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Psychiatry teaching service in the United States goes back at least 50 years, and there is some record of that as early as 1968.1 A specific group of patients, pejoratively referred to as frequent flyers, and more correctly as high utilizers, represents a subpopulation with repeat emergency department (ED) resource use and marked nonadherence to treatment recommendations. Most medical professionals agree that we should avoid using the term frequent flyers, as not only is it derogatory, but it clearly does not depict even the time spent on these patients. Most high utilizers may be homeless, abuse substances, have personality disorders, have developmental delays, be enrolled in a mental health plan, have a history of psychiatric hospitalizations, have unreliable social support, and may have a lifetime history of incarceration. They account for approximately one-quarter of all ED visits and use a disproportionate high share of resources.2,3 Frequent utilizers are of great concern to EDs, hospitals, and health care systems at large.
A substantial number of patients with mental illness present to EDs for treatment and their numbers are continuing to rise. Among these patients, the most common are those with substance use disorders, but there are also includes patients with suicidal ideation or those who have already...