Assessment of Mental Health Patients in ED – Is it time for standardisation?

Mr Ron Wilson1
1South Western Sydney Local Health District , Campbelltown, Australia

Mental Health (MH) presentations to ED’s can  be challenging and difficult. The presentations can be compounded with organic  causes and co-morbidities. The diverse population of MH clients may be from s disadvantaged groups with histories of abuse, neglect and substance mis-use. These patients may not routinely access regular medical services and may suffer with an undiagnosed condition. Our ED management of this group of patients introduced a systematic and streamlined approach to screen for underlying clinical issues. The ED developed an accepted health screening criteria for the “Medical Clearance” of mental health presentations. The screen may occur prior to, or after a mental health assessment. The process assists staff to identify the possibility of underlying clinical aetiologies to the presentation. Our physical assessment of mental health patients  has demonstrated a successful approach to the screening of the mental health patient attending a busy metropolitan ED of Sydney Australia.
Aim:  Develop a reliable, safe & systematic process for assessment of the Mental Health patient that may be attended prior to referral to mental health services. An agreed level of assessment that is acceptable for mental health patients, mental health staff and suitable as a screening tool prior to an admission to a mental health unit. Nature of the Problem: There was an inconsistency in the assessment and clinical management of mental health presentations.  Assumed “mental health” presentations were streamlined directly into mental services with a variance of assessment that would screen potentially (clinically) unwell patients. Actual physical illness could go undetected. The initial management may be a missed opportunity for the safety of the patient.

Planning Solutions: The implementation of the Mental Health Assessment in ED process was established, supported by consultation, education, policy, and evaluation. The systematic and streamlined approach to MH patients provides protections for best clinical practices incorporating

  1. Physiology
  2. Abnormal mental states
  3. First or subsequent presentations
  4. Poisoning / harm
  5. Gait

Outcome study revealed a successful approach was established where underlying clinical illness could be identified allowing early management. The application of the process can be applied to any Emergency Department or similar service.

Ron Wilson. Currently employed as the Clinical Nurse Consultant of the Emergency Departments at  Campbelltown and Camden Hospitals.  Has had 30 years experience in Emergency Nursing both Australia and International settings. He has work in tertiary centres, metropolitan EDs, rural and remote settings. He is also an endorsed nurse practitioner, and affiliated teaching fellow of the University of Western Sydney.