Psychiatric and Behavioral Emergencies

Preface The Hidden Costs of Behavioral and Psychiatric Emergencies

Dick C. Kuo, MD

Veronica Tucci, MD, JD Editors

The American Psychiatric Association defines mental illness as a range of disorders characterized by the dysregulation of mood, thought, and/or behavior and defines psychiatric emergencies as acute disturbances in thought, mood, or relationships that require immediate intervention. The most pervasive mental illness is depression, and the World Health Organization (WHO) predicts that by 2030, depression, not infectious disease or cancer, will be the leading cause of disease burden globally.1 The statistics are indeed staggering. The Centers for Disease Control and Prevention has estimated that 25% of adults in the United States will suffer from mental illness this year and nearly 50% of adults will develop at least one mental illness during their lifetime.2 Between 1992 and 2001, there were 53 million mental health-related Emergency Department (ED) visits in the United States. In 2002, the economic burden of mental illness in the United States was estimated to be over $300 billion dollars. By 2007, psychiatric and behavioral emergency visits doubled, and the economic burden of mental illness started to spiral even more out of control. According to the WHO, annual spending on mental health is less than $2 per person and less than $0.25 in low-income countries. Median health expenditures per capita range from $0.20 in low-income countries to $44.84 in high-income countries.1 Even in high-income countries like the United States, the mere pittance spent on mental illness prevention, stabilization, and treatment pales in comparison to the amount of money an average American worker spends on coffee (estimated by one study to exceed $1000 annually and over $20 per week).3 The limited amount of funds available for the stabilization and treatment of patients with severe mental illness had led to a marked decline in the number of beds in inpatient psychiatric facilities. Desperate and with no other place to go, patients with psychiatric emergencies are turning in droves to their local EDs. This issue of Emergency Medicine Clinics of North America is designed to aid emergency physicians in the management of acute exacerbations of mental illness. To that Emerg Med Clin N Am 33 (2015) xvii–xviii http://dx.doi.org/10.1016/j.emc.2015.09.001 0733-8627/15/$ – see front matter Ó 2015 Published by Elsevier Inc.

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Preface

end, we have provided comprehensive and up-to-date literature reviews on several high-impact topics in the field of behavioral emergencies, including navigating the medical clearance process, stabilizing the acutely agitated or psychotic patient, differentiating etiologies of altered mental status, identifying and managing depressed and suicidal patients, strategies for successfully patients with personality and somatoform disorders, addressing specific concerns of special populations, including pediatric, geriatric, pregnant, and trauma patients. Dick C. Kuo, MD Section of Emergency Medicine Department of Medicine Baylor College of Medicine 1504 Taub Loop Emergency Center Academic Offices 1EC 61 002 Houston, TX 77030, USA Veronica Tucci, MD, JD Section of Emergency Medicine Department of Medicine Baylor College of Medicine 1504 Taub Loop Houston, TX 77030, USA E-mail addresses: [email protected] (D.C. Kuo) [email protected] (V. Tucci) REFERENCES

1. Available at: http://apps.who.int/gb/ebwha/pdf_files/EB130/B130_9-en.pdf. Accessed August 10, 2015. 2. Available at: http://www.cdc.gov/mentalhealthsurveillance/. Accessed August 10, 2015. 3. Available at: http://consumerist.com/2012/01/20/most-american-workers-spendmore-than-1000year-on-coffee/. Accessed August 10, 2015.

The Hidden Costs of Behavioral and Psychiatric Emergencies.

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