Emergency departments are the canary in the mental health coal mine

Mar, 2021

Emergency departments (EDs) are often considered the “canary in the coal mine” and provide compelling insight into the strengths and weaknesses of Victoria’s mental health system.

Emergency physicians see system failures manifesting daily in the increasing numbers of people who visit EDs seeking help for mental health crises because they have nowhere else to go, particularly outside of business hours.

Australasian College for Emergency Medicine (ACEM) members report (and our data confirms) the unacceptably long waits people face for access to mental health care, often in inappropriate, and at times unsafe, environments.

It is a constant challenge for ED staff to find a safe pathway for people needing mental healthcare, such as admission to an inpatient bed, or at home with appropriate community supports in place.

An integrated model of care

While there is much that emergency physicians and other ED staff can do to improve the experience for people seeking help in a mental health crisis, they cannot do it alone.

To reduce reliance on EDs and provide more suitable alternatives for care in a safe and therapeutic environment, communities across Victoria need access to mental health care outside of business hours, and ED staff need pathways for referrals into homelessness and drug and alcohol services.

An integrated model of care is needed that can provide enhanced, trauma-informed services and support, tailored to respond to the needs of the most vulnerable groups of people with mental illness. Capacity for data linkage would help service providers better understand how people engage with and experience services, and strengthen decision making by system managers.

Safe, timely, expert and therapeutic

ACEM has previously called on the Royal Commission to ensure that EDs are adequately resourced and integrated into any redesigned mental health system in Victoria.

There needs to be the capacity to manage demand, as well as a clear framework for monitoring and evaluating the impact of proposed reforms on reducing the number of people left waiting for hours in Victoria’s EDs.

Emergency physicians want to work in a system that offers people safe, timely, expert and therapeutic care, regardless of whether they are physically or mentally unwell or distressed.

The Royal Commission is only a framework

The Royal Commission helps provide a framework for this vision, but if we genuinely want to fix the ongoing neglect and lack of care experienced by some of the most vulnerable people in our communities, solutions must be implemented now.

Emergency clinicians need to see immediate action and believe the community should not be made to wait any longer for the implementation of these overdue reforms.

Rather than the current situation where there is often literally nowhere else for people to go, EDs should just be one door into a high quality, evidence based, mental health care system.

Dr Mya Cubitt is Chair of the Victoria Faculty of the Australasian College for Emergency Medicine (ACEM), an Emergency and Acute Medical Unit Physician at the Royal Melbourne Hospital, and an Honorary Lecturer at the Department of Critical Care at The University of Melbourne.

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