The Long Wait: An Analysis of Mental Health Presentations to Australian Emergency Departments

By Australasian College for Emergency Medicine          [Download Resource]

‘Emergency departments often act as the ‘front door’ to the health system, playing a unique role in the provision of safe, high quality acute medical care to everyone in the community. Each year, more than a quarter of a million Australians present to EDs seeking help for acute mental and behavioural conditions. Yet for many of these patients, the evidence suggests that EDs are not adequately fulfilling their role as a timely and accessible entry point to the mental health system. …

While there is much that can be done to improve the experiences of people who present to EDs with mental health crises, it is also essential that system responses beyond the ED are improved. More needs to be done in the community to avoid the types of crises that precipitate a visit to the ED, and more appropriate, timely treatment options are needed to minimise the time that people with mental health presentations spend in the ED’

Key Content Areas:

• Pathways to mental health care
• Arrival mode to ED and urgency of emergency
• Urgency
• Waiting time until commencement of clinical care and duration of clinical care
• Episode end status
• Presentation characteristics

“ED is a difficult environment for all patients… It is crowded, noisy and confusing. The lights are on 24 hours a day. There are babies crying, monitors beeping, staff and patients moving about, phones ringing – constantly. ED clinicians have multiple competing demands and cubicles lack privacy. It can be difficult to understand what is going on… For patients with acute mental health issues, especially when they are in a state of high arousal, these factors are compounded… patients are often paranoid, confused or suicidal. They need a calm and private environment, with a clear plan and good communication. When patients are delayed in ED for long periods, they sometimes become angry and upset to the point where they require chemical sedation for their own safety, and the safety of other patients and staff in the ED. Chemical sedation carries risk – side effects and cardiorespiratory depression – there have been deaths from chemical sedation in ED… The biggest problem with this is that it is not fair on patients – our environment and processes get them to this point – this is not acceptable and we need to change the system.” (FACEM).