The Frequency of Emergency Department and Crisis Services Visits for Patients with Borderline Personality Disorder with Differing Models of Care

Frequent users of the emergency department (ED) are a small percentage of ED patients but account for a large percentage of visits. Given the cost to the health care system, it is important to explore strategies to prevent unnecessary visits. A prospective chart review of frequent users diagnosed with psychiatric illness in Emergency and Crisis services at one hospital was conducted. Detailed analysis was also completed on the subgroup of these patients diagnosed with borderline personality disorder (BPD) and/or self-harming behaviors to determine the impact of two models of psychiatric care on subsequent crisis or ED visits in the year after the index visit. The majority of patients presenting for mental health issues did so once. The mean number of subsequent presentations to the ED was 5.00, demonstrating that a small number of patients presented often. Patients with BPD and/or self-harming behaviors in a model of care that offered increased access to other services were less likely to have return visits. Patients with psychiatric issues often present at the ED and Crisis. Accessibility to supportive community care services can reduce the number of ED and Crisis visits.