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Assessing Mental Health Needs Related to Frequent Emergency Department Use by Underserved Populations:

A Photovoice Study
Department of Occupational Therapy
Sara Abrasheff, OTS; Jamaal Long, OTS; Kelcie Richburg, OTS; Rebekah Taylor, OTS;
Leslie Troxler, OTS; Chinyu Wu, PhD, OTR/L


Key Findings

Emergency medical services are costly yet precious

resources in todays society. However, frequent visitors
are noted at emergency departments (ED) across
hospitals in the United States (DiPietro, Kindermann, &
Schenkel, 2012; Doran, Raven, & Rosenheck, 2013;
Vinton, Capp, Rooks, Abbott, & Ginde, 2014). Although
mental health is an important aspect to be addressed,
there is no sufficient knowledge about mental health
issues encountered by underserved individuals from the
areas that lead to frequent ED use. it is important to gain
understanding from the patients perspective about their
lived experience of mental health issues and factors that
lead to frequent ED use.
In order to develop an effective mental health community
program, it is important to gain understanding from the
perspective of people in the community who have
experienced mental health issues and factors that lead to
frequent ED use. This study aimed to investigate unmet
needs of underserved populations that led to frequent
visits to emergency departments (ED).

Research Questions
What is the
experience of
mental health
issues among

What are the

factors that
lead to ED use
individuals who
mental health

What are the

strengths in the
community that
may serve as
resources to reverse
the problem of
frequent ED use
among underserved
experiencing mental
health issues?

Photovoice, a community-based participatory research
(CBPR) approach, was used to uncover the needs and
perspectives of underserved population
Three photo assignments, based on a theme
determined by the participants
Photo discussions at each meeting using the SHOWED
A final feedback meeting for the purpose of member
Verbatim of group meetings was transcribed and NVivo
10 used to store data
Inclusion/Exclusion Criteria:
Have had at least one emergency room visit in the past
12 months for a mental health condition (such as
psychotic complaints, excessive use of alcohol, drug
Age between 18 and 65
Speak English
Able to operate a point-and-shoot digital camera after a
brief instruction
Feel comfortable participating in small group
discussions SHOWED Method

Participant feedback included:

Reports of high medication use, resulting in oversedation
Suicide attempts
Financial restraints
Negative stigma towards mental illness and poverty
Compartmentalized medical/ psychiatric services
Each of these factors contributed to an increased number
of ED visits.

This population would benefit from an occupational

This population would benefit from an occupational

therapy psychoeducation program addressing topics such
as medication management and leisure exploration.
Currently, an activity group program is being developed
to help residents explore community resources.

1.What do we SEE here?

2.What is HAPPENING?
3.How does the story relate to OUR lives and how do we feel
about it?
4. WHY has the problem/asset existed?
5.How can we become EMPOWERED with our new
6.What can we DO about these problems/ assets in our lives?

A participant spoke
of coping
strategies when
dealing with
mental illness,
such as drawing.

A display of medications
taken by one participant


Participant Demographics



Average ED



A participant talked about

suicide attempts.

A participant discussed
feelings of emptiness and

DiPietro, B. Y., Kindermann, D., & Schenkel, S. M. (2012). Ill, itinerant, and
insured: The
top 20 users of emergency departments in Baltimore city. Scientific
World Journal,
2012, 726568. doi:10.1100/2012/726568; 10.1100/2012/726568
Hergenrather, K. C., Rhodes, S. D., Cowan, C. A., Bardhoshi, G., & Pula, S.
Photovoice as community-based participatory research: A qualitative
review. American Journal of Health Behavior, 33, 686-698.
Teti, M., Murray, C., Johnson, L., & Binson, D. (2012). Photovoice as a