Research Therapies — 02 March 2018

Mental health patients are waiting an “entirely unacceptable” period of time in emergency departments, in a practice experts are calling discriminatory and dangerous.

Photo: Mental health cases made up almost 30 per cent of patients waiting for over eight hours. (Australian Story: Mark Farnell) 

Nearly one third of patients waiting for a bed for over eight hours in emergency departments had presented with acute mental health issues, data compiled by the Australasian College for Emergency Medicine showed.

Anecdotally it has long been known mental health patients often wait longer to be admitted to hospital than those presenting with physical ailments.

Dr Simon Judkins, president of the College, said they had recently heard from a Western Australian colleague about a patient waiting six days in an emergency department for an inpatient bed.

“[The patient was] going through cycles of having to be physically restrained and then chemically re-sedated because they became so agitated,” he said.

“We believe that wouldn’t happen if the patient was actually out of the emergency department and into an inpatient bed.”

Dr Judkins had his own experience of witnessing a patient, a 14-year-old girl, who spent three days in a regional emergency department.

“Which has been incredibly distressing for not only the patient, but also the patients family and the staff,” he said.

“[They] feel an incredible sense of frustration knowing that these patients are suffering because they can’t get the care that they need.”

The college collated data from 65 emergency departments in Australia in December last year. 

Mental health cases comprised just 4 per cent of presentations, however they made up almost 30 per cent of patients waiting for more than eight hours.

“In some cases we have mental health patients waiting four, five and in one case up to six days in an emergency department for an inpatient bed under a specialist unit,” Dr Judkins said.

He said waiting for a long period of time in an emergency department was in no way a supportive or comfortable environment for those patients.

“As anybody knows who’s been to an emergency department, it’s a big and busy place and the lights are on 24/7, there’s always noise — it’s certainly not a place where you can receive appropriate ongoing care for your mental health,” he said.

“This is entirely unacceptable.

“There would be an outcry if we had a 14-year-old boy with appendicitis waiting in an emergency bed for four days for an operation, we don’t see that mental health patients should be any different.”

 

‘We’ve underinvested in mental healthcare for too long’

Dr Judkins said the perception that the needs of a patient presenting with acute physical pain should be seen ahead of a person with mental health needs, which are seen as more difficult to interpret, needed to be overcome.

“There’s no doubt when we have patients who come with suicidal thoughts and suicidal ideation for example — they are at a significant risk of death,” he said. 

“In many cases we’ve seen reports of patients who have subsequently left the emergency department, purely because they’ve been waiting for such a long period of time for the care they need.

“And there have been many reports in the past of people leaving the emergency department and having very, very poor outcomes.”

The College for Emergency Medicine said while community support can and should be improved, the figures are proof there is chronic under-investment in emergency care for mental health.

“I think we need to look at better systems, are we using the resources that we’ve got most effectively in a coordinated manner?” Dr Judkins said.

“But I don’t think we can look past the fact we’ve underinvested in mental healthcare for a very long period of time and we’re seeing the impacts of that.”

 

‘Waiting and waiting, feeling like it would never end’

Indigo Daya is an advisor to the Victorian Mental Illness Awareness Council, but nine years ago she was a mental health patient at an emergency department — and the memories are still fresh.

“Waiting and waiting and waiting, and feeling like it would never end,” she said.

“And what’s particularly striking from my own personal experience is that I couldn’t get any specialist help from people while I waited.”

Ms Daya said while there would be plenty of specialists nearby to help her if she broke her leg, there would be no councillors, therapists or peer support workers.

“If I’m feeling suicidal or I’m really frightened by something that’s going on in my head, there’s no one that I can talk to,” she said.

Sign on Royal Hobart Hospital emergency department floor.

Photo: Dr Judkins says the impacts of underinvestment in mental health are now being seen. (ABC News)

Emergency doctor and Western Australian chair of the College of Medicine, associate professor David Mountain said the problem was particularly bad in WA.

He said the latest data simply confirmed that it was “behind the eight ball”.

“People working in emergency departments have known they’ve been terrible for the last decade in WA,” he said.

Professor Mountain said the WA administrator and politicians had been neglectful, ignoring what was “a completely obvious problem allowed it to fester and get worse.”

This piece by Barbara Miller was first seen on ‘ABC News‘, 26 February 2018.   

 

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