ACEM calls for new approach in managing people with mental health presentations in NZ EDs

The peak body for emergency medicine in New Zealand and Australia has proposed solutions to improve models of care for patients with acute mental and behavioural conditions.

The call for action comes as a snapshot survey found mental health presentations are disproportionately experiencing access block compared with presentations for other conditions.

A snapshot of the patients present in seven New Zealand emergency departments in December 2017 found that, despite only 3.7% being identified as mental health presentations, they comprised 25% of patients experiencing access block.

Australasian College for Emergency Medicine (ACEM) New Zealand Faculty Chair Dr John Bonning says access block – defined as waiting in an emergency department for a hospital bed for more than eight hours – has been shown repeatedly to result in poorer health outcomes.

“On its own, access block a disturbing phenomenon, and illustrates a problem with the whole hospital system,” Dr Bonning said.

“So when some of the most vulnerable people in our communities – patients with acute mental and behavioural conditions – become caught up in access block, it is time for action.

“Increasing mental health presentations to emergency departments means it is incumbent on all stakeholders – District Health Boards, hospital employers and executives, and the government – to address this issue and develop new policies to support shorter stays in the emergency department.”

Dr Bonning said the College would advocate for change on measures including reporting access block for mental health presentations exceeding 12 hours to the health minister or an appropriate body such as a human rights or health rights commissioner.

“To minimise time spent in the emergency department, other measures might include alternative models of care, particularly after-hours mental health support models, and increasing mental health expertise in in emergency departments,” Dr Bonning said.

Further strategies include:

• Improve emergency department design to ensure settings support the wellbeing of patients experiencing acute mental and behavioural conditions, particularly those who are agitated and distressed (e.g. access to quiet, low-stimulus private spaces).
• Increase funding to community-based and inpatient mental health and alcohol and other drug services.  “It is likely that many mental health presentations to emergency departments occur as a result of chronic underfunding. ACEM believes that funding to mental health services should occur as a matter of urgency,” Dr Bonning said.

ACEM President Dr Simon Judkins said all community members have the right to timely, high quality emergency medical care in a respectful environment. This includes mental health care.

“Long waits for mental health care in emergency departments are unacceptable and discriminatory and are likely to lead to serious deterioration in the wellbeing of patients,” Dr Judkins said. “ACEM will advocate for a multidisciplinary approach to address the services and support available to patients presenting with mental health or behavioural needs, and improve patient outcomes.”

Link to survey