The Emergency Department or a Cup of Tea?

The Emergency Department or a Cup of Tea?

24 October 2018

Mental Health presentations at emergency departments (ED) are increasing dramatically. Figures from around the country suggest that there is a 27% annual increase in 10-19 year olds presenting to ED for crisis mental health help.

ED is not a place anyone wants to be, let alone when you are distressed and in crisis. A recent study showed that about 60% of people attending ED for mental health were classified as having an urgent to potentially life-threatening issue. Yet those seeking help at ED for mental health wait longer than if the problem were a physical health issue. Mental health is the issue in 4% of ED presentations, but account for 30% of patients waiting for more than eight hours.

To compound an already stressed system, mental health advocates predict of a tsunami of ED presentations once the National Disability Insurance Scheme (NDIS) achieves full roll-out and the funding for programs such as Partners in Recovery (PIR) stops. PIR is a program that aims to help people living with a mental illness to remain well, living and participating in the community.

Those who are currently accessing PIR are guaranteed continuity of supports, although we don’t know many details of that support yet. Those who are not already on a program such a PIR have no clear guarantee of help. The fear is that without programs such as PIR, which doesn’t require a referral, is free and relatively easy to connect with, there will be many who do not access help and become severely unwell- some of whom are likely to end up in ED.

The NSW Government recently announced a number of suicide prevention measures. Amongst the announcements was one for funding mental health cafes as an alternative to ED. Options for mental health support outside of business hours are limited and often people in crisis turn to the ED. In fact, more than half of people attending ED for mental health do so outside of business hours. Mental health cafes offer safe, therapeutic spaces for mental health consumers out of hours.

Originally mental health cafes were introduced in the United Kingdom with remarkable results. Since then, St Vincent’s Hospital Melbourne has also opened a café, the Safe Haven. The café is staffed by a mental health clinician and peer support workers. It does not offer clinical mental health interventions, but instead aims to support people to identify and locate what options may be available to support them as well as all-important company for those feeling isolated and lonely. It also helps people to understand about their own response to crises and to develop self-management skills.

This won’t solve the suicide crisis in Australia, but it is an important part of the puzzle. Those who work in the community mental health sector really lament the loss of programs such as PIR, but this offers something like “PIR-late & lite” and will help to support those who feel like there is no-one to help them. There is a real challenge remaining, which is reaching people before they end up at crisis point. It is only when we start to solve underlying issues of disadvantage in Australia then we will really start to reduce the suicide rate.

Ellen Marks

Dr Ellen Marks - General Manager Advocacy and Inclusion