Accidental vs. deliberate overdose admissions to the emergency department in Bali's largest hospital - a look into the effects of mental health on Indonesia's substance abuse problem

Background: Mental health care in Indonesia is under-resourced, drugs are easily available, and alcohol use is rising, increasing the risk of accidental and deliberate overdose.
Aims: Identify the demographics of overdose patients presenting to the emergency department. Determine: the substances commonly used in overdose; the percentage of accidental vs. deliberate overdoses; the psychiatric history of overdose patients; the reasons behind the overdoses occurring.
Methods: 22 overdose patients over the age of 18 that had presented to the emergency department at the RSUP Sanglah Hospital in a 1-year period were included in the study. Data was collected from records kept by the
hospital on gender, age, nationality, substance(s) used in overdose, presence of psychiatric disorder, whether theoverdose was accidental or deliberate, and the reason behind the overdose. Microsoft Excel was used to collect and
analyse the data.
Results: Overdoses were predominantly carried out by male Indonesians aged 25-34. Alcohol was the most common substance used (n=5, 22.7%). 55.5% (n= 12) of overdoses were accidental and 45.5% (n=10) were deliberate. 3 out of 22 patients had a diagnosed mental disorder. Unknown quantity consumed; unknown content consumed; over-consumption; and spiked drink caused accidental overdose. Suicidality and family issues caused deliberate overdose. Conclusions: Overdose rates were lower than expected. Accidental overdoses are likely due to easy access to substances, and a fear of retribution preventing admission to hospital. The high deliberate overdose rate plus low mental disorder rate suggests patients reach a mental-health crisis point before being diagnosed with a mental disorder