In Times of Need: Psychiatric Emergency Department Presentations in Autistic Adults

Abstract

Background:

Autistic individuals exhibit greater vulnerability to mental health challenges than the general population, yet they lack access to adequate mental health care. Barriers to seeking and receiving adequate mental health care, such as minority stress, adverse life events, discrimination, and stigmatization can result in increased reliance on general and psychiatric emergency departments (ED/PsyED) during mental health crises. There is however limited research detailing PsyED use in autistic adults.

Methods:

This large-scale retrospective chart review analyzed PsyED visits by autistic adults (aged 16 to 63) in an urban psychiatric hospital in Canada from 2018 to 2020. Data were collected from 345 autistic patients who had 1027 PsyED visits during this 3-year period. Demographic information, psychiatric and neurodevelopmental diagnoses, and reasons for PsyED visits were characterized. Predictors of reasons for visiting PsyED were examined using mixed-effects logistic regressions. Differences between single-time and recurrent visitors were explored.

Results:

Autistic patients were mostly white (56.2%), Canadian citizens (79.1%), heterosexual (50.7%), and assigned male at birth (72.2%). Many were of low socioeconomic status, with one-third earning less than 15,000 Canadian dollars yearly. Most (84.3%) had at least one co-occurring mental health condition, with 54.8% having two or more. Rates of attention-deficit/hyperactivity disorder and intellectual disability were both around 20%. Most frequent reasons for visits included suicidality (42.9%), aggression (24.6%), and mood symptoms (16.1%). Reasons for visiting PsyED were associated with specific mental health and neurodevelopmental diagnoses. Recurrent visitors (40.3%) did not differ in sociodemographic characteristics from single-time visitors, but had more complex clinical presentations.

Conclusion:

Mental health needs of autistic adults were high and complex in the PsyED setting, particularly those needing recurrent emergency visits. Addressing service gaps and barriers to ongoing mental health support is essential to enhance the continuity of care.

Community Brief

Why is this an important issue?

Autistic adults are more likely to experience mental health difficulties and face challenges in accessing adequate mental health care. When mental health needs are not properly addressed, it can lead to increased use of emergency department (ED) or psychiatric emergency department (PsyED), oftentimes in crises. Understanding who are the autistic adults seeking emergency mental health care and why they visit the PsyED is crucial for improving services and outcomes.

What was the purpose of this study?

We aimed to better understand the profile of autistic adults who visited the PsyED. More specifically, we wanted to document their sociodemographic characteristics and their mental health history. We also wanted to better understand why they visited the PsyED and examine factors linked to these reasons. Finally, we wanted to explore the differences between those who visited only once and those who visited PsyED recurrently.

What did the researchers do?

We reviewed medical records of 1027 PsyED visits by 345 autistic patients, aged 16 years or older, at an urban psychiatric hospital in Canada from 2018 to 2020. From the sociodemographic information provided by autistic patients and written text-based records by PsyED clinicians, we identified patient sociodemographic characteristics, mental health and neurodevelopmental diagnoses, and reasons for visits. We also examined which sociodemographic characteristics or mental health and neurodevelopmental diagnoses were most associated with specific reasons for visits. Finally, we explored how single-time and recurrent visitors differed on sociodemographic characteristics, mental health and neurodevelopmental diagnoses, and reasons for visits.

What were the results and conclusions of the study?

Autistic adults using PsyED often faced significant psychosocial challenges, including low income and high rates of co-occurring mental health conditions. Most visits were driven by crises such as suicidal thoughts and behaviors, aggression, or severe mood symptoms. Specific co-occurring diagnoses were linked to reasons for seeking emergency care. Recurrent visitors were more likely to present with suicidality or substance-related issues, while single-time visitors were more likely to seek help for mood or anxiety symptoms, but they did not differ in sociodemographic characteristics.

What is new or controversial about these findings?

This large-scale study is one of the few to systematically characterize and examine PsyED use in autistic adults. Findings show that autistic adults visiting PsyED have complex mental health needs that require specific attention from clinicians and the health care system to ensure adequate care.

What are the potential weaknesses in the study?

The study was based on reviews of medical records, which did not include sufficient information about the social contexts that are essential to fully understand what brings an autistic adult to the PsyED. The information identified relied on the account of the clinicians and came from a specific group of autistic people using PsyED care, hence does not necessarily reflect the mental health experiences of the broader autistic population, nor does it sufficiently include the autistic person’s perspective. The findings are specific to one Canadian urban hospital, which may not reflect situations in rural areas or other countries, including those with privatized health care.

How will these findings help autistic adults now or in the future?

The findings underscore the need for more tailored and accessible mental health support for autistic adults during mental health crises. These findings can guide health care providers and policymakers in developing autism-informed mental health services that also address systemic barriers, ensuring adequate mental health service from prevention efforts to emergency care.