Transforming mental health care

Psychiatric Emergency Care Centres are delivering results for patients and reducing the burden on busy emergency departments.

Nepean Hospital’s PECC has transformed mental health care and eased the burden on the emergency department, says the unit’s senior nurse Joanne Seymour.

Joanne, a mental health nurse practitioner, credits the PECC with delivering much faster assessment of patients followed by a high level of co-ordinated intervention by a range of health professionals and carers.

‘We historically had many mental health patients in the ED with no trained mental health nurse after hours,’ she said. ‘That was not optimal treatment for the patients and contributed to a serious access block in ED.’

PECC staff include two nurses on every shift, a NUM and a psychiatric Chief Medical Officer.

‘As soon as patients enter the PECC they get an immediate mental health triage – usually by a senior mental health nurse – whether they have co-morbid medical problems or are presenting predominately for psychiatric reasons,’ Joanne said.

‘We aim for immediate treatment as soon as the patient is assessed and admitted. Most do not need to be admitted to our in-patient unit. We are responsible for discharge planning and we quickly involve all required services – drug and alcohol, social workers etc.

‘In-patients are with us a maximum 48 hours but the average length of stay recently has been 11-12 hours.

‘If a person requires further treatment it is our job to find the most appropriate place for them. It’s important where possible to transfer people back to the area they live in so they can receive continuity of care.

‘If an adolescent or aged person is involved we may continue in-patient care for a couple of days until we can get them into an age-specific bed.’

Nepean’s PECC team have been operating for almost two years inside the ED as they wait for separate premises to become available. PECC in-patients are usually accommodated in a six-bed nursing bay within the ED.

‘Not having a physically separate PECC unit is very challenging. We are trying to manage people in an environment that’s not optimal, so we have to be very careful in identifying risk – for example, an absconding risk or self harming risk – when the patient comes in.

‘We nurse people on observation levels and every client is within line of sight of a mental health nurse at all times. If they need to go to the bathroom or outside for a cigarette then two staff escort them throughout the department to make sure they are safe. They get an intense level of intervention while they are here.’

Joanne says the PECC has definitely reduced access block in the ED.

‘Our interaction with ED staff is fantastic – they are very appreciative that we’ve supported their role and we work very well with them.

‘We educate ED staff formally and informally: they work collaboratively with us and observe what we do, and we also conduct regular education for the ED nurses and Medical Officers on multiple mental health issues. ‘ED staff have learned a lot about mental health issues and caring for mental health patients and, conversely, we’ve learnt a lot about medical issues and nursing people with complex medical problems.’

Joanne believes a PECC provides a unique working environment especially for nurses who are relatively early in their careers.

‘It is a significantly different work environment because it combines elements of both a standard in-patient facility and a community/assessment facility.

‘A relatively junior nurse working in a PECC would have a different focus to their learning and end up with a wider range of skills,’ she said.

Facts about PECCs

NSW Health is setting up Psychiatric Emergency Care Centres (PECC) in the emergency departments of nine major hospitals.

Four PECC units are now operating at Liverpool, Nepean, St George and St Vincent’s and five more will follow at Hornsby, Wyong, Blacktown, Campbelltown and Wollongong.

PECCs are one response to the sorts of problems identified by the NSW Auditor General’s report of May 2005. The AG found that some patients were spending long periods in EDs while waiting for acute mental health beds. Patients also were leaving the ED before being properly assessed – sometimes with serious consequences.

PECCs provide rapid access to specialist mental health care while helping to improve patient flow in EDs.

PECCs combine the functions of mental health assessment and discharge planning with observation and short-term care of up to 48 hours in a 4-6-bed unit.

Patients normally are referred to the PECC following initial medical triage and assessment in the ED.

PECCs are staffed round-the-clock by senior mental health nurses and other professionals.