Mental health patients stuck in emergency departments

 

Research revealed at the NSWNA mental health forum shows access block is getting worse

The widespread problem of mental health patients getting stuck in hospital emergency departments because of a shortage of mental health beds, has been highlighted by research at Manly Hospital.

Statistics gathered by Manly Hospital’s CNC of mental health, Michael Bullock and NUM of the Emergency Service, Sue Hair, reveal a serious access block involving mental health patients.

Michael and Sue presented their findings in a paper delivered to the NSW Nurses’ Association’s 2005 mental health forum.

Their statistics, put together at the start of this year, showed the average length of stay of mental health clients in the ED increased dramatically over the previous four years.

In 2000 less than 12% of presentations remained in the ED for more than eight hours. By 2004 the figure had jumped to over 51%.

The acuity of presentations also changed, with an increase of over 480% in triage category 2 patients during the previous four years.

The average length of stay of admitted mental health patients in the Emergency Department increased by over 280% in the previous four years, from 5.1 hours in 2000 to 14.5 hours in 2004.

The percentage of Emergency Department mental health admissions being transferred to the psychiatric unit decreased from 69% in 2000 to 33% in 2004, with remaining mental health admissions being managed in the ED or transferred to other facilities.

Michael Bullock told The Lamp the problem of access block was not confined to the ED.

‘It affects acute and sub-acute areas as well as rehab. There has been very little movement up and down the chain – if one link blocks up, they all do,’ Michael said.

‘It basically comes down to the serious lack of mental health beds, which results from mental health being the poor relation of the NSW health service.

‘Last year some of the psychiatrists and I looked at practical solutions and we decided another five or six mental health beds with the necessary extra staff would allow us to eliminate the blockage in the ED.’

Michael said the problem was made worse by the fact that the number of general adult acute beds at Manly had not increased since 1992.

He said that, despite shortages of money and staff, practical solutions could still be found – provided hospital managements were prepared to listen.

‘We lobbied management over the last six months to agree to quarantine two beds in our psychiatric unit so that when a patient is discharged we don’t give the bed away to out-of-area patients.

‘We now reserve these beds for our own patients coming through ED or from our crisis team. This has already decreased our access block in ED.

‘The ED still has mental health patients staying longer than 24 hours from time to time, but that’s rare compared to, say, six months ago.’

Michael and Sue’s research paper argues the need for a psychiatric emergency centre for 48-hour or 72-hour stays. It also calls for a step-down ward to accommodate patients waiting to go into rehab.

‘We need a ward where patients can still be monitored and supervised without taking up an acute admission bed,’ Michael said.

He said the increase in acuity of admissions at Manly Hospital was due to intense pressure on the limited facilities and services outside the hospital system.

‘Where else but in a public hospital can you be seen by a mental health clinician – usually a psychiatrist – within 12 hours? A lot of clients can’t afford private psychiatrist or private health cover and there very few private psychiatrists who bulk bill.’

MENTAL HEALTH DISCUSSION GROUP

The NSWNA’s annual mental health forum is an initiative of the union’s mental health reference group, an informal gathering of union officials and members who meet every two months to discuss professional issues.

Members in the mental health field are welcome to join the group. For details contact Angela Garvey on 8595 1234 or email agarvey@nswnurses.asn.au.