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The peak body for emergency medicine in Australia has written to health ministers across the country demanding urgent action to minimise the risk to patients and staff in the wake of recent hospital violence.

In the latest incident, a 23-year-old man has been charged after allegedly stabbing two staffers and assaulting another at a south-east Queensland hospital.

Speaking generally about hospital violence, Australasian College for Emergency Medicine (ACEM) President Dr Simon Judkins said: “We know that many people present to emergency departments in a time of deep health crisis and urgent need, and that many of these health crises are extremely complex.

“When incidents of violence occur, the knee-jerk reaction is to blame the perpetrator, which may be entirely appropriate in some cases. However, when patients present in a mental health crisis and are left to wait in unsupported environments and their behaviour escalates, not recognising and addressing the system issues leading to these behaviours will result in inappropriate blame and not result in any sustainable change.

“We have been outspoken about addressing the systemic issues which lead to violence, especially in mental health care.

“Emergency departments need to be resourced and supported so that they can respond properly to complex community health needs in an appropriate way. ACEM believes that a lack of appropriate resourcing is putting frontline emergency department staff, and other patients, at risk of violence.”

In the letter, ACEM has identified four actions that can be immediately implemented by governments to improve the safety and quality of mental health care and support for people presenting to an emergency department in crisis.

“We don’t need hospitals turning into fortresses to keep staff and patients safe, or gimmicks like body-worn cameras or other short-term, headline-grabbing announcements,” Dr Judkins said.

“Incidents like this have to drive real change, and more needs to be done to understand the causes of violence in emergency departments and to resource emergency departments to prevent violence and minimise its impact.”

Read ACEM’s letter to health ministers

_________

Dear Minister, 

Re: Request for meeting to discuss issues facing emergency departments

On behalf of the Australasian College for Emergency Medicine (ACEM), we wish to raise our deep concern at the unacceptable state of mental health support available to people seeking help through Emergency Departments (EDs) and to urge you to act immediately to improve this situation.

Earlier this week, a young man in desperate need of help presented with his mother in the early hours of the morning to an overcrowded Queensland ED seeking mental health care. After hours waiting in the noisy and chaotic environment, the patient’s mental health crisis intensified, staff were assaulted, Police were called and the young man is now facing assault charges. As his devastated mother has told us, “He came in seeking help and now he is being treated as a criminal”.    

Unfortunately, incidences such as the one described above are common throughout EDs across Australia. It is only through good fortune that this incident did not result in death; we may not always be so lucky. We know that incidences of violence are under-reported, but also that they are increasing across EDs. Clearly, better reporting of incidences of violence, and the conditions under which they occur, must be a key part of the solution.  

ACEM is deeply concerned that punishing the individual for the outcome in this case will not result in the significant system change that is required to improve the way people with mental health presentations are managed in the hospital system. The failures in the mental health system are being felt in our EDs every day, with dire consequences for patients and staff. Our members report feeling heart broken and burnt out at their inability to adequately assist people who come to the ED seeking help, and are deeply worried for their patient’s safety as well as their own.  This is not a problem that will be addressed by additional security guards, body-worn cameras and posters alone. More concerted, systemic action must be taken to protect the safety and wellbeing of ED staff and patients.

We see how mental health presentations peak after-hours, when the ED is the only option available for professional care but when access to mental health professionals is limited. Similarly, vital support from social work, drug and alcohol or homeless services is not available. As a result, their experience of the ED is harmful not helpful, and characterised by long waits with seemingly no end in sight in a stressful environment. Too few mental health beds and the lack of appropriate infrastructure to calm desperate and distressed patients exacerbate the harm. These long waits often result in people being sedated and physically restrained for long periods of time.  

This situation is not good enough. Everyone in Australia, regardless of age and location, should have access to timely and appropriate care, with EDs being just one door into a high quality, equitable and evidence-based mental health system.

We recognise that some Health Ministers have engaged with this crisis. However, there is now a need for urgent action. We are calling on all health departments in Australia to address this issue as a matter of urgency. The current arrangements burden individual patients, their families and EDs, and are unsustainable.

We ask that:

1. All Australian Governments act urgently to engage people with lived experience in reforms that deliver timely access to appropriate mental health care, with an immediate focus on after hours care in the community.

2. When psychiatric admission is required, processes need to be timely and streamlined so that acutely unwell people can access an appropriate inpatient bed any time of day or any day of the week.

3. States and territory health departments enforce a maximum 12-hour length of stay in the ED, by providing accessible, appropriate and resourced facilities to allow for ongoing care beyond the ED, with mandatory notification and review of all cases embedded in the key performance indicators of public hospital Chief Executive Officers (CEOs).

4. All 24-hour waits in an ED should be reported to the Health Minister regularly, alongside any CEO interventions and mechanisms for incident review. 
 
Background
 
ACEM has been outspoken in calling for improvements to the way people with mental health presentations are managed in EDs across the country through investments in new care models, therapeutic treatment spaces and access to inpatient beds when needed.

ACEM called for mandatory Ministerial reporting of long ED stays in February 2018, and then held a Mental Health in the Emergency Department Summit in Melbourne late last year that saw more than 170 emergency doctors, psychiatrists, consumers, clinicians and key decision makers discuss and agree on seven key principles to tackle Australia’s mental health crisis.

ACEM issued a communiqué after the summit, vowing to set the agenda for policy reform and declaring that “no one should stay longer than 24 hours in an emergency department”, particularly those experiencing mental health crisis.

Following the Summit, the Western Australian Government has said that it will introduce and support mandatory reporting of extreme wait times in emergency departments. The Northern Territory government has also announced a similar step towards improving patient care.
 
ACEM is now working with colleagues within the health system to develop a Consensus Statement that captures further commitments and provides the mandate for systemic actions by governments, services and health professionals across Australia.
 
ACEM is the peak body for emergency medicine in Australia and New Zealand, responsible for training emergency physicians and advancement of professional standards. www.acem.org.au
 
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