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Dissertation

The evaluation of a level I psychiatric emergency service

25 July 2003

Abstract

In the past three decades, the number of visits to psychiatric emergency service (PES) has grown dramatically. The increased utilization of PES makes understanding the state of the art innovations and developments of these services increasingly important to the mental health community. This study examined a PES located in Multnomah County in Oregon. There were two main objectives of this evaluation. First was to identify if the PES met the goals set by the county. Second was to provide information pertaining to the PES, which had not been available in the past. Such information was seen as vital to increase the understanding of PES and to provide guidance in how we develop such services. These goals were accomplished by a review of the research that led to the development of the PES, analysis of the data collected over three and half years of operation of the PES, a time series analysis of ten years of monthly suicide counts in Multnomah County, and a time series analysis of the percentage of individuals placed on physician holds that go on to commitment hearings. The results found the PES increased access to professional mental health crisis evaluations, but apparently did not impact suicide rates or the rate of individuals on physician holds going to commitment hearings. Specific attention was focused on information about utilization patterns, numbers of out of county clients, numbers of physician holds, which found that up to 35% of the evaluations were done on out of county residents, and the clinic saw approximately 15% more children and adolescents than the literature would have predicted. Further, the data from the study provided information that is new to the literature and would be important to consider when designing a PES.


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