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Abstract

Individuals experiencing mental health and substance use (MHSU) crises in British Columbia, Canada, often seek acute care in hospital emergency departments (EDs). Despite recent research demonstrating a marked increase in these visits, the evaluation of mental healthcare provided to those visiting the ED is limited. In particular, little is known about rates of standardized suicide screening, admission, follow-up referral, and the impact of geographic location and clinical presentation on wait times. The current study investigates, for the first time, descriptive statistics related to patient care based upon an independent, randomized, and retrospective audit of patient chart data. Spanning nine separate EDs within the Interior region of British Columbia, a sample of 1,491 patient visits was analyzed. Results demonstrated that suicidal ideation emerged as the most frequently documented reason for MHSU-related visits. Despite this prevalence, less than 10% of “at-risk” patients received standardized suicide screening. Additionally, only 25% of those who visited the ED for suicidal ideation and were discharged had any follow-up referral documentation noted in their chart. Notably, patient wait times from initial triage to physician assessment were highly variable, especially among those visiting the ED for problematic alcohol and substance use reasons. When evaluating metrics of patient care based on geographic categorization, differences emerged, reflecting distinct challenges for healthcare providers in rural EDs. Lastly, demographic and social determinants of health data were overwhelmingly missing from patient charts for several reasons. Taken together, these findings reveal significant gaps in how patients visiting for MHSU reasons are assessed and supported within ED settings. Low rates of suicide screening and post-discharge referral highlight opportunities for targeted quality improvement. By identifying current care patterns and gaps, this study provides foundational quantitative evidence to inform future decision-making that has the potential to improve outcomes for individuals experiencing MHSU crises.