Almost a decade after emergency doctors first called for urgent reform, the Australasian College for Emergency Medicine's (ACEM) latest report shows not only has there been no improvement, but ED time-based performance data points to further decline.
ACEM’s report Still Waiting: Trends in Mental Health Presentations to Australian Emergency Departments shows that since 2016-17 mental health presentations have increased in acuity and complexity, requiring more urgent and more intensive care. Despite this, people with urgent mental health needs are waiting longer to be seen by inpatient mental health clinicians, spending extended periods in the ED, and facing significant delays to inpatient admission.
ACEM Immediate Past President Dr Stephen Gourley said that EDs are increasingly serving as the community’s only point of access to mental health services despite years of calls for investment into the health system to build capacity to provide urgent mental health care.
“The data is clear. The solutions are known. The time for reform is now,” Dr Gourley said.
“For too many people needing urgent mental health care, the emergency department remains the only option, because no appropriate alternatives exist. We also need stronger investment across hospital and community settings so that people can be referred to the right care and supported beyond the ED.”
ACEM has been documenting these challenges for almost a decade. In 2018, The Long Wait report drew national attention to the lengthy stays experienced by people seeking mental health care in EDs. In 2020, the Nowhere Else to Go report showed how system failures were leaving people requiring mental health care ‘stuck’ in EDs and made clear recommendations for reform - recommendations that remain unimplemented.
These reports reflect the consequences of systemic underinvestment in community-based services, inadequate inpatient capacity and fragmented care pathways. ACEM’s Still Waiting report shows these problems have only deepened.
Data trends from 2016–17 to 2023–24 reveal:
- Increased presentations, with the number of mental health-related presentations increasing from 276,954 in 2016-17 to 310,162 in 2023-24.
- Rising demand, with the number of people presenting to EDs for mental health care rising by nearly 12 per cent over this period, with the sharpest increases among Aboriginal and Torres Strait Islander peoples and older persons
- Greater complexity and urgency, with more patients needing mental health care arriving by ambulance, triaged as high acuity (ATS 1–3), and more likely to require hospital admission compared with other ED patients; and
- Excessively long waits for admission, with 10 per cent of patients with a mental health diagnosis waiting more than 23 hours for an inpatient bed in 2023–24.
“EDs will always respond to people in crisis, but the growing demand reflects a system that is failing people with mental health needs by not providing the right care, or enough care, to prevent their condition from worsening,” Dr Gourley said.
Australian Medical Association President Dr Danielle McMullen said: “This is an important report and highlights yet again the devastating impact of a lack of investment in mental health, including in community services and in general practice — areas that can keep people out of busy hospital emergency departments, which can exacerbate symptoms for patients suffering from a mental health condition.
“Just this week the Productivity Commission found the National Mental Health and Suicide Prevention Agreement to be 'not fit for purpose’, citing a lack of progress, fragmentation, and poor accountability. It’s vital all governments work together to address funding needs and gaps in services to ensure patients get the care they need — when they need it.”
Dr Gourley said the Still Waiting report underscored the urgent need for whole-of-system reform, and that expanding community mental health services, increasing inpatient bed capacity, embedding cultural safety, and scaling up effective models would be critical to moving toward a more responsive and equitable mental health system. He said that without decisive action, Australia risked perpetuating a reactive model that failed to meet the needs of its most vulnerable people.
“While this report focuses on the numbers, it is vital to remember that every statistic represents a person seeking care,” Dr Gourley said. “Behind each figure is an individual, loved one or carer who has turned to an ED for help, whether in acute crisis or because no other care was available. These are the human stories behind the data, and they are why reform matters.
“The public narrative often defaults to describing the system as ‘overburdened’. But it’s important for us to be clear that people are not a burden – they are seeking care, often in their most vulnerable moments,” Dr Gourley said. “The problem is not those who walk through the doors, but a health system that has failed to keep pace with community need.”
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Background:
ACEM is the peak body for emergency medicine in Australia and Aotearoa New Zealand, responsible for training emergency physicians and advancement of professional standards. www.acem.org.au
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