders on frequent emergency department visits: A retrospective cohort study in Quebec, Canada","volume":"191","author":"Gaulin","year":"2019","journal-title":"CMAJ"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.annemergmed.2010.01.032","article-title":"Frequent users of emergency departments: The myths, the data, and the policy implications","volume":"56","author":"LaCalle","year":"2010","journal-title":"Ann. Emerg. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1512","DOI":"10.1016\/j.ajem.2013.08.006","article-title":"Frequent ED users: Are most visits for mental health, alcohol, and drug-related complaints?","volume":"31","author":"Liu","year":"2013","journal-title":"Am. J. Emerg. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"214","DOI":"10.2310\/8000.2013.130936","article-title":"Defining, quantifying, and characterizing adult frequent users of a suburban Canadian emergency department","volume":"15","author":"Moe","year":"2013","journal-title":"Can. J. Emerg. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"41","DOI":"10.12707\/RIV17095","article-title":"Determinants of non-urgent emergency department use","volume":"IV","author":"Dixe","year":"2018","journal-title":"Rev. Enferm. Ref."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Hitzek, J., Fischer-Rosinsky, A., Mockel, M., Kuhlmann, S.L., and Slagman, A. (2022). Influence of Weekday and Seasonal Trends on Urgency and In-hospital Mortality of Emergency Department Patients. Front. Public Health, 10.","DOI":"10.3389\/fpubh.2022.711235"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e215902","DOI":"10.1001\/jamanetworkopen.2021.5902","article-title":"Incidence of Access to Ambulatory Mental Health Care Prior to a Psychiatric Emergency Department Visit among Adults in Ontario, 2010\u20132018","volume":"4","author":"Kurdyak","year":"2021","journal-title":"JAMA Netw Open"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1136\/emermed-2015-205214","article-title":"Predictors of repeat visits to hospital psychiatric emergency departments in Malaga (Spain) and in Lisbon (Portugal)","volume":"34","author":"Warnke","year":"2017","journal-title":"Emerg. Med. J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.ienj.2017.06.001","article-title":"Contributing factors of frequent use of the emergency department: A synthesis","volume":"35","author":"Burns","year":"2017","journal-title":"Int. Emerg. Nurs."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1016\/j.jemermed.2013.05.007","article-title":"Frequent emergency department visits are more prevalent in psychiatric, alcohol abuse, and dual diagnosis conditions than in chronic viral illnesses such as hepatitis and human immunodeficiency virus","volume":"45","author":"Minassian","year":"2013","journal-title":"J. Emerg. Med."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Slankamenac, K., Heidelberger, R., and Keller, D.I. (2020). Prediction of Recurrent Emergency Department Visits in Patients with Mental Disorders. Front. Psychiatry, 11.","DOI":"10.3389\/fpsyt.2020.00048"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1136\/emermed-2014-204496","article-title":"Mortality, admission rates and outpatient use among frequent users of emergency departments: A systematic review","volume":"33","author":"Moe","year":"2016","journal-title":"Emerg. Med. J. EMJ"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1177\/1094428117752467","article-title":"Putting the \u201cPerson\u201d in the Center: Review and Synthesis of Person-Centered Approaches and Methods in Organizational Science","volume":"21","author":"Woo","year":"2018","journal-title":"Organ. Res. Methods"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Birmingham, L.E., Cochran, T., Frey, J.A., Stiffler, K.A., and Wilber, S.T. (2017). Emergency department use and barriers to wellness: A survey of emergency department frequent users. BMC Emerg. Med., 17.","DOI":"10.1186\/s12873-017-0126-5"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e535","DOI":"10.1002\/ams2.535","article-title":"Characteristics and subgroups of frequent emergency department users in an academic hospital in Japan","volume":"7","author":"Osawa","year":"2020","journal-title":"Acute Med. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1111\/jgs.16921","article-title":"Profiles of Frequent Geriatric Users of Emergency Departments: A Latent Class Analysis","volume":"69","author":"Dufour","year":"2021","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e12346","DOI":"10.1002\/emp2.12346","article-title":"Identifying subgroups and risk among frequent emergency department users in British Columbia","volume":"2","author":"Moe","year":"2021","journal-title":"J. Am. Coll Emerg. Physicians Open"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e055297","DOI":"10.1136\/bmjopen-2021-055297","article-title":"Profiles of frequent emergency department users with chronic conditions: A latent class analysis","volume":"12","author":"Chiu","year":"2022","journal-title":"BMJ Open"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1097\/MLR.0000000000000628","article-title":"Identifying Subgroups of Adult Superutilizers in an Urban Safety-Net System Using Latent Class Analysis: Implications for Clinical Practice","volume":"56","author":"Rinehart","year":"2018","journal-title":"Med. Care"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1007\/s11606-022-07873-y","article-title":"Cluster Analysis of the Highest Users of Medical, Behavioral Health, and Social Services in San Francisco","volume":"38","author":"Hewlett","year":"2023","journal-title":"J. Gen. Intern. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1186\/s12955-023-02200-3","article-title":"Profiles of quality of life among patients using emergency departments for mental health reasons","volume":"21","author":"Fleury","year":"2023","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1177\/07067437221087004","article-title":"Profiles, Correlates and Outcomes Among Patients Experiencing an Onset of Mental Disorder Based on Outpatient Care Received Following Index Emergency Department Visits","volume":"67","author":"Gabet","year":"2022","journal-title":"Can. J. Psychiatry"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.ajem.2022.01.052","article-title":"Profiles of high emergency department users with mental disorders","volume":"54","author":"Armoon","year":"2022","journal-title":"Am. J. Emerg. Med."},{"key":"ref_28","first-page":"902","article-title":"Substance Use, Homelessness, Mental Illness and Medicaid Coverage: A Set-Up for High Emergency Department Utilization","volume":"19","author":"Moulin","year":"2018","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1177\/07067437221136461","article-title":"Predictors of Death From Physical Illness or Accidental\/Intentional Causes among Patients with Substance-Related Disorders","volume":"68","author":"Fleury","year":"2023","journal-title":"Can. J. Psychiatry"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1001\/archgenpsychiatry.2011.2000","article-title":"Association of mental disorders in early adulthood and later psychiatric hospital admissions and mortality in a cohort study of more than 1 million men","volume":"69","author":"Gale","year":"2012","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1097\/EDE.0b013e3181577511","article-title":"Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): Explanation and elaboration","volume":"18","author":"Vandenbroucke","year":"2007","journal-title":"Epidemiology"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2099","DOI":"10.1377\/hlthaff.2012.1276","article-title":"Dispelling an urban legend: Frequent emergency department users have substantial burden of disease","volume":"32","author":"Billings","year":"2013","journal-title":"Health Aff. (Millwood)"},{"key":"ref_33","unstructured":"Canadian Association of Emergency Physicians (2024, May 14). Canadian Triage Acuity Scale. Available online: https:\/\/caep.ca\/wp-content\/uploads\/2017\/06\/module_I_slides_v2.5_2012.pdf."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Moe, J., Wang, Y.E., Schull, M.J., Dong, K., McGregor, M.J., Hohl, C.M., Holroyd, B.R., and McGrail, K.M. (2022). Characterizing people with frequent emergency department visits and substance use: A retrospective cohort study of linked administrative data in Ontario, Alberta, and B.C., Canada. BMC Emerg. Med., 22.","DOI":"10.1186\/s12873-022-00673-x"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"178","DOI":"10.24095\/hpcdp.29.4.05","article-title":"A deprivation index for health planning in Canada","volume":"29","author":"Pampalon","year":"2009","journal-title":"Chronic Dis. Can."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1097\/MLR.0000000000000905","article-title":"Validation of the Combined Comorbidity Index of Charlson and Elixhauser to Predict 30-Day Mortality across ICD-9 and ICD-10","volume":"56","author":"Simard","year":"2018","journal-title":"Med. Care"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1016\/0895-4356(92)90133-8","article-title":"Adapting a clinical comordibity index for use with ICD-9-CM Administrative Databases","volume":"45","author":"Deyo","year":"1992","journal-title":"J. Clin. Epidemiol."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Carter, R., Quesnel-Vallee, A., Plante, C., Gamache, P., and Levesque, J.F. (2016). Effect of family medicine groups on visits to the emergency department among diabetic patients in Quebec between 2000 and 2011: A population-based segmented regression analysis. BMC Fam. Pract., 17.","DOI":"10.1186\/s12875-016-0422-2"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1093\/fampra\/cmab079","article-title":"Specific content for collaborative care: A systematic review of collaborative care interventions for patients with multimorbidity involving depression and\/or anxiety in primary care","volume":"39","author":"Kappelin","year":"2022","journal-title":"Fam. Pract."},{"key":"ref_40","first-page":"965","article-title":"Continuity of care in a university-based practice","volume":"50","author":"Breslau","year":"1975","journal-title":"J. Med. Educ."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1362","DOI":"10.1503\/cmaj.061615","article-title":"Continuity of primary care and emergency department utilization among elderly people","volume":"177","author":"McCusker","year":"2007","journal-title":"CMAJ"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"92","DOI":"10.2105\/AJPH.92.1.92","article-title":"Adequacy of Treatment for Serious Mental Illness in the United States","volume":"92","author":"Wang","year":"2002","journal-title":"Am. J. Public Health"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1391","DOI":"10.1176\/ps.2008.59.12.1391","article-title":"Persistent depression and anxiety in the United States: Prevalence and quality of care","volume":"59","author":"Young","year":"2008","journal-title":"Psychiatr. Serv."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Fleury, M.J., Grenier, G., Vallee, C., Aube, D., Farand, L., Bamvita, J.M., and Cyr, G. (2016). Implementation of the Quebec mental health reform (2005\u20132015). BMC Health Serv. Res., 16.","DOI":"10.1186\/s12913-016-1832-5"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Moorin, R.E., Youens, D., Preen, D.B., and Wright, C.M. (2020). The association between general practitioner regularity of care and \u2018high use\u2019 hospitalisation. BMC Health Serv. Res., 20.","DOI":"10.1186\/s12913-020-05718-0"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"295","DOI":"10.24095\/hpcdp.38.7\/8.04","article-title":"Individual, programmatic and systemic indicators of the quality of mental health care using a large health administrative database: An avenue for preventing suicide mortality","volume":"38","author":"Thibodeau","year":"2018","journal-title":"Health Promot. Chronic Dis. Prev. Can."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1093\/intqhc\/mzl025","article-title":"Quality indicators for international benchmarking of mental health care","volume":"18","author":"Hermann","year":"2006","journal-title":"Int. J. Qual. Health Care"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Samartzis, L., and Talias, M.A. (2019). Assessing and Improving the Quality in Mental Health Services. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17010249"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"730","DOI":"10.1093\/aje\/kwv114","article-title":"Asymptotically Unbiased Estimation of Exposure Odds Ratios in Complete Records Logistic Regression","volume":"182","author":"Bartlett","year":"2015","journal-title":"Am. J. Epidemiol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1093\/biomet\/61.2.215","article-title":"Exploratory latent structure analysis using both identifiable and unidentifiable models","volume":"61","author":"Goodman","year":"1974","journal-title":"Biometrika"},{"key":"ref_51","unstructured":"Lazarsfeld, P.F., and Henry, N.W. (1968). Latent Structure Analysis, Hougton Miffilin."},{"key":"ref_52","unstructured":"Hagernaars, J.A., and McCutcheon, A.L. (2009). Applied Latent Class Analysis, Cambridge University Press."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1214\/aos\/1176344136","article-title":"Estimating the dimension of a model","volume":"6","author":"Schwarz","year":"1978","journal-title":"Ann. Stat."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1007\/BF01246098","article-title":"An entropy criterion for assessing the number of clusters in a mixture model","volume":"13","author":"Celeux","year":"1996","journal-title":"J. Classif."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1080\/10705510701575602","article-title":"PROC LCA: A SAS Procedure for Latent Class Analysis","volume":"14","author":"Lanza","year":"2007","journal-title":"Struct. Equ. Model."},{"key":"ref_56","unstructured":"StataCorp (2021). Stata Statistical Software 17, StataCorp."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1016\/j.genhosppsych.2014.09.010","article-title":"Predictors of frequent emergency department use among patients with psychiatric illness","volume":"36","author":"Chang","year":"2014","journal-title":"Gen. Hosp. Psychiatry"},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Vu, F., Daeppen, J.B., Hugli, O., Iglesias, K., Stucki, S., Paroz, S., Canepa Allen, M., and Bodenmann, P. (2015). Screening of mental health and substance users in frequent users of a general Swiss emergency department. BMC Emerg. Med., 15.","DOI":"10.1186\/s12873-015-0053-2"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.genhosppsych.2019.07.006","article-title":"Factors associated with emergency department use for mental health reasons among low, moderate and high users","volume":"60","author":"Fleury","year":"2019","journal-title":"Gen. Hosp. Psychiatry"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1176\/appi.ps.201400097","article-title":"Predictors of recurrent use of psychiatric emergency services","volume":"66","author":"Weber","year":"2015","journal-title":"Psychiatr. Serv."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/S0165-0327(01)00379-2","article-title":"Barriers to help-seeking by men: A review of sociocultural and clinical literature with particular reference to depression","volume":"71","year":"2002","journal-title":"J. Affect. Disord."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1177\/0706743717714467","article-title":"Service Use and Unmet Needs for Substance Use and Mental Disorders in Canada","volume":"62","author":"Urbanoski","year":"2017","journal-title":"Can. J. Psychiatry"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/j.pec.2015.08.028","article-title":"The primary care physician\/psychiatrist joint consultation: A paradigm shift in caring for patients with mental health problems?","volume":"99","author":"Saillant","year":"2016","journal-title":"Patient Educ. Couns."},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Davy, C., Bleasel, J., Liu, H., Tchan, M., Ponniah, S., and Brown, A. (2015). Effectiveness of chronic care models: Opportunities for improving healthcare practice and health outcomes: A systematic review. BMC Health Serv. Res., 15.","DOI":"10.1186\/s12913-015-0854-8"},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Fleury, M.J., Grenier, G., Gentil, L., and Roberge, P. (2021). Deployment of the consultation-liaison model in adult and child-adolescent psychiatry and its impact on improving mental health treatment. BMC Fam. Pract., 22.","DOI":"10.1186\/s12875-021-01437-5"},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Coventry, P.A., Hudson, J.L., Kontopantelis, E., Archer, J., Richards, D.A., Gilbody, S., Lovell, K., Dickens, C., Gask, L., and Waheed, W. (2014). Characteristics of effective collaborative care for treatment of depression: A systematic review and meta-regression of 74 randomised controlled trials. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0108114"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/j.ienj.2015.01.005","article-title":"The impact of a flow strategy for patients who presented to an Australian emergency department with a mental health illness","volume":"23","author":"Bost","year":"2015","journal-title":"Int. Emerg. Nurs."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1111\/1742-6723.13335","article-title":"Review article: Interventions for people presenting to emergency departments with a mental health problem: A systematic scoping review","volume":"31","author":"Johnston","year":"2019","journal-title":"Emerg. Med. Australas."},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Krieg, C., Hudon, C., Chouinard, M.C., and Dufour, I. (2016). Individual predictors of frequent emergency department use: A scoping review. BMC Health Serv. Res., 16.","DOI":"10.1186\/s12913-016-1852-1"},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"Gentil, L., Grenier, G., Vasiliadis, H.M., Huynh, C., and Fleury, M.J. (2021). Predictors of Recurrent High Emergency Department Use among Patients with Mental Disorders. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18094559"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1097\/PEC.0000000000000421","article-title":"Substance abuse and mental health visits among adolescents presenting to US emergency departments","volume":"31","author":"Fahimi","year":"2015","journal-title":"Pediatr. Emerg. Care"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"e64","DOI":"10.1111\/j.1553-2712.2011.01086.x","article-title":"Frequent users of emergency department services: Gaps in knowledge and a proposed research agenda","volume":"18","author":"Pines","year":"2011","journal-title":"Acad. Emerg. Med."},{"key":"ref_73","doi-asserted-by":"crossref","unstructured":"Gentil, L., Grenier, G., Meng, X., and Fleury, M.J. (2021). Impact of Co-occurring Mental Disorders and Chronic Physical Illnesses on Frequency of Emergency Department Use and Hospitalization for Mental Health Reasons. Front. Psychiatry, 12.","DOI":"10.3389\/fpsyt.2021.735005"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1186\/s13033-020-00409-z","article-title":"Patterns of primary care among persons with schizophrenia: The role of patients, general practitioners and centre factors","volume":"14","year":"2020","journal-title":"Int. J. Ment. Health Syst."},{"key":"ref_75","doi-asserted-by":"crossref","unstructured":"Gentil, L., Grenier, G., Vasiliadis, H.M., and Fleury, M.J. (2022). Predictors of Length of Hospitalization and Impact on Early Readmission for Mental Disorders. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph192215127"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1111\/sltb.12892","article-title":"Profiles of patients using emergency departments or hospitalized for suicidal behaviors","volume":"52","author":"Fleury","year":"2022","journal-title":"Suicide Life-Threat. Behav."},{"key":"ref_77","unstructured":"Mueser, K.T., Noordsy, D.L., Drake, R.E., and Fox, L. (2003). Integrated Treatment for Dual Disorders: A Guide to Effective Practice, Guilford Press."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1007\/s12264-014-1493-5","article-title":"Involuntary admission and treatment of patients with mental disorder","volume":"31","author":"Zhang","year":"2015","journal-title":"Neurosci. Bull."},{"key":"ref_79","first-page":"CD007906","article-title":"Intensive case management for severe mental illness","volume":"61","author":"Dieterich","year":"2017","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1159\/000496742","article-title":"Effect of Assertive Community Treatment for Patients with Substance Use Disorder: A Systematic Review","volume":"25","author":"Penzenstadler","year":"2019","journal-title":"Eur. Addict. Res."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ajem.2023.09.008","article-title":"Effectiveness of emergency department based interventions for frequent users with mental health issues: A systematic review","volume":"74","author":"Gabet","year":"2023","journal-title":"Am. J. Emerg. Med."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1007\/s11606-012-2005-9","article-title":"Primary care physician perceptions on caring for complex patients with medical and mental illness","volume":"27","author":"Loeb","year":"2012","journal-title":"J. Gen. Intern. Med."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1177\/0004867413484369","article-title":"A retrospective quasi-experimental study of a community crisis house for patients with severe and persistent mental illness","volume":"47","author":"Siskind","year":"2013","journal-title":"Aust. N. Z. J. Psychiatry"},{"key":"ref_84","doi-asserted-by":"crossref","unstructured":"Gabet, M., Grenier, G., Cao, Z., and Fleury, M.J. (2020). Implementation of three innovative interventions in a psychiatric emergency department aimed at improving service use: A mixed-method study. BMC Health Serv. Res., 20.","DOI":"10.1186\/s12913-020-05708-2"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"e144","DOI":"10.1192\/bjo.2022.534","article-title":"Short-stay crisis units for mental health patients on crisis care pathways: Systematic review and meta-analysis","volume":"8","author":"Anderson","year":"2022","journal-title":"BJPsych Open"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1111\/inm.12658","article-title":"Crisis resolution and home treatment in the UK: A survey of model fidelity using a novel review methodology","volume":"29","author":"Lamb","year":"2020","journal-title":"Int. J. Ment. Health Nurs."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"869","DOI":"10.1007\/s10597-024-01239-w","article-title":"Barriers and Facilitators to High Emergency Department Use Among Patients with Mental Disorders: A Qualitative Investigation","volume":"60","author":"Fleury","year":"2024","journal-title":"Community Ment. Health J."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"7","DOI":"10.5334\/ijic.2457","article-title":"Implementing Key Strategies for Successful Network Integration in the Quebec Substance-Use Disorders Programme","volume":"16","author":"Fleury","year":"2016","journal-title":"Int. J. Integr. Care"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/21\/7\/864\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:08:26Z","timestamp":1760108906000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/21\/7\/864"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,30]]},"references-count":88,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2024,7]]}},"alternative-id":["ijerph21070864"],"URL":"https:\/\/doi.org\/10.3390\/ijerph21070864","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,30]]}}}