Use of psychiatric emergency services and enrollment status in a public managed mental health care plan

Objective: This study examined the sociodemographic and clinical characteri stics of acute-care psychiatric patients who visited the emergency, departm ent at a large public hospital in terms of the patients' enrollment status in the region's public managed mental health care plan. The results of the analyses were expected to provide information about the degree and types of access to care for individuals who are and are not enrolled in the plan. M ethods: Data were collected over a seven-month period for 2,419 patients wh o visited a large, inner-city crisis triage unit. Patients were grouped acc ording to whether they were currently enrolled, previously enrolled, or nev er enrolled in the public managed mental health care plan. Univariate and l ogistic regression models were used to determine differences between the th ree groups. Results: In general, patients who were currently enrolled in th e plan had a higher rate of functional psychosis, past use of psychiatric s ervices, and functional disability and lower rates of substance use and hom elessness. Previously enrolled patients had a more moderate rate of psychos is but a higher rate of substance use, functional disability, and homelessn ess. The never-enrolled patients bad a lower rate of psychosis, functional disability, and past use of psychiatric services, and moderate substance us e. Conclusions: The region's public health plan appeared to be succeeding i n engaging and keeping the most psychiatrically impaired patients in treatm ent; however, individuals with moderate psychiatric symptoms and high level s of substance abuse may never have been enrolled in the plan because of Me dicaid ineligibility or because they dropped out of treatment. Problematic behavior and history, of hospitalization were the best predictors of enroll ment status.