Barriers to Care Among High Emergency Department Users With Mental Disorders—A Mixed Methods Study

The increasing number of high emergency department (ED) users is a growing concern worldwide. Patients with mental disorders (MD) are among the largest contributors to high ED use. As high ED use is often seen as an indicator of a healthcare system's shortcomings, high ED users with MD may perceive unique barriers to care. Analysing the associated patient characteristics and service use along with structural and motivational barriers to outpatient care use could help explain the high ED use among patients with MD, and help recommend more patient-centered interventions. Data were extracted from a 2021-2022 survey and medical records of 182 high ED users with MD in four large ED networks from Quebec (Canada), including open-ended questions administered to 20 of these patients. A mixed methods approach (multivariable regression, thematic analysis) identified variables associated with the number of unmet care needs, and structural and motivational barriers to care explaining high ED use. The study partially confirmed its first hypothesis that patients with more health issues who were dissatisfied with services would have more barriers to care. The study confirmed its second hypothesis: structural barriers were more prevalent than motivational ones in relation to high ED use, and patients with high unmet needs had more care barriers than those with no unmet needs. Findings suggest services could be greatly improved to reduce high ED use, and that unmet needs should be investigated further to better address the care barriers of this vulnerable population.