The Mental Health Commission (MHC) has published a report demonstrating substantial variations in the level of mental health services provided in hospital emergency departments across all health regions in Ireland.
Authored by the Inspector of Mental Health Services, Professor Jim Lucey - and based on a 100% response from every HSE hospital with an emergency department or a minor injury unit - the report, entitled ‘Acute Mental Healthcare in Hospital Emergency Departments in Ireland’ highlights the need to increase the range of acute mental health services provided nationally to improve urgent access and quality of unscheduled mental health care.
The report shows that mental health assessment in emergency departments is associated with substantial delays especially for ‘out-of-hours’ assessment; and a ‘poverty of appropriate space’ across most emergency departments. It also includes references to prolonged and inappropriate placement in emergency departments of children seeking acute support.
The Chief Executive of the Mental Health Commission, John Farrelly, welcomed the Inspector’s report, which he said not only demonstrates the commitment of frontline staff working in difficult circumstances across the country, but will assist the HSE to reform the provision of acute mental health services in Irish hospitals.
“Every year, an estimated 51,000 people access mental health services for the first time through a hospital emergency department,” said Mr Farrelly. “It is clear from the Inspector’s report that Model 4 hospital emergency departments are overburdened and need to be supplemented with services in lower-level hospitals, or in the community where people need them most. Rising acute mental health demand, staff shortages and lack of space is leading to significant delays and a revolving door system, where adults and children experiencing mental health difficulties are repeatedly returning to emergency departments.
“Emergency departments increasingly provide a place of safety,” he added. “However, this must be balanced against the prolonged inappropriate placement of unwell children and distressed adults in 24/7 emergency departments, as identified in this report. Any response must include an assurance by the HSE that emergency departments have sufficient senior clinicians and decision makers on-site to swiftly triage, treat or refer people who are unwell into appropriate services.”
In his report, Professor Lucey outlined inconsistencies in the care for children presenting to emergency departments , with the survey pointing to persistent failures across the country to ensure timely access to child and adolescent mental health services (CAMHS) through many emergency units.
“Survey respondents report numerous cases of prolonged and inappropriate placement of children in emergency departments, and in acute medical wards,” Professor Lucey said. “These persistent gaps in services are consistent with those identified in recent national reports on the challenges faced by young people accessing acute mental health services.”
Professor Lucey noted responses in his report describing inadequate environmental resources in emergency departments and inconsistent staffing levels, both of which, he says, are further contributing to inconsistent service for those seeking acute mental health care. “Mental health staff levels in emergency departments vary throughout the country,” he said. “We know that wherever mental health nursing levels are low, the numbers of persons with self-harm, suicidality, and substance-misuse build up.”
The Inspector’s report also recognises the scale of mental health services already provided in emergency departments, but notes that the difficulties within these departments will only be resolved through greater investment in community mental health services and in the hospital’s emergency departments.
“We need to enhance access to mental health services for adults and children across all emergency departments, and particularly to reduce the pressure in Model 4 hospitals, by improving mental health resources in Model 3 hospitals - and the smaller injury units – which would facilitate redistribution of mental health demand and ensure urgent care moves closer to community mental health teams where local care planning is possible,” Professor Lucey said.
“Our reliance on emergency departments needs to reduce but it is unlikely to decline without more investment upstream in primary care and in community spaces as outlined in Ireland’s national mental health strategy, Sharing the Vision. A wide range of community mental health initiatives need immediate roll-out and evaluation.”
