Using machine learning to assist decision making in the assessment of mental health patients presenting to emergency departments.

OBJECTIVE: The objective of this study was to assess the predictability of admissions to a MH inpatient ward using ML models, based on routine data collected during triage in EDs. This research sought to identify the most effective ML model for this purpose while considering the practical implications of model interpretability for clinical use. METHODS: The study utilised existing data from January 2016 to December 2021. After data pre-processing, an exploratory analysis revealed the non-linear nature of the dataset. Six different ML models were tested: Random Forest, XGBoost, CatBoost, k-Nearest Neighbours (kNN), Explainable Boosting Machine (EBM) using InterpretML, and Support Vector Machine using Support Vector Classification (SVC). The performance of these models was evaluated using various metrics including the Matthews Correlation Coefficient (MCC). RESULTS: Among the models evaluated, the CatBoost model achieved the highest MCC score of 0.1952, demonstrating superior balanced accuracy and predictive power, particularly in correctly identifying positive cases. The InterpretML model also performed well, with an MCC score of 0.1914. While CatBoost showed strong predictive capabilities, its complexity poses challenges for clinical interpretation. Conversely, the InterpretML model, though slightly less powerful, offers better transparency and is more practical for clinical use. CONCLUSION: The findings suggest that the CatBoost model is a compelling choice for scenarios prioritising the detection of positive cases. However, the InterpretML model's ease of interpretation makes it more suitable for clinical application. Integrating explanation methods like SHAP with non-linear models could enhance model transparency and foster clinician trust. Further research is recommended to refine non-linear models within decision support systems, explore multi-source data integration, understand clinician attitudes towards ML, and develop real-time data collection systems. This study highlights the potential of ML in predicting MH admissions from ED data while stressing the importance of interpretability, ethical considerations, and ongoing validation for successful clinical implementation.