Australia’s health system still failing people with acute mental health needs: Report

‘Between the bright lights, yelling, police, pain and chaos of the surroundings – and my distress – I begin pacing, humming, tapping… just to try and block it out. Due to the long wait, I am either chemically restrained because of my distress, or repeatedly pressured to “calm down”, which funnily enough does not work.
 
‘By the time I have waited [for] eight to 13 hours to speak to someone from mental health, I am silenced by the medication, by privacy concerns, and by the increase in my distress.’
 
This is the voice of a person who has presented multiple times to the emergency department with acute mental health concerns. Their story is recorded in The long wait: An analysis of mental health presentations to Australian emergency departments, a report released today by the Australasian College for Emergency Medicine (ACEM).
 
Alarmingly, the report found that people with mental health conditions waited significantly longer than those with physical injuries, with the average wait for 90% of patients recorded at 11.5 hours for mental health compared to just 7 hours for physical.
 
Patients presenting for mental health concerns were twice as likely to leave before their treatment is completed than patients with physical injuries.
 
Waits for mental health services tended to be even longer in South Australia, Western Australia and Tasmania, with the longest average at 16.5 hours in South Australia.
 
The report analyses the statistics of more than 250,000 Australians per year who present to emergency departments (ED) seeking help for acute mental and behavioural conditions including suicidality, mania and psychosis.
 
Dr James Antoniadis, GP and psychodynamic psychotherapist, told newsGP he was unsurprised by the results of ACEM’s report, and believes long waits in ED for people presenting with mental health conditions are a result of constricted options for inpatient management.
 
‘We have a drastic shortage of inpatient beds … and then we’ve got the emergency department which is having to try and help people who want inpatient care, a bed, someone who’s going to look after them for a while,’ Dr Antoniadis told newsGP.
 
‘If the beds aren’t there, the best emergency can do is sit them [there] for as many hours as necessary until the patient calms down a bit. That’s not treatment, that’s just waiting out the storm.’
 
The report found that Aboriginal and Torres Strait Islander patients were significantly overrepresented, making up 3% of the Australian population but 11% of all ED mental health presentations across the country.
 
Overall, people presenting at the ED with acute mental health and behavioural conditions were 18% less likely to be seen within the appropriate timeframe for their presentation urgency than people with other medical conditions.
 
ACEM considers the results of its report to be ‘damning’ of the lack of timely healthcare provided for people with acute mental health concerns through ED, although it points to systemic strain rather than placing blame on ED staff.
 
‘We can, and must, do better,’ President of ACEM Dr Simon Judkins said.

‘These are problems that emergency doctors cannot solve alone; they reflect a sector under great stress and lack of a plan for system-wide development.’
 
Dr Antoniadis agrees the issues outlined in the ACEM report stem from systemic problems and would like to see greater investment in hospitals and treatment centres specifically dedicated to the management of severe mental health concerns.
 
He also highlights the role of general practice as ‘the rung below’ treatment in the emergency department, and warns that neglecting proper training and funding in primary care will lead to further pressure placed on emergency departments.
 
‘People get to emergency because they’ve given up on other avenues,’ Dr Antoniadis said.
 
‘General practice should be the first source of back referral from the emergency department for people who are in acute crisis. For example, the emergency department sees the person with acutely high blood pressure, gets it under control and says, “Go back to your GP tomorrow and get them to manage your blood pressure”. It needs to be similar with acute care in psychiatry.
 
‘But mental health care is time-consuming – it involves talking, you can’t just write a prescription and send someone out the door in times of crisis – and an underfunded approach to mental health in general practice, in which GPs are penalised for longer consultations, means the general practice sector will avoid taking on those longer cases. This pushes them back up through the emergency departments, only to be deflected back again when patients can’t get into a hospital.’

ACEM Australian College for Emergency Medicine emergency medicine Mental health care