Barriers to providing optimal management of psychiatric patients in the emergency department (psychiatric patient management)

Dombagolla, Mahesha Hk; Kant, Joyce A.; Lai, Fiona Wy; Hendarto, Andreas; Taylor, David

doi:10.1016/j.auec.2019.01.001

Cited by 17 publications

(23 citation statements)

References 37 publications

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“…The increasing activity within Australian EDs has resulted in overcrowding and lack of privacy, while policy changes have placed pressure on staff to discharge patients within 4 hours of presenting (Dombagolla et al . 2019; Innes et al . 2014).…”

Section: Introductionmentioning

confidence: 99%

Repeat presentations to the emergency department for non‐fatal suicidal behaviour: Perceptions of patients

Meehan

Baker

Blyth

et al. 2020

Int J Mental Health Nurs

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Presentations to emergency departments (EDs) for non‐fatal suicidal behaviour (NFSB) are increasing in Australia and overseas. Our understanding of the factors contributing to this trend remains unclear. In this qualitative phenomenological study, we explored patient perceptions of their ED experience and the interventions provided. The study group comprised 10 adults who had had 3 or more presentations to the ED in a 12‐week period for NFSB. Individual interviews were conducted in person with participants and transcribed verbatim. Three broad themes emerged from analysis of the transcripts: ED – a safety net; 'treatment – what treatment!'; and maintaining ED dependence. The findings highlight a failure to understand the needs of those with NFSB and establish better ED treatment strategies and models of aftercare for this sub‐group of patients. The findings have implications for mental health nurses working with consumers in the ED and in broader case management roles.

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Section: Introductionmentioning

confidence: 99%

Repeat presentations to the emergency department for non‐fatal suicidal behaviour: Perceptions of patients

Meehan

Baker

Blyth

et al. 2020

Int J Mental Health Nurs

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“…Additionally, many Australian EDs do not have dedicated 24‐hour specialist mental health service/practitioners available to conduct assessments and commence treatment (Dombagolla et al . 2019; Zun 2012). This may cause further frustrations to both patients and carers and significantly delay access to definitive care.…”

Section: Introductionmentioning

confidence: 99%

“…There are several barriers to providing optimal care to patients with mental health problems in EDs including structural issues such as lack of appropriate physical space, adequate access to inpatient beds, concern for patient and staff safety, and limited resources for training (Dombagolla et al . 2019). Previous studies have shown that ED staff lack formal mental health training, psychiatric knowledge, and experience to deal with these patients (Dombagolla et al .…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies have shown that ED staff lack formal mental health training, psychiatric knowledge, and experience to deal with these patients (Dombagolla et al . 2019; Gerdtz et al . 2012; Innes et al .…”

Section: Introductionmentioning

confidence: 99%

“…Complexity of care for those presenting to the ED with acute behavioural disturbance may also be compounded by dual diagnoses and concomitant intoxication (Dombagolla et al . 2019). Individuals with drug‐ and alcohol‐related ED presentations are known to have high rates of re‐attendance due to associations between substance misuse and a wide range of medical conditions impacting gastroenterological and/or neurological function (Rehm 2011).…”

Section: Introductionmentioning

confidence: 99%

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Characteristics and clinical outcomes for mental health patients admitted to a behavioural assessment unit: Implications for model of care and practice

Daniel

Mukaro

Yap

et al. 2020

Int J Mental Health Nurs

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Behavioural assessment units (BAU) have been established in emergency departments (EDs) to provide short‐term observation, treatment, and care to people experiencing acute behavioural disturbance. A prospective observational study was conducted in a cohort of adult patients admitted to one BAU located within an ED (July–December 2017) to compare clinical characteristics, treatment outcomes, and use of restrictive interventions for those who received a specialist mental health (MH) assessment with those who did not. Of the 457 patients, 61.5% received a specialist MH assessment. This group had a lower acuity (Australasian Triage Score 10.4%; CI 0.2–2.0% vs 13.6%; CI 9.3–19.5%); more arrived with police (28.8%; CI 23.8–34.3 vs 5.1%; CI 2.7–9.4%); and were subjected to restrictive interventions while in the BAU. Security responses for unarmed threat (code grey) were higher (10.9%; CI 7.8–15.0% vs 4.4%; CI 2.3–8.5%), as was the use of chemical restraint (4.2%; CI 2.4–7.2 vs 0.0% CI 0.0 – 2.1%). Those requiring specialist MH assessment had a longer length of stay (12.7 vs 5.2 hours). Further development of the BAU model of care must include targeted, evidence‐based strategies to minimize the use of restrictive interventions and ensure timely access to acute mental health services.

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Acute psychiatric care: approaches to increasing the range of services and improving access and quality of care

et al. 2022

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Acute services for mental health crises are very important to service users and their supporters, and consume a substantial share of mental health resources in many countries. However, acute care is often unpopular and sometimes coercive, and the evidence on which models are best for patient experience and outcomes remains surprisingly limited, in part reflecting challenges in conducting studies with people in crisis. Evidence on best approaches to initial assessment and immediate management is particularly lacking, but some innovative models involving extended assessment, brief interventions, and diversifying settings and strategies for providing support are potentially helpful. Acute wards continue to be central in the intensive treatment phase following a crisis, but new approaches need to be developed, evaluated and implemented to reducing coercion, addressing trauma, diversifying treatments and the inpatient workforce, and making decision‐making and care collaborative. Intensive home treatment services, acute day units, and community crisis services have supporting evidence in diverting some service users from hospital admission: a greater understanding of how best to implement them in a wide range of contexts and what works best for which service users would be valuable. Approaches to crisis management in the voluntary sector are more flexible and informal: such services have potential to complement and provide valuable learning for statutory sector services, especially for groups who tend to be underserved or disengaged. Such approaches often involve staff with personal experience of mental health crises, who have important potential roles in improving quality of acute care across sectors. Large gaps exist in many low‐ and middle‐income countries, fuelled by poor access to quality mental health care. Responses need to build on a foundation of existing community responses and contextually relevant evidence. The necessity of moving outside formal systems in low‐resource settings may lead to wider learning from locally embedded strategies.

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Barriers to providing optimal management of psychiatric patients in the emergency department (psychiatric patient management)

Cited by 17 publications

References 37 publications

Repeat presentations to the emergency department for non‐fatal suicidal behaviour: Perceptions of patients

Repeat presentations to the emergency department for non‐fatal suicidal behaviour: Perceptions of patients

Characteristics and clinical outcomes for mental health patients admitted to a behavioural assessment unit: Implications for model of care and practice

Acute psychiatric care: approaches to increasing the range of services and improving access and quality of care

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