The peak body for emergency medicine in Australia and New Zealand has proposed solutions to improve models of care for patients with acute mental and behavioural conditions, including mandatory reporting of cases involving extreme waiting times for specialised care.
The call for action comes as new figures show a significant over-representation of mental health presentations in chronic access block, with nearly one third of patients with an acute mental illness waiting more than eight hours in emergency departments, and some of these patients waiting much longer.
“Waiting in an emergency department for a hospital bed for more than eight hours is defined as ‘access block’,” says Australasian College for Emergency Medicine (ACEM) President Dr Simon Judkins. “When this occurs, it has been shown repeatedly to result in poorer health outcomes.
“On its own, access block is a disturbing phenomenon, and illustrates a problem with the whole hospital system.
“So when some of the most vulnerable people in our communities – patients with acute mental and behavioural conditions – become caught up in access block, it is time for action.
“Increasing mental health presentations to emergency departments means it is incumbent on all stakeholders – health jurisdictions, health networks, health system managers, hospital employers and executives, and governments – to address this issue and develop new policies to support shorter stays in the emergency department.”
Dr Judkins said the College would lobby state and territory governments and federal bureaucrats on measures including reporting access block for mental health presentations exceeding 12 hours to the relevant health minister or an appropriate body such as a human rights or health rights commissioner.
“To minimise time spent in the emergency department, other measures might include alternative models of care, particularly after-hours mental health support models, and increasing mental health expertise in in emergency departments,” Dr Judkins said.
Further strategies include:
- Improve emergency department design to ensure settings support the wellbeing of patients experiencing acute mental and behavioural conditions, particularly those who are agitated and distressed (e.g. access to quiet, low-stimulus private spaces).
- Increase funding to community-based and inpatient mental health and alcohol and other drug services. “It is likely that many mental health presentations to emergency departments occur as a result of chronic underfunding. ACEM believes that funding to mental health services should occur as a matter of urgency,” Dr Judkins said.
Mental Health Access Block study
Researchers took a snapshot of emergency departments in December 2017, with 65 Australian emergency departments reporting on the number of patients present at that time. While only 4% were mental health presentations, they comprised 19% of patients waiting for beds and 28% of those experiencing access block.
The problem of access block was worse in some jurisdictions compared with others, and particularly notable in Western Australia (66.7%) and Queensland (38.7%).
Hospitals in rural and regional areas also reported higher levels of access block than metropolitan hospitals, suggesting inequitable access to specialist mental health inpatient services across the country.
Over the past year, the maximum length of stay for an emergency department patient with a mental health presentation was 145 hours, or six days. Sixty-two per cent of emergency departments reported patients had wait times of more than 24 hours, while 23 per cent reported patients waited more than 72 hours.
Dr Judkins said: “All community members have the right to timely, high quality emergency medical care in a respectful environment. This includes mental health care.
“Long waits for mental health care in emergency departments are unacceptable and discriminatory and are likely to lead to serious deterioration in the wellbeing of patients.
“ACEM will use this study, backed up by ongoing research throughout the year, to advocate for a multidisciplinary approach to address the services and support available to patients presenting with mental health or behavioural needs, and improve patient outcomes.”
Download the Mental Health Access Block study
ACEM Public Affairs Manager
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0498 068 023