Ensuring continuity of care for dual disorder: overview of outpatient services after emergency department discharge

Despite several existing outpatient services, individuals with dual disorders make extensive use of the emergency department to try to meet their needs. The objectives of this study were to: (1) describe the outpatient services provided to individuals with dual disorders, and (2) compare these services according to the most frequent discharge diagnoses after leaving the emergency department. The frequent discharge diagnoses have been classified into five groups: suicide attempts, psychotic/agitation symptoms, anxiety/depressive symptoms, suicidal ideation, and substance intoxication or withdrawal symptoms. This retrospective cross-sectional descriptive study took place in four emergency department settings in Québec, Canada. Data from emergency department visits and referrals to outpatient services between May 2015 and April 2016 were collected from the medical records of 150 adults with dual disorders. Results showed a low proportion of referrals to primary care or specialized substance use outpatient services; mention of dual disorder in referrals was also rare. Only 19% of individuals received referrals for both mental health and substance use services, suggesting a potential under-recognition of dual disorders. The distribution of services and referrals differed among the five groups, with individuals presenting for suicide attempts and those expressing suicidal ideations accounting for the lowest and highest proportions, respectively.