And it highlights how our existing systems are not always meeting people’s needs, particularly Māori, presenting with a mental health crisis, says Dr John Bonning, President-Elect, Australasian College for Emergency Medicine (ACEM).
“The Emergency Departments (EDs) of hospitals around the country often act as the ‘front door’ to the health system. We see the worst of what can happen to people at their most traumatised and saddest times. The suicide toll is the tip of the iceberg with countless more acute presentations daily following selfharm, overdose or other crises, between 2 and 20% of ED presentations can have mental health components," says Dr Bonning.
“The deeply concerning data, which continues to show an increase in the number of people taking their lives, highlights issues of equity in the country that we are not yet addressing, particularly for Māori, given the increasing rate and disproportionate statistics for Māori.
“Emergency Departments around the country have become the default mental health service, in particular out of office hours, which can mean inappropriately lengthy and unsafe waits for people presenting with a mental health crisis.
“EDs around the country are struggling with ever-increasing presentations of patients overall, are frequently at full capacity, and may not be equipped or set up for people who are experiencing a mental health crisis and may be contemplating or have attempted suicide or self-harm.
“People presenting to the Emergency Department with a mental health crisis can suffer the most because they can have very long and inappropriate lengths of stay. They are more likely than other patients to leave the Emergency Department prior to treatment being completed, at their own risk and against medical advice.
“In June this year, ACEM brought together more than 80 emergency doctors, nurses, department managers and patient advocates at the Mental Health in Aotearoa New Zealand Emergency Department Summit.
“It highlighted the many distressing experiences that Emergency Department staff see with people presenting to EDs with a mental health crisis.
“Whilst patients usually get initial assessment and acute care, sometimes, patients with mental health and addiction issues, can spend over 24 to 48 hours waiting for a definitive mental health assessment and, if required, admission from the Emergency Department.
“New Zealand’s mental health system must ensure equitable and timely access to those in crisis. More work needs to be done to build and sustain a functioning, integrated, mental health system that supports the prevention, early intervention and better management of mental health crises over extended hours.
“Māori are overrepresented in our mental health statistics, and our current services, including Emergency Departments, often do not meet the needs of Māori, so something has to change, otherwise the data will not improve.
“EDs must be resourced and equipped to refer people to appropriate and timely mental health services and support.
“Another step forward is more robust data collection, evidence and reporting on suicide prevalence to ensure the most appropriate services provided, and outcomes achieved to provide accountability across the system.”
Communique: Mental Health in Aotearoa New Zealand Emergency Department Summit.
ACEM is the peak body for emergency medicine in Aotearoa New Zealand and Australia, responsible for training emergency physicians and advancement of professional standards. www.acem.org.au