Each year, more than a quarter of a million Australians present to emergency departments seeking help for acute mental and behavioural conditions.

One emergency physician remembers when the “young and proud” Aboriginal man in his 20s was brought into the emergency department by his father.

“He was agitated and upset. He said he wanted to kill himself but wouldn’t engage with us any further.”

The man was seen by the psychiatry team and admitted as an involuntary patient. There were no beds available, and he was to stay in the ED until one become available.

On his second day in the ED, he managed to escape.

“It was no one’s fault, it was a fault of the system, which let him down.”

A few hours later, a distraught member of the public ran up to the ED.

They’d found the young man nearby.

“I’ll never forgot the anguish on his father’s face when he was given the news of his son’s death.”

We often talk about not having beds leading to deaths, but here it was. A stark reminder that we are dealing with people’s lives.”

The story of this young man’s death is harrowing, but not isolated.

It’s one of a dozen portraits of a mental health system failing to meet the needs of people presenting to emergency departments in mental health crises, published in a new report today by the Australasian College for Emergency Medicine (ACEM).

According to the report, more than 250,000 Australians visit the emergency department each year seeking help for acute mental and behavioural conditions.

But mental health patients are having to wait longer than other patients to be assessed and treated, and as a result, are sometimes leaving the emergency department before finishing treatment – at their own risk, and against medical advice.

ACEM president Simon Judkins said the health system was “clearly failing a group of patients that need help and find it very hard to advocate for themselves”.

“We need to be pretty open and honest about the fact that we’re not doing a good job,” Dr Judkins said.

The analysis, based on Australian Institute of Health and Welfare data from 287 public hospitals, follows a report published in February that found mental health patients were waiting for hours, sometimes days in emergency departments to be assessed and treated.

In July, figures released by the Tasmanian Government show some mental health patients waited as long as six days in the ED before being admitted or discharged, and last month, psychiatric patients say they were forced to sleep on the floor of the ED while waiting for a bed.

“That’s just a dysfunctional, broken system if that’s what we’re tolerating,” Dr Judkins said.

Today’s report, which paints a more comprehensive national picture, found patients presenting to the ED with mental health problems had to wait longer to be assessed and treated than patients with a similar severity of physical illness.

For all emergency department presentations, 90 per cent of people left the ED within seven hours. For people with mental health problems, this figure was closer to 11.5 hours – and as high as 16.5 hours in one state.

“We do have a problem generally with long waits, and patients needing inpatient care … but we found that mental health patients are disproportionally impacted by this,” Dr Judkins said.

“These delays undermine patients’ health and recovery, place considerable stress and strain on emergency department teams, and waste limited health resources.”

The report found that in most jurisdictions mental health patients were twice as likely as non-mental health patients to leave the ED prior to their treatment being completed: almost 7000 people who sought help for mental health problems at an emergency department in 2016-2017 left before finishing treatment.

People in need of medically intervention are being turned away. Photo: ABC 

“Anybody who’s worked in an ED long enough knows that if a patient has left the ED, and they’ve killed themselves a very short time later … Well, you only have to go through that once in your career to realise that there’s got to be a better solution to what we’re doing now,” Dr Judkins said.

The report also found Indigenous Australians are over-represented when it comes to mental health presentations to the emergency department: they comprise 11 per cent of presentations, but make up around 3 per cent of the Australian population.

‘I wanted help and one was giving me help’

Having to wait for hours in the ED while “agitated and anxious” – and sometimes under physical or chemical restraint – is an experience Fiona Nguyen knows well.

She’s spent a good part of the last decade in and out of emergency departments in the midst of mental health crises, following a history of trauma from sexual assault and domestic violence.

“Pretty much every crisis that I’ve had I’ve ended up in the ED – anything between six to 12 hours to a couple of days,” she said.

Fiona can remember a time she was discharged from the ED because there simply weren’t any available beds.

“They let me go home and said I should follow up with my community treatment team the next day.

Fiona Nguyen is a consumer consultant with the University of Melbourne’s Centre for Mental Health. Photo: ABC 

“I ended up trying to take my life … and then ended up back in hospital in that same emergency room three or four hours later, this time with physical injuries.”

Fiona said she felt like no-one was listening: “I wanted help, and no one was giving me help.

“It was really hard and very traumatic, and obviously could have been prevented if a better system was in place.”

Fiona now works in community mental health peer support. She said peer support workers should be available in every emergency department, in addition to better community mental health services.

“[Peer support workers] play an integral role for patients to feel less distressed, more understood, and to be able to share [their] story without judgement.”

A sector under ‘great stress’

According to Dr Judkins, emergency departments across the country need to be better equipped to deal with the increasing number of Australians presenting to the ED with acute mental health problems.

“If you’ve ever been in an ED on a Saturday night, you know it’s a very busy, noisy, and fairly chaotic place to be,” he said.

“We need better environments and resources within the ED, and when there’s a decision that a patient needs to be admitted, we need a bed for them.”

However, Dr Judkins said these were not problems emergency doctors could solve alone, and that they reflected a mental health sector under “great stress”.

We get patients turning up to the ED for mental health care who have been chronically unwell … who don’t have a provider in the community they can access.”

In many communities, emergency departments are the only option for people undergoing acute mental health problems, he said, and more needed to be done to avoid the types of crises that result in people presenting to the ED as a “last resort”.

“Emergency departments have become the go-to place for whenever the system is failing,” he said.

“We need to ensure there’s more choice.”

Alison Verhoeven, chief executive of the Australian Healthcare and Hospitals Association, agreed, and said it was “unacceptable” that people with mental health conditions had to wait longer to access treatment.

“People should be treated according to their triage category … but we also need to think about alternative types of clinics and safe places for people with mental health conditions,” Ms Verhoeven said.

Call for a national plan

In May, the Victorian Government announced it would spend $705 million on mental health care measures, including 89 new and existing acute inpatient hospital beds, as well as six mental health “crisis hubs”.

Dr Judkins said the measures were a good idea, but required other support structures around them to make sure “they don’t fall over”.

He added that more needed to be done at a national level.

“One of things that’s frustrating is that it doesn’t seem like we actually have a plan. We get these ad-hoc announcements of funding … but it seems to be more of a spot-fire approach,” he said.

“There’s always political point scoring over these things.

“We’ve got to have a common goal, and ensure that we can provide a much better level of care.”

Next week, 150 emergency doctors, psychiatrists and clinicians will meet in Melbourne to discuss possible solutions.

“It’s taken a long time to get to this crisis point, and we hope that bringing all these people together … we can actually start to develop a cohesive plan to start fixing this problem,” Dr Judkins said.

-ABC