Recent Mental Health Emergency Room Usage in Treatment-Seeking, Adult Consumers in One Rural, Community-Based, Outpatient Clinic: Role of Nights Spent Homeless

Background and Purpose: Experiencing homelessness is a devastating psychosocial stressor. However, the role of nights spent homeless in recent mental health emergency room (ER) usage in service-seeking rural consumers has been understudied. Recent mental health ER usage is defined as the number of psychiatric or emotional problem-related ER contacts within the last 30 days (Substance Abuse and Mental Health Services Administration [SAMHSA], 2021). Using SAMHSA National Outcome Measures’ survey data from one northeastern, rural, county mental health clinic, this study investigated the role of nights spent homeless in recent mental health ER usage for treatment-seeking adult consumers.

Methods: Consumers were adults who sought mental health treatment services between June 2020 and August 2022 (n=1293). Most consumers were White (89.1%), non-Hispanic (88.8%), straight (85.5%) women (51.9%), who had attained a high school diploma or equivalent (36.6%), and were employed full-time (31.6%). On average, consumers were in middle adulthood (M=36.86 years, SD=13.56 years). Measures included two self-report items: (1) the times within the last 30 days a consumer went to the ER for a mental health problem, and (2) the nights spent homeless in the past 30 days. Ordinary least squares multiple regression was used to develop a statistically significant model of nights homeless’ role in consumer’s recent mental health ER usage while controlling for demographic, educational, and employment characteristics statistically significantly associated with recent ER usage.

Results: On average, treatment-seeking consumers reported mental health ER usage less than 1 time out of the last 30 days (M=.14 times, SD=1.04 times). Mental health ER usage was correlated with nights spent homeless (r=.082, p=.004). Employment status demonstrated a statistically significant main effect on recent mental health ER usage (F(7,1244)=2.526, p=.014). Racial identity, Hispanic ethnicity, gender identity, sexual identity, education, and age were not statistically significantly associated with mental health ER usage. Controlling for employment status, regression results indicated a statistically significant model of recent mental health ER usage (F(8,1179)=3.008, p=.002, R2=.020). The number of nights spent homeless was statistically significantly associated with ER usage within the regression model (b=.075, p=.010).

Conclusions and Implications: These results suggest that nights spent homeless are a statistical factor in recent mental health ER usage for rural, treatment-seeking, adult mental health consumers. Unstable housing may increase acute mental health resource utilization risk because the stress of locating stable housing interferes with employment, health insurance, and primary mental health service stability. Rural mental health clinics may want to rapidly house consumers experiencing homelessness to support reduced ER usage. Consumers with any mental health ER usage history should be triaged with case management and peer services to resolve barriers to accessing primary mental health services. To contribute to theory, future research should replicate this study with a larger, multisite, random sample of treatment-seeking mental health consumers in urban, suburban, and rural settings.