Mental healthcare reforms urgently needed

A disturbing media report of a mental health patient’s experience being restrained in hospital is further evidence of major systemic failings in mental healthcare in South Australia and Australia and the need for urgent reforms, says the Australasian College for Emergency Medicine (ACEM).

ACEM President Dr John Bonning said:

“This is a tragic and unacceptable situation, and this patient should be applauded and supported for speaking out. Unfortunately, similar stories are still too common, and major systemic improvements are urgently needed to properly care for some of our communities’ most vulnerable patients.

Unacceptably, it is still routine for mental health patients to wait days in emergency departments (EDs) for a bed in hospital, in an environment designed for a maximum stay of four hours.

Emergency department staff are well trained in the initial assessment and management of patients with psychiatric health issues, as much as we are trained to deal with other medical emergencies. However, it is once initial assessment and management occurs in the ED, and patients requiring more definitive care are referred on to inpatient services for admission, that dangerously long waits and delays occur, as a result of longstanding systemic issues.

EDs are safe and welcoming places, and we accept all patients, whatever their health emergency, but long waits in busy and chaotic emergency departments make a bad situation much worse for distressed mental health patients.

ACEM has been working with emergency department staff from across South Australia, highlighting these issues to government and health system executives for many years. So far we haven’t seen any evidence of improvements in community care, or inpatient areas but are hopeful some new resources for community access are being planned.

This is not just a South Australian issue, and radical change is needed across the country. We want to work with all stakeholders, clinicians and consumers, to make a difference.”

ACEM South Australia Faculty Chair Dr Mark Morphett said:

“Emergency departments have a key role to play in the treatment of mental health patients, and ED staff will always do their best to provide care. However, EDs often already run at or over capacity, and through design and stretched resources, find it very difficult to provide the therapeutic environment for patients requiring mental health care. We acknowledge that the stressed environment of ED, with long waits to admission and definitive care, actually harms many patients.

This latest media report also highlights the issue of physical restraint, which must be the last resort. Working in EDs, all other options need to be looked at; a sentiment reinforced in ACEM’s Consensus Statement on Mental Health in the Emergency Department.

Often, the use of restrictive practices is related to limited access to suitable inpatient treatment, or specialist mental health teams, and should only be used when required for patient and staff safety, and only for the minimal time required. EDs are also generally not designed to look after patients requiring involuntary care; often lacking infrastructure and personnel.

With mental health patients in South Australia continuing to experience dangerously long waits in the ED for definitive care by specialist inpatient teams, following their initial assessment by emergency doctors, clearly major, whole-of-system reforms and alternative care options are urgently needed.”

Later this month, ACEM will release a comprehensive set of recommendations for improvements and reforms to mental healthcare in Australia in a new report.”

Background: ACEM is the peak body for emergency medicine in Australia and New Zealand, responsible for training emergency physicians and advancement of professional standards.

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