Essay On Mental Health Consumers Presenting To Emergency Departments

 

Across Australia and around the world, the delivery of mental health care has changed from being solely the responsibility of psychiatric institutions to being predominately community-based. The increased prevalence of "psychiatric boarding"—people awaiting in the halls or ED chambers, seeking psychiatric inpatient admission—shows how mental health appearances cause anxiety for EDs by upsetting the treatment standards as well as ED workflow (Nordstrome et al., 2019). The higher prevalence of restrictive behaviours by the persons who attend additionally exacerbates the experience for a patient who comes to the ED for a psychiatric condition. The use of coercive techniques to provide restrictive treatments, which restrict freedom, includes compelled hospitalisation, mechanical and physical restriction, including forced medicine (Knott et al., 2020).

 

Therefore, it can be stated that the presentation of mental health patients in ED might impact both patients and healthcare workers. Hence, the research question will be what would be the EDs' conscious experience of responding to psychological health crises have been like as well as what variables affect how well help is provided throughout the mental crisis?

 

Wiley library, PubMed, as well as CINAHL are utilised to choose the pertinent papers. Nevertheless, just recent papers were selected in order to keep the literature review up to date. A publication published between 2016 and 2022, published in English, and relevant to mental health treatment in an ED care environment is the inclusion standard for this research article. Publications focusing on some other care aspects as well as those published during 2015 or earlier are excluded from this research. For this search following keywords were used: MENTAL HEALTH PATIENT, EMERGENCY DEPARTMENTS (ED), NURSING VIEW ON MENTAL HEALTH CARE, and HEALTHCARE WORKERS VIEW. Also, to search for appropriate articles Boolean words like OR and AND were used.

 

 

According to the qualitative literature review, Roennfeldt et al., (2021) mention the number of mental health visits to an ED has skyrocketed, because emergency rooms are now where patients go when they are experiencing a serious mental health problem. A growing body of research indicates that most of the ED are neither suitable nor efficient for treating patients who are experiencing mental health emergencies. The individual view of those looking for help throughout a psychotic episode has not received enough consideration. The results include everything from the efficacy of therapy to the satisfaction of using EDs. The study found traits linked to poor encounters as well as opportunities to enhance people's satisfaction. The results demonstrate the prevalence and effects of poor ED encounters as well as the discrepancy between what patients who visit the ED predict and what they actually experience during care. Roennfeldt et al., (2021) further stated patients in the majority of studies mentioned feeling judged by ED personnel. These included obscene comments as well as laughter. In investigations of people who regularly came to ED, staff encounters were primarily unpleasant and dissatisfied. As a result, the finding from this study indicates a lack of competency among ED professional to manage the mentally ill patient.

 

 

According to a qualitative study on remote Australian hospitals, Pawaskar et al., (2022) conducted a semi-structured interview with the ED workers. The author mentions proper patient care was seen by professionals as being severely hampered by a lack of de-escalation, referrals, as well as psychiatric knowledge. Because of uncertainty surrounding their eventual treatment, these variables contribute to raising the number of mentally ill individuals who remained within the ED. Staff members reported a need for additional face-to-face education whilst admitting the importance of real-world experience in handling mental health presenters as the greatest approach to boost clinician assurance. This would better prepare employees to handle psychiatric presentations. The respondents stated that several doctors inside the ED adopted a defensive therapeutic practice as a result of the unique difficulties linked with mental health-related admissions. Respondents stated a belief that doctors extended the ED treatment to avoid being held accountable for the actions of a psychiatric patient because of the perceived danger, that such people might pose to themselves along to society if released.

 

The research done by Roennfeldt et al., (2021) is reliable because it is a synthesis of existing literature. Hence, it provides a better understanding of the actual problem. Therefore, this paper has filtered information, and the finding of this paper can be generalizable. Also, according to the evidence pyramid, a systematic review always has a greater quality of evidence (Linares-Espinos et al., 2018). Therefore, this paper also has a very high level of evidence. However, the analyses in this publication had some limitations; they mostly described the views of individuals who had made repeated visits to an ED. As a result, they might not accurately represent participants who made sporadic visits or were making their first appearance.

 

 

Also, the evidence presented in Pawaskar et al., (2022) is adequate to understand the problem. This is a primarily qualitative study, based in rural Australia. Hence, the findings from this paper can be easily applied to the Australian context. According to the evidence pyramid, it can be considered level-3 evidence (Decker & Hamilton, 2018). Hence, it might have some unfiltered information. However, such studies can be helpful to analyse real-world instances and make a more systematic review based on this information. However, this study also has some limitations. Just a few young physicians and no senior physicians participated in the study which might restrict the relevance of the outcomes to the entire populace of ED professionals. The sample was primarily made up of nurses.

 

 
1. The nurse and other ED staff must respect, listen to their problem, can perform necessary duties to improve the care experiences (Thomas et al., 2018).

 

 

2. The provided care needs to be sensitive, according to the condition of the patient (Beks et al., 2018).

 

 

3. Training must be provided to all ED staff to improve their knowledge and understanding of how to manage a mentally ill patient in ED (Roennfeldt et al., 2021). 

 

 

This literature review demonstrates the poor care experience of the mentally ill patient in the ED setting. All of this is caused by insufficient knowledge of staff and perceived bias. Hence, training needs to be provided to improve staff knowledge.

 

Beks, H., Healey, C., & Schlicht, K. G. (2018). 'When you're it': A qualitative study exploring the rural nurse experience of managing acute mental health presentations. Rural and remote health, 18(3), 180-190. https://search.informit.org/doi/abs/10.3316/informit.141200674821092

 

 

Decker, V. B., & Hamilton, R. M. (2018). The nursing knowledge pyramid: A theory of the structure of nursing knowledge. Advances in Nursing Science, 41(3), 293-302. DOI: 10.1097/ANS.0000000000000204

 

 

Knott, J., Gerdtz, M., Dobson, S., Daniel, C., Graudins, A., Mitra, B., ... & Chapman, P. (2020). Restrictive interventions in Victorian emergency departments: A study of current clinical practice. Emergency Medicine Australasia, 32(3), 393-400. https://doi.org/10.1111/1742-6723.13412

 

 

Linares-Espinós, E., Hernández, V., Domínguez-Escrig, J. L., Fernández-Pello, S., Hevia, V., Mayor, J., ... & Ribal, M. J. (2018). Methodology of a systematic review. Actas Urológicas Españolas (English Edition), 42(8), 499-506. https://doi.org/10.1016/j.acuroe.2018.07.002

 

 

Nordstrom, K., Berlin, J. S., Nash, S. S., Shah, S. B., Schmelzer, N. A., & Worley, L. (2019). Boarding of Mentally Ill Patients in Emergency Departments: American Psychiatric Association Resource Document. The western journal of emergency medicine, 20(5), 690–695. https://doi.org/10.5811/westjem.2019.6.42422

 

 

Pawaskar, R., Mahajan, N., Wangoo, E., Khan, W., Bailey, J., & Vines, R. (2022). Staff perceptions of the management of mental health presentations to the emergency department of a rural Australian hospital: a qualitative study. BMC Health Services Research, 22(1), 1-10. https://doi.org/10.1186/s12913-022-07476-7

 

 

Roennfeldt, H., Wyder, M., Byrne, L., Hill, N., Randall, R., & Hamilton, B. (2021). Subjective Experiences of Mental Health Crisis Care in Emergency Departments: A Narrative Review of the Qualitative Literature. International journal of environmental research and public health, 18(18), 9650. https://doi.org/10.3390/ijerph18189650

 

 

Thomas, K. C., Owino, H., Ansari, S., Adams, L., Cyr, J. M., Gaynes, B. N., & Glickman, S. W. (2018). Patient-Centred Values and Experiences with Emergency Department and Mental Health Crisis Care. Administration and policy in mental health, 45(4), 611–622. https://doi.org/10.1007/s10488-018-0849-y