Improving support for mental health ED presentations

Almost one in five emergency department presentations are by mental health clients, and more needs to be done to improve services, a University of Otago, Wellington, study has found.

Published in today’s New Zealand Medical Journal, Department of Public Health researchers used 2017/18 ED data from Wellington Regional Hospital to compare ED presentations of mental health clients and non-clients to identify areas in need of improvement.

Silke Kuehl

Dr Silke Kuehl

Lead author Dr Silke Kuehl, Affiliate Researcher with the Department of Psychological Medicine, who has a 20-year background of emergency and mental health nursing, says the number of people trying to access mental health and/or addiction services has risen dramatically both here and overseas, leaving health services struggling to meet demand.

“Given the high number of presentations by mental health clients to ED, it seems that mental health services were unable or unsuitable to meet their often-complex needs,” she says.

Of the more than 49,000 presentations, 18 per cent were by clients of mental health services. Compared to other presenters, mental health clients were often younger, female, and Māori; they also required more urgent care, waited longer, and were often/predominantly admitted under the emergency department.

The researchers found many attended for mental health concerns, pain, or trauma, but current ED data does not identify self-harm behaviour.

“These people are vulnerable to unequal treatment, physical illness, adverse health outcomes and premature mortality.

“This study is important because if we know more about the characteristics of mental health clients presenting to ED and how ED manages to provide care, we can discover any service or data gaps and determine if any improvements are required,” Dr Kuehl says.

The researchers believe improving how mental health data is captured, along with enhancing systems and processes, are needed to ensure ED staff can better meet the often-complex needs of mental health patients.

“Optimal ED management requires a holistic approach and close links with mental health and community services. Along with this, improved capturing of ED mental health data and monitoring is needed to help guide service improvement initiatives.

“By assessing mental health clients’ wellbeing and addressing their unmet needs, future ED presentations would likely reduce, which is a win-win for all.”


Almost one in five emergency department presentations are by mental health clients: a secondary data analysis

Silke Kuehl, Abigail Freeland, James Stanley, Ruth Cunningham

New Zealand Medical Journal (2024 May 17; 137 (1595)

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