Demographics of mental healthcare presentations in a northwest Ontario emergency department

Objectives Providing emergency mental health services for populations in remote rural areas of Canada is challenging.
Program needs are distinct. We describe the emergency mental health workload and service needs at the Sioux Lookout
Meno Ya Win Health Centre (SLMHC) in northwest Ontario.
Methods Emergency department (ED) data were collected for mental health, addiction and self-harm diagnoses (MHA) in
2018/2019. Comparisons were made to similar sized provincial hospitals and EDs. Mental health admissions data from Oct
1, 2018 to Dec 31, 2019 were manually collected from hospital medical charts for demographics, suicide attempts/ideation
and frequency of applications for Form 1 psychiatric assessment.
Results The volume of MHA ED visits as a percentage of total ED visits was 4 times higher at SLMHC when compared to both the 67 other Ontario level C hospitals (<100 beds) and  the 15 level C hospital with a similar volume of ED visits (15,000–20,000), (15% vs 4%). Self-harm presentations were 308 at SLMHC versus an average of 42±37 at the 15 level C
hospitals with a similar ED volume. From Oct 1, 2019 to Dec 31, 2019, there were 49 patients requiring a Form 1, with an average wait time of 55 h before transfer to a schedule 1 facility.
Conclusion There is an increased level of mental health, addiction and self-harm presentations in this northern ED. Lack of alternative resources indicate the need for the development of an integrated model of mental health care service. Reliance on the ED for crisis management indicates the need for the development of more regionally relevant models of care.