A recently published paper retrospectively examined the demographics, substance use, mental health and co-morbidities of the 20 most frequent attenders at the Mater Misericordiae University Hospital in 2014.1 

The study found that the majority (17) of the 20 most frequent attenders were male, all were unemployed and the median age was 38.5 years (range 21 to 59). Seven had no fixed abode and a further five were living in temporary hostel accommodation.  Nineteen were either single or separated.

Among the 20, 16 misused either drugs or alcohol: 10 were current illicit drug users, six had a benzodiazepine addiction, three a heroin addiction, and one was polydrug dependent. The average attendance rate by illicit drug users was twice that of non-drug users. The majority (12) were alcohol dependent, with a further two reporting alcohol abuse.  Seventeen were smokers.  Thirteen had mental health issues, four of whom had depression and a further four had both depression and schizophrenia. Two had personality disorders.  Full details of the demographics, substance use, mental health status and co-morbidities of the 20 most frequent attenders are provided in Table 1.

The authors point out that a small number of repeat attenders may be responsible for a disproportionate level of emergency department attendances. These repeat attenders generally have substance misuse and psycho-social issues.  Moreover, the authors highlight the burden of alcohol and drug dependence on the Irish health services and state that in 2007, €1.2 million was spent on alcohol-related illnesses.  The authors also highlight the high incidence of mental health problems among frequent attenders and propose that this may be due to insufficient community-based mental health services.  They conclude that frequent attenders are a complex group needing a holistic multi-disciplinary approach that would involve addressing underlying issues such as drug and alcohol dependency, mental health issues and social deprivation, with significant investment outside the hospital setting to relieve pressure on emergency departments.

1 Ramasubbu B, Donnelly A and Moughty A (2016) Profile of frequent attenders to a Dublin inner city emergency department. Irish Medical Journal (109/4) https://www.drugsandalcohol.ie/25379/