Response to Royal Commission into mental health interim report

In supporting recommendations for greater service capacity, including 170 additional acute mental health beds and easier after hours access in the community, the College is also urging that the current discrepancy between funding and overreliance on hospital emergency departments (EDs) to deliver mental health services is addressed.

ACEM President Dr John Bonning said: “As ACEM has demonstrated so clearly across Australia and New Zealand, system-wide failures have resulted in an overdependence on EDs to provide mental health care and services. This is despite EDs not being recognised as integral parts of the mental health service system,” said Dr Bonning.

“While measures are needed to provide patients experiencing mental health crisis with options other than the ED, EDs must also be properly resourced to cope with existing and future demand and address dangerously long waits for patients.”

In Victoria, this issue is illustrated by the discrepancy between the 1.9% of mental health funding that goes to EDs, while ED staff manage 27.5% of the total referrals to public clinical mental health services.

“While the recommendations are welcome, ACEM remains concerned about the lack of immediate relief for people presenting in acute need to emergency departments, as well as the welfare of the health professionals in EDs who are trying to advocate for access to safe and effective care,” said Dr Bonning.

“Over occupancy of in-patient beds means overcrowded EDs, where mental health patients wait hours and sometimes days for urgently required mental health care. Our members urgently need alternatives to reduce the known harms to patients needing mental health care.”

ACEM Immediate Past President Dr Simon Judkins said: “EDs must be valued, adequately-resourced and integral components of any redesigned mental health system in Victoria. There needs to be the capacity to manage demand, as well as a clear framework for monitoring and evaluating the impact of proposed reforms on reducing the number of patients left waiting for hours in Victoria’s EDs.”

“As ACEM and our members have demonstrated, there is now compelling evidence about just how dangerous overcrowded EDs are and what works in minimising both long waits and the reliance on restrictive practices,” said Dr Judkins.

“Initiatives such as real time escalation to the CEO once a patient has been waiting in the ED for 12 hours, and Ministerial reporting at 24 hours, are the most effective ways to monitor demand and capacity in the system and drive improvements in governance, safety and service coordination.

“More broadly, ACEM calls on the Royal Commission, in its final report, to recognise and ensure that EDs are integrated into a whole of health system that is delivering timely and appropriate care.”

Background

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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