Community is key to reducing emergency department demand
3 min read
As more Western Australians than ever before are seeking urgent mental health care from hospital emergency departments, and wait times are soaring to more than 21 hours, one must ask the question – when an individual’s mental health reaches crisis point, hasn’t the system already failed them?
Public hospitals see “logjammed” emergency departments
The Australian Medical Association (AMA) released its annual Public Hospital Report Card: Mental Health Edition last month, which paints the picture of a system under immense pressure, with both consumers and clinical staff feeling the effects of the strain.
The overall rate of mental health presentations has almost doubled, from 67 to 130 per 10,000 West Australians, and this upward trend is expected to continue.
WA now has the equal second-highest rate of mental health presentations in the country compared to other states and territories, in stark contrast with its position 20 years ago.
The impact of waiting for mental health care
Every hour someone waits for acute care in an emergency department is another hour at risk, with lengthy wait times increasing distress, fatigue and uncertainty.
For someone experiencing a mental health crisis, waiting for more than 21 hours in this intensified atmosphere of stress can compound trauma and further exacerbate mental health challenges.
And for some, the lengthy wait times are a barrier to accessing care at all.
In August this year, a Western Australian mother who waited for 50 hours in Fiona Stanley’s emergency department to seek critical mental health care for her daughter told ABC Radio, “We just thought, we can’t do this any longer. So, we left.”
Those who are seeking care are not the only ones impacted by a system under strain. Extended wait times also put pressure on hospital staff, who are working under increasingly stressful conditions with limited resources.
As national AMA president, Dr Danielle McMullen, explained after the release of the report, “We will continue to see the figures in this report card get worse and medical and health staff leaving the profession due to burnout and stress.”
Amplifying the pressure on the system is the lack of long-term or follow-up support for those seeking acute care in hospital, which creates a ‘revolving door’ – without scaffolding and follow up support, individuals find themselves back in emergency departments.
So, how can we re-frame our thinking and create a health system where fewer West Australians are forced to present to emergency departments?
Creating more pathways of support will reduce demand
While having a critical care team is essential for some individuals and in some scenarios, it is not the only way – and some would argue it is not the best way – to provide mental health care.
Community-based support services are key in providing early intervention for individuals whose mental health is deteriorating – ultimately stopping them from reaching crisis point and needing to present to an emergency department.
Having more of these supports available in the community, where people can connect with them long before they reach crisis point, is a critical piece of the puzzle.
Not only is this the best way to reduce demand on hospital emergency departments, but it also provides more effective, holistic, long-term mental health care instead of short-term fixes.
Services that have regular contact with an individual have more opportunities to offer personalised care, and research shows that people are more likely to reach out to – and have better outcomes with – individuals they know.
Investing in community-based supports by properly funding services that already exist and investing in new ones where required, is an affordable and scalable option. Particularly when compared to costly hospital infrastructure projects that focus only on increasing the number of beds available.
Greater investment in community-based mental health services is key to people accessing mental health care when and where they need it, rather than spending endless hours in emergency department waiting rooms.