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051105 MH Presentations Mental health presentations to the emergency department Intensive care for adults in Victorian public hospitals 2003 i Mental health presentations to the emergency department ii Intensive care for adults in Victorian public hospitals 2003 Published by Victorian Government Department of Human Services, Melbourne, Victoria, Australia. © Copyright State of Victoria, Department of Human Services, 2005. This publication is copyright. No part may be reproduced by any process except in accordance with the provisions of the Copyright Act 1968. Also published on www.health.vic.gov.au Authorised by the Victorian Government, 555 Collins Street, Melbourne. May 2006 (051105) Department of Human Services Victorian State Government Emergency Medicine Research Unit Royal Melbourne Hospital Study sites: Royal Melbourne Hospital Alfred Hospital Dandenong Hospital Geelong Hospital Maroondah Hospital Jonathan Knott MBBS, FACEM, GDEB Research Fellow Emergency Medicine Research Unit Royal Melbourne Hospital Alex Pleban BSW Project Offi cer Emergency Medicine Research Unit Royal Melbourne Hospital David Taylor MD, MPH, DRCOG, FACEM Director of Emergency Medicine Research Unit Royal Melbourne Hospital David Castle MBChB, MSc, MD, MRCPsych FRANZP Professorial Fellow Mental Health Research Institute University of Melbourne Intensive care for adults in Victorian public hospitals 2002-03 iii Foreword The Department of Human Services commissioned the Emergency Medicine Unit at the Royal Melbourne Hospital to conduct this research to gain an increased understanding of the nature of mental health presentations to emergency departments and why emergency departments are being used as a point of care for people experiencing mental health problems. The research builds on the work of the Hospital Admission Risk Program’s (HARP) Mental Health Working Party. The research reference group contributed to the research design and analysis and endorses the report. A major fi nding of the research is that many people presenting to emergency departments are already receiving care from public mental health services or have done so in the recent past. The research found more than one in ten presentations were related to the fact that no acute mental health bed was immediately available at a time when the person was assessed as being in need of an admission to hospital. The research reference group has considered the research. The fi ndings indicate the mental health service system is struggling at a time of unprecedented demand for mental health care and look at how this demand is being experienced at the emergency department. While emergency departments are one of the potential entry points into public mental health care, their role should be to assist people with the most urgent mental health diffi culties. It is important that consumers whose treatment needs can be more appropriately addressed by other elements of the service system are supported to access these alternatives. The fi ndings of the research have been presented at a forum where people working in mental health services, emergency departments, police and ambulance services, as well as consumers and department staff, had the opportunity to discuss the research and look at ways of improving care for consumers. The forum discussion is summarised at the end of the report. The reference group sees a need for additional resources for mental health, including beds and community- based care and better information for consumers and families to obtain help when needed. The examination of models of care within both mental health services and the emergency departments is also important work to be undertaken. The principle of a consumer-focused continuum of care should inform planning resulting from this report; however, the operationalisation of this principle will require that all parts of the service system contribute to meeting the needs of consumers and their families in a comprehensive manner and with the collaboration of all involved. Professor Bruce Singh Chair, Research Reference Group iv Intensive care for adults in Victorian public hospitals 2002-03 Mental health presentations to the emergency department v Contents Executive summary 1 Study 1: Mental health presentations to Victorian emergency departments 1 Study 2: Determinants of emergency department utilisation for mental health issues 1 Key fi ndings 1 Summary of forum 3 Background 4 The role of emergency departments 4 Introduction 5 Sites involved in the study 6 Methodology 9 Study 1: Mental health presentations to Victorian emergency departments 9 Study 2: Determinants of emergency department utilisation for mental health problems 10 Results: study one 11 Demographics 12 Ambulance referrals 14 Other referral sources 16 Emergency presentation 18 Ancillary services 32 Diagnosis 33 Relevant past history 35 Arrival with police 36 Referred to EDs only because no acute mental health bed available 39 Results: study two 41 Forum 43 Priority areas 45 Improving care for people who present to EDs with a mental health problem 45 Policy implications 46 Practice implications 47 Further research 47 Appendix A: ICD-10 codes included in project 49 Appendix B: Data collection documentation 51 Appendix C: Country of birth of mental health presentations to the ED 56 Appendix D: The Victorian Mental Health Act 1986 57 Defi nitions 58 References 58 vi Review of the 2003–04 Victorian surveys of consumer and carer experience of public mental health services Figures Figure 1: Total mental health admissions to inpatient units 7 Figure 2: Legal status under Mental Health Act on admission to mental health unit 8 Figure 3: Day of presentation to the ED by mental health patients 18 Figure 4: Time of arrival in the ED by mental health patients 18 Figure 5: Day of presentation to the ED for mental health patients 19 compared with non-mental health patients (per cent) Figure 6: Time of arrival in the ED compared with non-mental health patients (per cent) 19 Figure 7: Time of arrival in the ED by mental health patients, by site 20 Figure 8: Services sought prior to the ED (per cent), by site 21 Figure 9: Triage category (per cent), by site 22 Figure 10: Time to see clinician, by site 23 Figure 11: Time of arrival for mental health patients with a delay > six hours to mental health review 25 Figure 12: Day of arrival for mental health patients with a delay 31 > six hours to mental health review Figure 13: Proportion of all mental health patients’ admissions via the ED (per cent) 31 Figure 14: Proportion of mental health patients receiving ancillary services 32 by number of ED presentations in last 12 months Figure 15: Day of presentation for mental health patients referred to the ED 39 because no acute mental health bed available Figure 16: Time of presentation for mental health patients referred to the ED 39 because no acute mental health bed available Figure 17: Flow diagram for enrolment of interviewees 41 Mental health presentations to the emergency department vii Tables Table 1: Catchment area population and funded acute bed numbers 7 Table 2: Mental health presentations to the ED 12 Table 3: Age of mental health patients 12 Table 4: Residential situation 13 Table 5: Employment status 13 Table 6: Country of birth 13 Table 7: Proportion of mental health patients arriving by ambulance, by site 14 Table 8: Referral source to ambulance 14 Table 9: Location of ambulance call-out 15 Table 10: Reason for ambulance involvement 15 Table 11: Proportion of mental health patients arriving with police 16 Table 12: Disposition of mental health patients arriving with Crisis Assessment and Treatment Team 16 Table 13: Disposition of mental health patients referred by LMO 17 Table 14: Services sought prior to ED presentation 20 Table 15: Triage category 21 Table 16: Time to see clinician, by site 22 Table 17: Intoxicants on arrival in the ED 23 Table 18: Proportion of mental health patients referred to mental health services 24 Table 19: Delay from referral to review by mental health services 24 Table 20: Total ED length of stay 26 Table 21: Proportion of mental health patients admitted and legal status at discharge, 27 by total ED length of stay Table 22: Investigations for mental health patients in the ED 27 Table 23: Drugs used for chemical restraint 28 Table 24: Legal status on arrival of mental health patients presenting to the ED 29 Table 25: Legal status on departure of mental health patients presenting to the ED 29 Table 26: Disposition of mental health patients from the ED, by site 30 Table 27: Summary of disposition of mental health patients from the ED, by site 31 Table 28: Ancillary services for mental health patients in the ED 32 Table 29: Top 12 ICD-10 codes 33 Table 30: Mental health issues at ED presentation 34 Table 31: Time of last mental health admission 35 Table 32: ED presentations in the previous 12 months 35 Table 33: Proportion of mental health patients arriving with police, by site 36 Table 34: Triage category for mental health patients arriving with police 36 Table 35: Time to see clinician for mental health patients arriving with police 36 Table 36: ED length of stay for mental health patients arriving with police 37 Table 37: Disposition of mental health patients arriving with police 37 Table 38: Legal status of mental health patients arriving with police 38 Table 39: Intoxication of mental health patients arriving with police 38 Table 40: Proportion of mental health patients referred to the ED 40 because no acute mental health bed available, by site 40 Table 41: Total ED
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