Evaluating the effectiveness of crisis support spaces in Queensland, Australia: a mixed-methods study

The COVID-19 pandemic has been associated with detrimental effects on mental health and psychological well-being. Although multiple studies have shown decreases in mental health-related Emergency Department (ED) presentations early in the COVID-19 pandemic, the medium-term effects on mental health-related ED presentations have remained less clear. This study aimed to evaluate the effect of the pandemic on mental health ED presentations by comparing observed presentation numbers to predictions from pre-pandemic data. This retrospective cohort study tallied weekly ED presentations associated with mental health disorders from a state-wide minimum dataset. Three time periods were identified: Pre-Pandemic (January 1, 2018-March 8, 2020), Statewide Lockdown (March 9, 2020-June 28, 2020), and Restrictions Easing (June 29, 2020-June 27, 2021). Time series analysis was used to generate weekly presentation forecasts using pre-pandemic data. Observed presentation numbers were compared to these forecasts. Weekly presentation numbers were lower than predicted in 11 out of 16 weeks in the Statewide Lockdown period and 52 out of 52 weeks in the Restrictions Easing period. The largest decrease was seen for anxiety disorders (Statewide Lockdown: 76.8% of forecast; Restrictions Easing: 36.4% of forecast), while an increase was seen in presentations for eating disorders (Statewide Lockdown: 139.5% of forecast; Restrictions Easing: 194.4% of forecast). Overall weekly mental health-related presentations across Queensland public EDs were lower than expected for the first 16 months of the COVID-19 pandemic. These findings underline the limitations of emergency department provision of mental health care and the importance of alternate care modalities in the pandemic context.

In response to the coronavirus disease 2019 (COVID-19) outbreak in early 2020, a public health order was enacted in March 2020 that required all people arriving in New South Wales from overseas to quarantine for fourteen days.1 To manage the process and minimise the risk of community transmission, all people who arrived from 16 March 2020 were accommodated in 30 temporarily re-purposed hotels in inner Sydney and the central business district. People with identified acute or ongoing health care needs were referred to the Royal Prince Alfred (RPA) Virtual Hospital, including those who tested positive for the severe acute respiratory syndrome coronavirus 2 (SARS CoV-2), and were housed in three Special Health Accommodation hotels to facilitate remote monitoring of their symptoms and signs according to the RPA Virtual Hospital model of care.2 Analysis of the characteristics of these patients will inform the public health and hospital response to COVID-19 and ensure a patient-centred approach to health services for quarantined people. We undertook a retrospective study of emergency department (ED) presentations by patients referred from Special Health Accommodation hotels in Sydney during 1 June – 30 September 2020. We analysed clinical characteristics and outcomes recorded in electronic medical records, including diagnosis categories, comorbid conditions, and ED length of stay. Our study was approved by the Sydney Local Health District Research Ethics Committee (references, X20-0365; 2020/ETH02007). During June – September 2020, 2774 people were registered for accommodation in Special Health Accommodation hotels, of whom 461 (16.6%) presented at least once to the RPA ED (542 ED presentations in total). Thirteen patients (2.8%) were diagnosed with COVID-19, none of whom required intensive care. The most frequent ED diagnosis categories were mental health (102 presentations, 19%) and cardiovascular conditions (84, 15%) (Box 1). The most frequent reasons for mental health presentations were anxiety (43 presentations), suicidal ideation (24), and acute psychosis (11) (Box 2). The median length of stay for presentations with mental health conditions (543 min; interquartile range [IQR], 372–788 min) was longer than for non-mental health presentations (433 min; IQR, 302–598 min). Mental health-related presentations were also associated with higher triage acuity: 86 presentations (84%) were deemed urgent or potentially life-threatening, compared with 316 of the 440 ED presentations not related to mental health (72%). A larger proportion of mental health presentations were by patients with pre-existing mental health conditions (65, 64% v 49 non-mental health presentations, 11%). Characteristic Number Age (years), mean (SD) 43.5 (22.0) Sex (men) 284 (52.4%) Triage category 1 (life threatening) 0 2 (potentially life threatening) 87 (16%) 3 (urgent) 315 (58%) 4 (semi-urgent) 121 (22%) 5 (non-urgent) 19 (4%) Diagnosis category Mental health 102 (19%) Cardiovascular 84 (15%) Abdominal/gastrointestinal 68 (13%) Musculoskeletal 35 (6%) Injury 32 (6%) Neurological 28 (5%) Urological 27 (5%) Fever/infection 26 (5%) Social 23 (4%) Obstetrics/gynaecology 23 (4%) Allergy/skin rash 19 (4%) Respiratory 12 (2%) Ear, nose, throat, and eye 12 (2%) Administrative/pathology tests/prescriptions 11 (2%) General complaints 10 (2%) Drug health/toxicology 10 (2%) Haematology/oncology 7 (1%) Other 13 (2%) Length of stay: less than 4 hours, by disposition All presentations 86/542 (16%) Discharged from emergency department 58/416 (14%) Admitted to inpatient ward 28/126 (22%) Pre-existing conditions (461 patients) None 154 (33%) Mental health 89 (19%) Hypertension 83 (18%) Ischaemic heart disease 25 (5%) Diabetes mellitus 34 (7%) Respiratory disorder 28 (6%) Renal disorder 5 (1%) Cancer 15 (4%) Neurological disorder 13 (3%) Pregnancy 24/220 (11%) Disposition at discharge Treatment complete 409 (75%) Admitted to critical care ward 14 (3%) Admitted to ward 112 (21%) Discharged 7 (1%) The COVID-19 pandemic continues to have significant direct and indirect health care consequences, including effects on mental health.3 Mental health presentations to the RPA ED comprised 19% of presentations by people from Special Health Accommodation hotels, five times the proportion for all ED presentations in Australia (3.6%).4, 5 Further, lengthy ED stays (the median stay was longer than nine hours) probably compounded psychological stress in patients who presented with mental health problems; only 16% of patients were admitted or discharged within the recommended four hours (Box 1). Our study, the first to assess the impact of mental health during hotel quarantine in Australia, highlights the need for increased psychological support and other services for people in quarantine.6 While quarantine was a vital public health measure for curbing the spread of SARS-CoV-2, isolation can cause direct and indirect physical and psychological harm.7 All patients who presented to the RPA ED with mental health problems were routinely followed up by RPA Virtual Hospital psychologists. A prospective study is currently underway to better understand the psychological impact of hotel quarantine as the COVID-19 pandemic response evolves in 2021. We thank all the staff who provided care for patients in the Special Health Accommodation hotels and COVID-19 hot zones in the Royal Prince Alfred emergency department. No relevant disclosures.

Transgender individuals experience significant oppression resulting in mental health disparities. Factors associated with their need for acute mental health care are unknown. This study compared characteristics of transgender individuals who presented for acute mental health care with population-based comparison samples. This cross-sectional study examined transgender individuals who had a mental health-related emergency department (ED) visit (N=728) or hospitalization (N=454). Transgender individuals were identified, and their data were linked with health administrative data. The transgender ED and hospitalization samples were each compared with two samples: all individuals in Ontario who had an ED visit or hospitalization (unmatched) and individuals matched on age, region of residence, and mental health care utilization history. Individuals' sociodemographic and clinical factors were compared. After matching, transgender individuals in the ED sample were more likely than those in the comparison group to be in the lowest neighborhood income quintile (37% versus 27%) and the highest residential instability quintile (47% versus 38%) and to be diagnosed as having a mood (26% versus 19%) or personality disorder (4% versus 1%). Transgender individuals in the hospitalization sample were more likely to be in the lowest neighborhood income quintile (36% versus 27%) and the highest residential instability quintile (45% versus 35%) and to be diagnosed as having a mood (40% versus 35%) or personality disorder (5% versus 2%). Transgender individuals who accessed acute mental health care had unique sociodemographic and clinical factors associated with their presentation that persisted after matching. More research into the factors associated with their acute care presentation is warranted, including how experiences of marginalization play a role.

Purpose: The study compared physician-based outpatient mental health care follow-up between transgender and gender diverse (TGD) individuals and the general population who had a mental health-related emergency department (ED) visit or hospitalization. Methods: This retrospective population-based cohort study used linked health administrative data to examine all adult psychiatric patients discharged from an ED visit (ED cohort) or hospitalization (hospitalization cohort) between 2012 and 2018 in Ontario, Canada. TGD individuals were identified and their data linked with health administrative data. The primary outcome was the proportion of individuals with any outpatient physician visit for mental health reasons within 30 days of the index discharge. Multivariable logistic regression analyses examined follow-up outcomes, including by diagnostic category, with adjustment for sociodemographic and clinical factors. Results: There were 728 TGD and 581,708 general population individuals with a mental health-related ED visit, while 454 TGD and 217,507 general population individuals had a psychiatric hospitalization. TGD individuals had higher 30-day post-ED follow-up (adjusted risk ratio [aRR] =1.21; 95% confidence interval [CI]: 1.02–1.42), particularly with a psychiatrist (aRR = 1.27; 95% CI: 1.07–1.52) and for those with an anxiety and related disorder diagnosis (aRR = 1.63; 95% CI: 1.23–2.15). Meanwhile, TGD individuals had lower 30-day follow-up posthospitalization (aRR = 0.80; 95% CI: 0.66–0.98) after adjusting for covariates. Conclusions: TGD individuals have greater rates of post-ED mental health follow-up, particularly with a psychiatrist, but lower rates of follow-up after a hospitalization. The higher follow-up after ED visits likely reflects greater clinical need. Lower follow-up after hospitalization is concerning given the risk of adverse outcomes and requires further research.

Objective Older people represent a large proportion of emergency department (ED) presentations, with multiple comorbidities a strong predictor of frequent attendance. This study examined associations between the general practice management received by older patients with chronic disease and ED attendance. Methods This retrospective study examined linked data from general practice and ED for patients aged ≥65 years who presented to a general practitioner (GP) between 2010 and 2014. Data from the computerised medical records of patients attending 50 general practice clinics in the inner east Melbourne region ere linked with ED attendance data from the same region. Patients with chronic disease were identified and characteristics of ED versus non-ED attendees were compared. Poisson regression was used to explore factors associated with ED usage. Results During the study period, 67474 patients aged ≥65 years visited a GP, with 63.3% identified as having at least one chronic condition and 21.4% of these having at least one ED presentation. Over 70% of the ED presentations in this group resulted in hospital admissions. The most common diagnoses for ED presentation were cardiovascular disorders, pain and injuries. ED attendance was associated with being aged ≥85 years (incidence rate ratio (IRR) 2.09; 95% confidence interval (CI) 1.96-2.11), higher socioeconomic status (IRR 1.49; 95% CI 1.45-1.53), having a GP management plan (IRR 1.47; 95% CI 1.43-1.52), multimorbidity (IRR 1.53; 95% CI 1.46-1.60), more frequent GP visits (IRR 1.10; 95% CI 1.05-1.15) and having a higher numbers of prescriptions (IRR 1.51; 95% CI 1.44-1.57). Conclusion This study suggests that ED presentation is associated with greater frailty and multimorbidity in patients. Further research is necessary to determine why higher rates of chronic disease management through GP management plans and more frequent visits did not mediate higher rates of presentation and the reasons behind the socioeconomic differences in ED presentation for patients in this age group. What is known about the topic? Increases in the volume and rate of ED presentations by older people will markedly affect emergency and acute hospital care and patient flow as the proportion of older Australians increases. What does this paper add? We used a novel and highly transferable data linkage between data collected from the clinical records of general practice patients and their associated data from ED and hospital settings and examined the relationship between GP management received by older patients with chronic disease and ED attendance. What are the implications for practitioners? Increasing utilisation of GP services may not have an effect on reducing ED attendance, particularly for older patients who may experience poorer overall health.

Cannabis use is a modifiable risk factor for the development and exacerbation of mental illness. The strongest evidence of risk is for the development of a psychotic disorder, associated with early and consistent use in youth and young adults. Cannabis-related mental health adverse events precipitating Emergency Department (ED) or Emergency Medical Services presentations can include anxiety, suicidal thoughts, psychotic or attenuated psychotic symptoms, and can account for 25–30% of cannabis-related ED visits. Up to 50% of patients with cannabis-related psychotic symptoms presenting to the ED requiring hospitalization will go on to develop schizophrenia. With the legalization of cannabis in various jurisdiction and the subsequent emerging focus of research in this area, our understanding of who (e.g., age groups and risk factors) are presenting with cannabis-related adverse mental health events in an emergency situation is starting to become clearer. However, for years we have heard in popular culture that cannabis use is less harmful or no more harmful than alcohol use; however, this does not appear to be the case for everyone. It is evident that these ED presentations should be considered another aspect of potentially harmful outcomes that need to be included in knowledge mobilization. In the absence of a clear understanding of the risk factors for mental health adverse events with cannabis use it can be instructive to examine what characteristics are seen with new presentations of mental illness both in emergency departments (ED) and early intervention services for mental illness. In this narrative review, we will discuss what is currently known about cannabis-related mental illness presentations to the ED, discussing risk variables and outcomes both prior to and after legalization, including our experiences following cannabis legalization in Canada. We will also discuss what is known about cannabis-related ED adverse events based on gender or biological sex. We also touch on the differences in magnitude between the impact of alcohol and cannabis on emergency mental health services to fairly present the differences in service demand with the understanding that these two recreational substances may impact different populations of individuals at risk for adverse events.

Five-Year Trends in Pediatric Mental Health Emergency Department Visits in Massachusetts: A Population-Based Cohort Study

Community care units (CCUs) are a model of residential psychiatric rehabilitation aiming to improve the independence and community functioning of people with severe and persistent mental illness. This study examined factors predicting improvement in outcomes among CCU consumers. Hierarchical regression using data from a retrospective cohort (N = 501) of all consumers admitted to five CCUs in Queensland, Australia between 2005 and 2014. The primary outcome was changed in mental health and social functioning (Health of the Nation Outcome Scale). Secondary outcomes were disability (Life Skills Profile-16), service use, accommodation instability, and involuntary treatment. Potential predictors covered service, consumer, and treatment characteristics. Group-level and individualised change were assessed between the year pre-admission and post-discharge. Where relevant and available, the reliable and clinically significant (RCS) change was assessed by comparison with a normative sample. Group-level analyses showed statistically significant improvements in mental health and social functioning, and reductions in psychiatry-related bed-days, emergency department (ED) presentations and involuntary treatment. There were no significant changes in disability or accommodation instability. A total of 54.7% of consumers demonstrated reliable improvement in mental health and social functioning, and 43.0% showed RCS improvement. The majority (60.6%) showed a reliable improvement in psychiatry-related bed-use; a minority demonstrated reliable improvement in ED presentations (12.5%). Significant predictors of improvement included variables related to the CCU care (e.g. episode duration), consumer characteristics (e.g. primary diagnosis) and treatment variables (e.g. psychiatry-related bed-days pre-admission). Higher baseline impairment in mental health and social functioning (β = 1.12) and longer episodes of CCU care (β = 1.03) increased the likelihood of RCS improvement in mental health and social functioning. CCU care was followed by reliable improvements in relevant outcomes for many consumers. Consumers with poorer mental health and social functioning, and a longer episode of CCU care were more likely to make RCS improvements in mental health and social functioning.

Primary youth mental health services in Australia have increased access to care for young people, yet the longer-term outcomes and utilisation of other health services among these populations is unclear. To describe the emergency department presentation patterns of a help-seeking youth mental health cohort. Data linkage was performed to extract Emergency Department Data Collection registry data (i.e. emergency department presentations, pattern of re-presentations) for a transdiagnostic cohort of 7024 youths (aged 12-30 years) who presented to mental health services. Outcome measures were pattern of presentations and reason for presentations (i.e. mental illness; suicidal behaviours and self-harm; alcohol and substance use; accident and injury; physical illness; and other). During the follow-up period, 5372 (76.5%) had at least one emergency department presentation. The presentation rate was lower for males (IRR = 0.87, 95% CI 0.86-0.89) and highest among those aged 18 to 24 (IRR = 1.117, 95% CI 1.086-1.148). Almost one-third (31.12%) had an emergency department presentation that was directly associated with mental illness or substance use, and the most common reasons for presentation were for physical illness and accident or injury. Index visits for mental illness or substance use were associated with a higher rate of re-presentation. Most young people presenting to primary mental health services also utilised emergency services. The preventable and repeated nature of many presentations suggests that reducing the ongoing secondary risks of mental disorders (i.e. substance misuse, suicidality, physical illness) could substantially improve the mental and physical health outcomes of young people.

BackgroundGlobally the older population is increasing rapidly. As a result there is an increase in frail older persons living within the community, with increased risks of a hospital admission and higher mortality and morbidity rates. Due to complexity of care, health care professionals face challenges in providing effective case management and avoiding unplanned admissions to hospital. A community virtual ward (CVW) model was developed to assist health care professionals to support older persons at home during periods of illness and/or functional decline.MethodsA quantitative observational study was conducted to examine if a CVW model of care reduced unplanned hospital admissions and emergency department (ED) presentations in 54 patients over a 12-month period. The sign-rank test examined matched data on bed days, ED presentations, and unplanned hospital admissions pre- and post-CVW implementation. Other risk factors for admission to hospital were examined using the Mann–Whitney test pre-and post-CVW admission, including falls, living alone, and cognition. Correlations between hospital admission avoidances and unplanned hospital admissions and ED presentations were tested using Spearman’s ρ test.ResultsThere was a reduction in ED presentations post-CVW admission (P<0.001), and median unscheduled admissions were reduced (P=0.001). Those living alone had a lower number of ED presentations (median 0.5, interquartile range 0–1) prior to admission in comparison to those living with a caregiver, with no differences observed during admission to CVW. For those who experienced a fall during CVW admission, the odds ratio (OR) of requiring long-term care doubled for each extra fall (OR =2.24, 95% CI 1.11 to 4.52, P=0.025). Reduced cognition was associated with an increased risk of ED presentations (ρ=0.292, P<0.05) but not associated with increased risks of unplanned hospital admissions (ρ=0.09, P=0.546). There were no significant correlations seen between admission avoidance and the number of unplanned hospital admissions or ED presentations.ConclusionThrough an integrated approach to care, a CVW model in the care of older persons can reduce ED presentations and unplanned hospital admissions.

Emergency departments (EDs) are the primary entry point for individuals in acute mental health crisis in Australia. However, EDs are ill-suited to meet the complex needs of this population, often resulting in suboptimal outcomes. This study evaluates the impact of a novel model designed to improve crisis care coordination by integrating a transition coordinator (TC) role and the AIMS (Assessment, Intervention, Monitoring, Step-up/Step-down) framework across community mental health services, ED, and inpatient settings. Data were collected from an Australian metropolitan public mental health service over 5years (2020-2024). Routinely gathered TC records documented proactive identification of mental health deterioration and subsequent care pathways. Additional data from 2022 onward tracked all ED presentations by individuals receiving case management. Descriptive statistics were used to examine changes in service use and care coordination outcomes. Over the study period, 4382 individuals were proactively flagged to the TC, with 72.6% supported in the community and 1230 admitted via direct or coordinated pathways. Coordinated admissions rose substantially, while unplanned ED presentations declined by 21.4% from 2022 to 2024. Among flagged individuals, uncoordinated admissions dropped by 66.1%. Early detection and enhanced communication across services were key contributors. The introduction of the TC role and AIMS framework significantly improved proactive identification, reduced unplanned ED presentations, and fostered timely, coordinated crisis responses. These changes illustrate the importance of building capacity, capability, and culture to shift from reactive to proactive care. This study demonstrates the role of structured coordination in improving outcomes for individuals experiencing mental health crises. The TC functions as a dedicated clinical bridge between community and hospital settings, facilitating earlier identification of mental health deterioration and streamlined crisis responses. Importantly, this role supports case managers in navigating logistical and systemic barriers, ensuring people received timely, appropriate care while minimizing unnecessary ED presentations. From a clinical practice perspective, the findings advocate for investment in roles and frameworks that prioritize continuity of care, shared decision-making, and person-centered pathways. The implementation of the AIMS framework offers a common clinical language across services, enhancing communication and reducing fragmentation during transitions. Clinicians are empowered to move away from a crisis-driven mindset and instead adopt a proactive stance, treating admission not as a failure but as a legitimate and therapeutic component of care when appropriately timed. The reduction in unplanned admissions not only improved patient outcomes but also relieved pressure on ED and inpatient services, suggesting benefits for both care quality and system efficiency. For clinical teams, this model underscores the value of multidisciplinary collaboration, reflective practice, and a shift in service culture that prioritizes early intervention and recovery-oriented care. These insights are especially pertinent as mental health systems seek to balance demand pressures with compassionate, effective service delivery.

Many children and adolescents in the United States are exposed to neighborhood gun violence. Associations between violence exposure and children's short-term mental health are not well understood. To examine the association between neighborhood gun violence and subsequent mental health-related pediatric emergency department (ED) utilization. This location-based cross-sectional study included 128 683 ED encounters for children aged 0 to 19 years living in 12 zip codes in Philadelphia, Pennsylvania, who presented to an urban academic pediatric ED from January 1, 2014, to December 31, 2018. Children were included if they (1) had 1 or more ED visits in the 60 days before or after a neighborhood shooting and (2) lived within a quarter-mile radius of the location where this shooting occurred. Analysis began August 2020 and ended May 2021. Neighborhood violence exposure, as measured by whether a patient resided near 1 or more episodes of police-reported gun violence. ED encounters for a mental health-related chief complaint or primary diagnosis. A total of 2629 people were shot in the study area between 2014 and 2018, and 54 341 children living nearby had 1 or more ED visits within 60 days of a shooting. The majority of these children were Black (45 946 [84.5%]) and were insured by Medicaid (42 480 [78.1%]). After adjusting for age, sex, race and ethnicity, median household income by zip code, and insurance, children residing within one-eighth of a mile (2-3 blocks) of a shooting had greater odds of mental health-related ED presentations in the subsequent 14 days (adjusted odds ratio, 1.86 [95% CI, 1.20-2.88]), 30 days (adjusted odds ratio, 1.49 [95% CI, 1.11-2.03]), and 60 days (adjusted odds ratio, 1.35 [95% CI, 1.06-1.72]). Exposure to neighborhood gun violence is associated with an increase in children's acute mental health symptoms. City health departments and pediatric health care systems should work together to provide community-based support for children and families exposed to violence and trauma-informed care for the subset of these children who subsequently present to the ED. Policies aimed at reducing children's exposure to neighborhood gun violence and mitigating the mental symptoms associated with gun violence exposure must be a public health priority.

This study examined two methods of detecting alcohol-related emergency department (ED) presentations, provisional medical diagnosis and nursing triage text, and compared patient and service delivery characteristics to determine which patients are being missed from formal diagnosis in order to explore why alcohol-related ED presentations are under-detected. Data were reviewed for all ED presentations from 2004 to 2006 (n = 118,881) for a major teaching hospital in Sydney, Australia. Each record included two nursing triage free-text fields, which were searched for over 60 alcohol-related terms and coded for a range of issues. Adjusted odds ratios were used to compare diagnostically coded alcohol-related presentations to those detected using triage text. Approximately 4.5% of ED presentations were identified as alcohol-related, with 24% of these identified through diagnostic codes and the remainder identified by triage text. Diagnostic coding was more likely if the patient arrived by ambulance [odds ratio (OR) = 2.35] or showed signs of aggression (OR = 1.86). Failure to code alcohol-related issues was more than three times (OR = 3.23) more likely for patients with injuries. Alcohol-related presentations place a high demand on ED staff and less than one-quarter have an alcohol-related diagnosis recorded by their treating doctor. In order for routine ED data to be more effective for detecting alcohol-related ED presentations, it is recommended that additional resources such as an alcohol health worker be employed in Australian hospitals. These workers can educate and support ED staff to identify more clearly and record the clinical signs of alcohol and directly provide brief interventions.

BackgroundPatients presenting to Emergency Department (ED) with self-harm are recognized to be at high risk of suicide and other causes of death in the immediate period following ED presentation. It is also recognized that there is a large variation in the management and care pathways that these patients experience at EDs.AimsThis study asks if there is a significant variation in mortality risk according to hospital attended and if this is explained by differences in care management.MethodsPopulation-wide data from the Northern Ireland Registry of Self-Harm from April 2012 were linked with centrally held mortality records to December 2019, providing data on self-harm type and ED care. Cox proportional hazards models analyzed mortality risk, coded as suicide, all-external causes and all-cause mortality.ResultsAnalysis of the 64,350 ED presentations for self-harm by 30,011 individuals confirmed a marked variation across EDs in proportion of patients receiving mental health assessment and likelihood of admission to general and psychiatric wards. There was a significant variation in suicide risk following attendance according to ED attended with the three-fold range between the lowest (HRadj 0.32 95% CIs 0.16, 0.67) and highest. These differences persisted even after adjustment for patient characteristics, variation in types of self-harm, and care management at the ED.ConclusionsThis study suggests that while the management of self-harm cases in the ED is important, it is the availability and access to, and level of engagement with, the subsequent management and care in the community rather than the immediate care at EDs that is most critical for patients presenting to ED with self-harm. However, the initial care in ED is an important gateway in initiating referrals to these services.

IntroductionThere are concerns that the COVID-19 pandemic is having an indirect negative impact on young people. We aimed to assess the impact of the pandemic on emergency department (ED) presentations...