ACEM President Dr Simon Judkins said the audit’s findings align with the experiences of Emergency Department staff across Australia and New Zealand – where systemic failures mean patients experiencing mental health crisis turning to EDs for help because they have nowhere else to go.
The Auditor General’s report shows that of the 212,679 people accessing WA state-managed mental health care between 2013 and 2017, 43,700 (21%) relied solely on the ED for help, and for 50% of people, their first contact with state-funded mental health services was in the ED.
“The report starkly highlights an overreliance on Western Australian hospital Emergency Departments to deliver mental health care, despite EDs not being specifically funded, resourced or supported to do so,” said Dr Judkins.
“This places Emergency Departments and staff under enormous pressure as they struggle to keep up with demand and provide patients experiencing mental health issues with the care and attention they need.
“Overcrowded EDs mean dangerously long waits for patients. Our members report unacceptable increases in the number of mental health patients waiting 24 hours; earlier this year Fiona Stanley Hospital had 110 incidences of 24 hour stays in just one month.”
Despite the WA Government previously committing to address the issue of long-stay patients in EDs by reporting and acting on 24 hour stays, it has yet to do so. Data on 24 hour stays should be freely published to encourage accountability.
The system in WA is also failing to meet the needs of patients with acutely complex, long term mental health conditions, with only 10% of mental health patients accounting for 52% of all ED mental health presentations, and 92% of all in-patient mental health care. The audit report shows at least 284 people in WA spent at least a year in an acute hospital bed, with 126 of these patients (or 44%), spending more than 365 consecutive days in an acute in-patient ward. This is despite these beds being intended only for short stays of 15 days or less to stabilise a patient.
“Clearly, for some people in WA, the ED is the only source of state-funded mental health care that they access. For many others, the ED is the gateway or access point to other state-funded services such as in-patient beds or community treatment services. However, there are major issues to do with availability and access which must be addressed as current arrangements are unsustainable,” said Dr Judkins.
Alarmingly, over five years, 2,278 people had to visit the ED three or more times in one week before being admitted to hospital, while nine people visited the ED 10 or more times in a week before admission.
“Clearly there are too few options for people needing long term mental health care in the community, and this demand is being inappropriately met through in-patient specialist mental health wards,” said Dr Judkins.
“ACEM has repeatedly raised concerns that hospital Emergency Departments, without adequate resources and support, are far from the best environments for patients experiencing mental health crisis, and protracted waits for treatment make difficult situations worse,” said Dr Judkins.
“Across Australia and New Zealand we see too many instances of mental health patients waiting for 24 hours or longer in EDs to receive the treatment they need. ACEM has called for all states and territories to embrace a national standard which ensures that no patient is left waiting for 24 hours or more in an Emergency Department – as well as similar measures in New Zealand.
“People in mental health crisis and their families need a system that offers comprehensive, coordinated, multidisciplinary care, 24 hours a day, seven days a week, rather than more narrowly-focused, stand-alone, stop-gap solutions.
“ACEM would welcome the opportunity to provide further input and to work collaboratively with Governments and all parties on service models to help improve the situation in WA, and across Australia and New Zealand.”
ACEM is the peak body for emergency medicine in New Zealand and Australia, responsible for training emergency physicians and advancement of professional standards. www.acem.org.au
This link provides a range of resources on mental health care in the Emergency Department, including the proceedings from ACEM’s mental health summits and other research reports.