Pilot Study to Determine the Feasibility of Early Interventions for ED Attendees who Present with Moderate and High Levels of Psychological Distress

Background

Mental health problems result in high levels of morbidity and mortality and impose high societal costs. Population surveys have not only revealed an increasing prevalence of mental illness and sub threshold levels of psychological distress within the community; but also, relatively consistent and unimproved levels of treatment-seeking behaviours. This unmet need for mental health interventions represents an important public health issue for global health care systems. The Emergency Department (ED) represents an ideal access point for hard to reach individuals and can be seen as a gateway to mental health services, particularly for individuals whom are not seeking treatment for such issues. However, if populations with sub threshold symptoms of mental illness can be routinely screened and targeted during opportunistic presentations, then interventions can be offered to help alleviate distress. Ultimately, this would be beneficial in the long term for the individual, their families and the community as a whole; due to the high costs associated with mental health issues

Aim

This study aimed to use a novel approach for mental health treatment, by offering telephone-delivered Motivational Interviewing (MI) to ED attendees with moderate to high levels of psychological distress. The intervention focussed on ED attendees who were not seeking treatment for mental health problems, with the intention to encourage and motivate them to seek further assistance.

Methods

This study was undertaken in two phases: The first phase comprised a survey of ED attendees over a 24-hour / 2-week time period, to measure the prevalence of psychosocial distress, and to inform the intervention phase of the study. The second phase involved screening ED attendees, using the Kessler Psychological Distress Scales (K10), to identify those with moderate to high levels of psychological distress. Participants were randomised into either a low stress group, or a moderate to high stress group which comprised a control and intervention group (3 arms in total). The intervention was delivered by telephone MI and comprised 2 to 4 sessions of up to one hour, as determined by the participant’s needs. Success of the intervention was determined if / when participants actively sought help from their General Practitioner (GP) for their mental health issue. Other measures included the MI effect on psychological distress; with participant follow up conducted at 1, 3, 6 and 12 months, post recruitment.

Results

Overall, the intervention group reported less psychological distress over the 12-month follow up period, although the intervention’s aim to increase GP access was ultimately unsuccessful. However, men in the intervention group did report a statistically significant reduction in depression symptoms, with significant effects lasting up to 12 months. The MI intervention delivered by telephone was deemed acceptable for males, with 80% reporting satisfaction for the MI delivered by telephone.

Discussion

For the treatment of mental health issues, men represent a generally hard to access population with lower attendance of health appointments when compared to women; nor do they perceive the need for mental health treatment as easily as women. The telephone intervention utilised in this study was accepted by the male non-treatment seeking sample and suggests that men’s treatment needs may be different to that of women’s. As such, it may be necessary to explore male-centred models of care that cater exclusively to this gender. Aside from being a crisis service for mental health, the ED also offers a controlled environment for opportunistic health service presentations, where interventions for the promotion of mental health appears to be currently underutilised. The systematic screening of ED attendees can help identify individuals with underlying sub threshold levels of mental ill-health and appears to be particularly useful for patients whom are hard to access due to suboptimal treatment seeking behaviours.

Conclusion

Overall, this study suggests that telephone-based MI represents a feasible and flexible option to help alleviate psychological distress among non-treatment seeking populations. Early detection and targeted interventions that can help prevent the progression of psychological distress are clearly desirable for this vulnerable and hard to access subpopulation. The current study also suggests that screening and delivering early interventions offer a cost-effective method to help reduce the progression of psychological distress symptoms and develop psychological resources for EDs of the future.