Abstract
Non-urgent visits to emergency departments (ED) for mental health issues are a worldwide phenomenon. But are they really non-urgent?
Non-urgent ED visits by patients with mental health issues are usually a result of unmet need in the community. Identifying the predictors of non-urgent visits to ED for mental health patients should therefore be contextualised in conjunction with local services, their availability and accessibility. Mental health liaison services are often provided as a model of care in ED to ‘mop up’ issues requiring attention, which are unresolved. Nevertheless, access to primary care mental health interventions, where available, is known to reduce non-urgent ED visits. These usually comprise psychosocial interventions, person-centred care plans and guiding patients to service provision and case management, all strategies targeted at out-of-hospital care, for mental health patients. In this study it is not clear whether the data analysed were from a cohort of patients who already had contact with such services, or if for them the ED was simply the default option.
Triage is a one-off activity to signpost patients according to their needs on arrival to ED. I believe such mental health patients are at risk of sudden fluctuations, which potentially drastically alters their triage score from non-urgent (CTAS 5) to emergent (CTAS 2). Equally, it is impossible to ascertain whether patients non-urgently categorised were assigned appropriately at the point of triage. Such patients may appear innocuous and thereby categorised as non-urgent, yet could be contemplating serious self-harm. In my experience, patients with mental health issues who present to the ED feel their problems are, at the very least, overwhelmingly urgent. They are a high-risk group. It is the quiet patients that must be watched and I have witnessed successfully contemplated suicide within an ED, from patients categorised as non-urgent.
Triage and mental health assessment tools for patients presenting to EDs help to categorise the circumstances behind the scores. Some assessment instruments focus on children and others on adults. These may have been a better indicator of the urgency or non-urgency of ED attendance where retrospective data analysis cannot illuminate this topic. Further work is acknowledged. Any data that can illuminate patient groups most at risk of ED visits with mental health issues will have opened a Pandora’s box and are only at the outset of a journey to understand the changes required to adequately support the needs of mental health patients.