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Adults with developmental disabilities and psychiatric illness visit EDs more than general population despite access to care


People who have both developmental disabilities and psychiatric illness are using the emergency department at high rates despite having access to primary and psychiatry care. Researchers at the Institute for Clinical Evaluative Sciences (ICES) and the Centre for Addiction and Mental Health (CAMH) found that rates for people with developmental disabilities and psychiatric illness are higher than the general population and also higher than people with either psychiatric illness or developmental disabilities alone.

“The public might assume that people with developmental disabilities and psychiatric illness use emergency rooms a lot because they can’t get in to see their doctor or don’t have access to primary care. But our study shows that they do see primary care doctors and often also have psychiatric care. They use the emergency department frequently because they have high needs and these needs are not being met with the care they are receiving,” says lead author Yona Lunsky, clinician-scientist at CAMH and adjunct scientist at ICES.

The population-based study compared Ontario adults with and without developmental disabilities and mental illnesses. It looked at their use of primary, psychiatric and emergency department care between April 1, 2007 and March 31, 2009 and found:

  • 45 per cent of adults with developmental disabilities also had a psychiatric diagnosis ("dual diagnosis").
  • 26 per cent of adults with a dual diagnosis were classified as having a serious mental illness.
  • People with developmental disabilities had an increased likelihood of emergency department visits.
  • Patients with serious mental illness and developmental disabilities had the highest rates of such visits.  

“We need to begin looking at quality of care, and not simply whether these patients have access to care, or whether they have enough care. We also need to consider other types of care beyond medical services and how they can be linked to medical care. Needs can be so multifaceted that the primary care doctor is not able to address all these needs alone,” says Lunsky.

This is the first population-based study to examine different levels of severity for people with dual diagnosis and to compare them to the general population. It is also the first study to look at how different types of health services (psychiatry, primary care and emergency care) are used by adults with developmental disabilities.

Author block: Yona Lunsky, Elizabeth Lin, Rob Balogh, Julie Klien-Geltink, Andrew S. Wilton and Paul Kurdyak.

The study “Emergency department visits and use of outpatient physician services by adults with developmental disability and psychiatric disorder,” appears in the Canadian Journal of Psychiatry.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.

The Centre for Addiction and Mental Health (CAMH) is Canada's largest mental health and addiction teaching hospital, as well as one of the world's leading research centres in the area of addiction and mental health. CAMH combines clinical care, research, education, policy development and health promotion to help transform the lives of people affected by mental health and addiction issues. Fully affiliated with the University of Toronto, CAMH is a Pan American Health Organization/World Health Organization Collaborating Centre. For more information, please visit www.camh.ca.


Read the Journal Article