Mental health patients face 'discriminatory' wait in emergency departments

New research shows mental health patients admitted to emergency departments wait longer than other patients. Photo / 123RF

Mental health patients admitted to emergency departments wait longer than other patients to get proper treatment, new research has found - putting their lives and future health at risk.

Emergency departments aim to have all patients seen and moved out of the ED into the appropriate ward within six hours. Those that are stuck there for longer than eight hours are considered to be experiencing "access block" - usually due to lack of hospital bed capacity.

A snapshot survey at seven of the country's emergency departments last December found that although only 3.7 per cent of ED in-patients present with mental health issues, they make up a quarter of the patients who experience access block.

The Australasian College for Emergency Medicine (ACEM), which trains New Zealand emergency doctors and carried out the survey, is calling for the Government and DHBs to make urgent improvements to the hospital system to ensure the "discriminatory" practice stops.

"Chronic underfunding" was the likely reason for a spike in mental health patients presenting at EDs, ACEM's New Zealand faculty chair Dr John Bonning said.

Three quarters of mental-health presentations happen outside normal hours, Bonning said. The bulk are due to overdoses but anxiety, psychosis and depression also bring mental health patients to the ED.

Some are brought in by family against their will, while police are increasingly bringing people to the emergency department rather than putting them in the cells. Many mental health patients need a minder while in the ED.

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Mental health patients are "labour intensive, complex patients", Bonning said. "That's not to impugn mental health staff who are working in ED - it's a plea for more resources to keep these people in the community, at the top of the cliff, not the emergency department at the bottom."

ED medical staff try to care for mental health patients but can't provide long-term care for those stuck there for up to 24 hours.

"They can't sit and talk with them, work through their issues, so they're not necessarily getting the best care. We have very good psychologists and mental health nurses but these people have very complex needs."

Access block is disturbing and shows a problem with the whole hospital system, Bonning said.

"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."

ACEM wants the Minister of Health or a human rights body alerted any time a mental health patient stays in the ED for more than 12 hours. The college also wants improved access to alternative models of care, such as mental health support after hours and more funding for drug and alcohol rehab services.

Better ED design, including quiet, low-stimulus spaces, would help mental health patients cope, ACEM says.

The college's president, Dr Simon Judkins, said everyone has the right to timely, high-quality emergency medical care in a respectful environment - including 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 well-being of patients," he said.

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