Early Identification of Mental Health Disorders: Using the Mental Health Inventory-5 (MHI-5) in a free-standing Emergency Room

Abstract

Emotional distress in high-acuity emergency care settings is frequently underrecognized, resulting in missed opportunities for early behavioral health intervention. At a free-standing Emergency Room (ER) in a small, semi-urban city in a largely rural region of Texas, internal audits revealed a 100% miss rate for identifying adult patients with symptoms of depression or anxiety during triage. Professional guidelines, including recommendations from the American Association for Emergency Psychiatry and the U.S. Preventive Services Task Force, emphasize routine mental health screening in emergency departments to improve patient safety and outcomes. National data indicate increasing psychiatric-related visits, particularly among youth, many of whom remain undiagnosed. Undiagnosed emotional distress also places additional burdens on emergency care providers managing complex physical presentations without awareness of underlying psychological factors. This highlights the critical need for structured mental health screening protocols in emergency settings to enhance early detection and support comprehensive patient care.

This quality improvement project explored how embedding the Mental Health Inventory-5 (MHI-5) screening tool into the intake process at a freestanding emergency department affected early detection of psychological distress in adults aged 18 and older. Over a nine-week implementation period, 710 of 2,583 eligible patients (27.5%) completed the screening. A total of 147 patients screened positive for psychological distress (20.7%); however, only 38 (25.9%) were documented in the electronic health record reflecting a significant gap in follow-through. Staff noted increased awareness and confidence in addressing mental health concerns. The MHI-5 screening tool identified emotional needs not captured during routine triage. Recommendations include improving documentation workflows, adding EHR prompts, and continuing staff training to support consistent use.