A Qualitative Study of Barriers and Facilitators to Transitions From the Emergency Department to Outpatient Mental Health Care.

ABSTRACT

OBJECTIVE: People with psychiatric disorders are among the most frequent users of emergency departments (EDs). The transition of care from the ED to outpatient mental health treatment may be important for continuity of care; however, little is known about the barriers and facilitators that patients experience in transitions to and engagement in outpatient mental health care. In this qualitative study, the authors examined the perspectives of patients and providers on these barriers and facilitators at the patient, provider, and health care system levels. METHODS: The authors (trained interviewers) conducted 30 semistructured interviews with patients and 15 interviews with 13 mental health providers. Data were analyzed by using thematic analysis. RESULTS: Patients and providers discussed similar barriers and facilitators to patient transitions and engagement in care. Patients with psychiatric disorders experienced barriers and facilitators at multiple levels when engaging in mental health care after discharge from the ED. Patient-level themes included openness to treatment and logistical challenges. Provider-level themes focused on the connection between patients and providers and on establishing and maintaining contact. Themes at the health care system level were coordination between the ED and outpatient clinics, managing appointments, and health care resources. CONCLUSIONS: Key factors that influence transitions of care from the ED to outpatient treatment include patients' complex health and life circumstances, the establishment of a relationship with providers built on trust and compassion, and the level of coordination between care settings.