Optimising emergency department and acute care for people experiencing mental health problems: a nominal group study
Donna Marynowski-Traczyk
A W , Marianne Wallis B C , Marc Broadbent C , Paul Scuffham A , Jesse T. Young D E F G , Amy N. B. Johnston H I , Gerard FitzGerald J , Ed Heffernan K L , Stuart A. Kinner D E M N , Ping Zhang A , Gerben Keijzers O P Q , Emma Bosley R S , Melinda Martin-Khan T , Laurie Shevlin U and Julia Crilly A O V
A Menzies Health Institute Queensland, Griffith University, Qld, Australia. Email: p.scuffham@griffith.edu.au; p.zhang@griffith.edu.au
B Faculty of Health, Southern Cross University, NSW, Australia.
C School of Nursing, Midwifery, and Paramedicine, University of the Sunshine Coast, Qld, Australia. Email: mwallis@usc.edu.au; marc.broadbent@usc.edu.au
D Justice Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Vic, Australia. Email: jesse.young@unimelb.edu.au; s.kinner@unimelb.edu.au
E Centre for Adolescent Health, Murdoch Children’s Research Institute, Vic, Australia.
F School of Population and Global Health, The University of Western Australia, WA, Australia.
G National Drug Research Institute, Curtin University, WA, Australia.
H School of Nursing, Midwifery and Social Work, University of Queensland, Qld, Australia. Email: amy.johnston@uq.edu.au
I Department of Emergency Medicine, Princess Alexandra Hospital, Qld, Australia.
J School of Public Health and Social Work, Queensland University of Technology, Qld, Australia. Email: gj.fitzgerald@qut.edu.au
K Queensland Forensic Mental Health Service, Queensland Health, Qld, Australia. Email: ed.heffernan@health.qld.gov.au
L School of Public Health, University of Queensland, Qld, Australia.
M Mater Research Institute-UQ, University of Queensland, Qld, Australia.
N Griffith Criminology Institute, Griffith University, Qld, Australia.
O Department of Emergency Medicine, Gold Coast University Hospital, Qld, Australia. Email: Gerben.Keijzers@health.qld.gov.au; julia.crilly@health.qld.gov.au
P Faculty of Health Sciences and Medicine, Bond University, Qld, Australia.
Q School of Medicine, Griffith University, Qld, Australia.
R Information Support, Research and Evaluation, Queensland Ambulance Service, Qld, Australia. Email: Emma.Bosley@ambulance.qld.gov.au
S School of Clinical Sciences, Queensland University of Technology, Qld, Australia.
T Faculty of Medicine, University of Queensland, Qld, Australia. Email: m.martinkhan@uq.edu.au
U Queensland Police Service, Qld, Australia. Email: shevlin.lauriej@police.qld.gov.au
V School of Nursing and Midwifery, Griffith University, Qld, Australia.
W Corresponding author. Email: Donna.Marynowski@health.qld.gov.au
Australian Health Review 46(5) 519-528 https://doi.org/10.1071/AH21092
Submitted: 17 March 2021 Accepted: 12 August 2021 Published: 19 November 2021
Abstract
Objective The aim of this study was to identify potential model of care approaches and systems processes for people presenting to acute healthcare settings with mental health problems, including mental illnesses.
Methods Five (consensus) nominal group technique sessions were conducted in 2019 with a purposive sample of stakeholders from health, police, ambulance and consumer agencies (n = 21). Sessions were recorded, transcribed and analysed for thematic content.
Results Potential model of care approaches and systems processes for people with mental health problems in the emergency department include: a skilled collaborative approach to care; consumer-focused service; knowledge improvement; early assessment; the development of models, systems and processes; and the built environment. In the broader acute care setting, the themes of formal care, linking of services, enhancing informal and innovative care options, improving information sharing and enhancing training and education were identified.
Conclusions Coherent and multifaceted approaches to the provision of care to people with mental health problems and diagnosed mental illnesses who are requiring emergency care include the linking and sharing of systems and information, changing the built environment and exploring new models of service delivery.
What is known about the topic? There is considerable evidence of interventions used in the emergency department and acute healthcare settings for this vulnerable group of people with mental health problems and diagnosed mental illnesses; however, the evidence for appropriate model of care approaches and systems processes is limited.
What does this paper add? For people with mental health problems in emergency departments and for people with diagnosed mental illnesses in acute care settings, targeted directions to further support treatment include the linking and sharing of systems and information, changing the built environment and exploring new models of service delivery.
What are the implications for practitioners? Planning changes to services for mental health clients with acute problems needs to incorporate clinicians, health service planners, architects and a range of emergency services personnel.
References
[1] Tomlinson M, Rudan I, Saxena S, Swartz L, Tsai AC, Patel V. Setting priorities for global mental health research. Bull World Health Organ 2009; 87 438–46.| Setting priorities for global mental health research.Crossref | GoogleScholarGoogle Scholar | 19565122PubMed |
[2] Australian Institute of Health and Welfare. Mental health services in Australia. 2020. Available at: https://www.aihw.gov.au/reports/mental-health-services/mental-health-services-in-australia. [verified 3 May 2020].
[3] Trautmann S, Rehm J, Wittchen H. The economic costs of mental disorders. Do our societies react appropriately to the burden of mental disorders? EMBO Rep 2016; 17 1245–9.
| The economic costs of mental disorders. Do our societies react appropriately to the burden of mental disorders?Crossref | GoogleScholarGoogle Scholar | 27491723PubMed |
[4] Council of Australian Governments Health Council. The fifth national mental health and suicide prevention plan. 2017. Available at: https://www.coaghealthcouncil.gov.au/Portals/0/Fifth%20National%20Mental%20Health%20and%20Suicide%20Prevention%20Plan.pdf. [verified 4 April 2020].
[5] Evangelista E, Lee S, Gallagher A, Peterson V, James J, Warren N, et al Crisis averted: how consumers experienced a police and clinical early response (PACER) unit responding to a mental health crisis. Int J Ment Health Nurs 2016; 25 367–76.
| Crisis averted: how consumers experienced a police and clinical early response (PACER) unit responding to a mental health crisis.Crossref | GoogleScholarGoogle Scholar | 26931611PubMed |
[6] Boscarato K, Lee S, Kroschel J, Hollander Y, Brennan A, Warren N. Consumer experience of formal crisis-response services and preferred methods of crisis intervention. Int J Ment Health Nurs 2014; 23 287–95.
| Consumer experience of formal crisis-response services and preferred methods of crisis intervention.Crossref | GoogleScholarGoogle Scholar | 24575860PubMed |
[7] Australian Institute of Health and Welfare. Emergency department care 2017–18. 2019. Available at: https://www.aihw.gov.au/reports/hospitals/emergency-dept-care-2017-18/data. [verified 4 April 2020].
[8] Johnston ANB, Spencer M, Wallis M, Kinner SA, Broadbent M, Young JT, et al Review article: Interventions for people presenting to emergency departments with a mental health problem: a systematic scoping review. Emerg Med Australas 2019; 31 715–29.
| Review article: Interventions for people presenting to emergency departments with a mental health problem: a systematic scoping review.Crossref | GoogleScholarGoogle Scholar |
[9] Harvey N, Holmes CA. Nominal group technique: an effective method for obtaining group consensus. Int J Nurs Pract 2012; 18 188–94.
| Nominal group technique: an effective method for obtaining group consensus.Crossref | GoogleScholarGoogle Scholar | 22435983PubMed |
[10] McMillan SS, King M, Tully MP. How to use the nominal group and Delphi techniques. Int J Clin Pharm 2016; 38 655–62.
| How to use the nominal group and Delphi techniques.Crossref | GoogleScholarGoogle Scholar | 26846316PubMed |
[11] Evans N, Hannigan B, Pryjmachuk S, Gillen E, Edwards D, Longo M, et al Using the nominal group technique to involve young people in an evidence synthesis which explored ‘risk’ in inpatient mental healthcare. Res Involv Engagem 2017; 3 16
| Using the nominal group technique to involve young people in an evidence synthesis which explored ‘risk’ in inpatient mental healthcare.Crossref | GoogleScholarGoogle Scholar | 29062541PubMed |
[12] McMillan SS, Kelly F, Sav A, Kendall E, King MA, Whitty JA, et al Using the nominal group technique: how to analyse across multiple groups. Health Serv Outcomes Res Methodol 2014; 14 92–108.
| Using the nominal group technique: how to analyse across multiple groups.Crossref | GoogleScholarGoogle Scholar |
[13] McMillan SS, Kelly F, Sav A, Kendall E, King MA, Whitty JA, et al Consumers and carers versus pharmacy staff: Do their priorities for Australian pharmacy services align? Patient 2015; 8 411–22.
| Consumers and carers versus pharmacy staff: Do their priorities for Australian pharmacy services align?Crossref | GoogleScholarGoogle Scholar | 25512020PubMed |
[14] Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006; 3 77–101.
| Using thematic analysis in psychology.Crossref | GoogleScholarGoogle Scholar |
[15] Callaly T, Fletcher A. Providing integrated mental health services: a policy and management perspective. Australas Psychiatry 2005; 13 351–6.
| Providing integrated mental health services: a policy and management perspective.Crossref | GoogleScholarGoogle Scholar | 16403129PubMed |
[16] Powell Davies G, Williams AM, Larsen K, Perkins D, Roland M, Harris MF. Coordinating primary health care: an analysis of the outcomes of a systematic review. Med J Aust 2008; 188 S65–8.
| Coordinating primary health care: an analysis of the outcomes of a systematic review.Crossref | GoogleScholarGoogle Scholar | 18429740PubMed |
[17] Islam MM, Poly TN, Li YC. Recent advancement of clinical information systems: opportunities and challenges. Yearb Med Inform 2018; 27 83–90.
| Recent advancement of clinical information systems: opportunities and challenges.Crossref | GoogleScholarGoogle Scholar | 30157510PubMed |
[18] Durbin J, Goering P, Streiner DL, Pink G. Does systems integration affect continuity of mental health care? Admin Policy Mental Health 2006; 33 705–17.
| Does systems integration affect continuity of mental health care?Crossref | GoogleScholarGoogle Scholar |
[19] Colaiaco B, Roth CP, Ganz DA, Hanson M, Smith P, Wenger NS. Continuity of information between mental health and primary care providers after a mental health consultation. Psychiatr Serv 2018; 69 1081–6.
| Continuity of information between mental health and primary care providers after a mental health consultation.Crossref | GoogleScholarGoogle Scholar | 30041587PubMed |
[20] Digel Vandyk A, Young L, MacPhee C, Gillis K. Exploring the experiences of persons who frequently visit the emergency department for mental health-related reasons. Qual Health Res 2018; 28 587–99.
| Exploring the experiences of persons who frequently visit the emergency department for mental health-related reasons.Crossref | GoogleScholarGoogle Scholar | 29231128PubMed |
[21] Digel Vandyk A, Kaluzienski M, Goldie C, Stokes Y, Ross-White A, Kronick J, et al Interventions to improve emergency department use for mental health reasons: protocol for a mixed-methods systematic review. Syst Rev 2019; 8 84
| Interventions to improve emergency department use for mental health reasons: protocol for a mixed-methods systematic review.Crossref | GoogleScholarGoogle Scholar |
[22] Morphet J, Innes K, Munro I, O’Brien A, Gaskin CJ, Reed F, et al Managing people with mental health presentations in emergency departments – A service exploration of the issues surrounding responsiveness from a mental health care consumer and carer perspective. Australas Emerg Nurs J 2012; 15 148–55.
| Managing people with mental health presentations in emergency departments – A service exploration of the issues surrounding responsiveness from a mental health care consumer and carer perspective.Crossref | GoogleScholarGoogle Scholar | 22947687PubMed |
[23] Innes K, Morphet J, O’Brien A, Munro I. Caring for the mental illness patient in emergency departments – an exploration of the issues from a healthcare provider perspective. J Clin Nurs 2014; 23 2003–11.
| Caring for the mental illness patient in emergency departments – an exploration of the issues from a healthcare provider perspective.Crossref | GoogleScholarGoogle Scholar | 24313388PubMed |
[24] Wand T, Crawford C, Bell N, Murphy M, White K, Wood E. Documenting the pre-implementation phase for a multi-site translational research project to test a new model emergency department-based mental health nursing care. Int Emerg Nurs 2019; 45 10–6.
| Documenting the pre-implementation phase for a multi-site translational research project to test a new model emergency department-based mental health nursing care.Crossref | GoogleScholarGoogle Scholar | 31047855PubMed |
[25] Hoffer Gittell J, Godfrey M, Thistlethwaite J. Interprofessional collaborative practice and relational coordination: improving healthcare through relationships. J Interprof Care 2013; 27 210–3.
| Interprofessional collaborative practice and relational coordination: improving healthcare through relationships.Crossref | GoogleScholarGoogle Scholar |
[26] Bailey K, Rising Paquet S, Ray BR, Grommon E, Lowder EM, Sightes E. Barriers and facilitators to implementing an urban co-responding police-mental health team. Health Justice 2018; 6 21
| Barriers and facilitators to implementing an urban co-responding police-mental health team.Crossref | GoogleScholarGoogle Scholar | 30467739PubMed |
[27] Robertson J, Fitts MS, Petrucci J, McKay D, Hubble G, Clough AR. Cairns Mental Health Co‐Responder Project: essential elements and challenges to programme implementation. Int J Ment Health Nurs 2020; 29 450–9.
| Cairns Mental Health Co‐Responder Project: essential elements and challenges to programme implementation.Crossref | GoogleScholarGoogle Scholar | 31840401PubMed |
[28] Hungerford C, Richardson F. Operationalising Recovery-oriented services: The challenges for carers. Adv Ment Health 2013; 12 11–21.
| Operationalising Recovery-oriented services: The challenges for carers.Crossref | GoogleScholarGoogle Scholar |
[29] Wynaden D, Orb A. Impact of confidentiality on carers of people who have a mental disorder. Int J Ment Health Nurs 2005; 14 166–71.
| Impact of confidentiality on carers of people who have a mental disorder.Crossref | GoogleScholarGoogle Scholar | 16181153PubMed |
[30] Commonwealth of Australia. A national framework for recovery-oriented mental health services: Policy and theory. 2013. Available at: http://www.health.gov.au/internet/main/publishing.nsf/content/mental-pubs-n-recovfra. [verified 4 April 2020].
[31] Australasian College for Emergency Medicine. The long wait: an analysis of mental health presentations to Australian emergency departments. 2018. Available at: https://acem.org.au/getmedia/60763b10-1bf5-4fbc-a7e2-9fd58620d2cf/ACEM_report_41018. [verified 4 April 2020].
[32] Shattell MM, Harris B, Beavers J, Tomlinson SK, Prasek L, Geevarghese S, et al A recovery-oriented alternative to hospital emergency departments for persons in emotional distress: ‘the living room’. Issues Ment Health Nurs 2014; 35 4–12.
| A recovery-oriented alternative to hospital emergency departments for persons in emotional distress: ‘the living room’.Crossref | GoogleScholarGoogle Scholar | 24350746PubMed |
[33] Lester NA, Thompson LR, Herget K, Stephens JA, Campo JV, Adkins EJ, et al CALM interventions: behavioral health crisis assessment, linkage, and management improve patient care. Am J Med Qual 2018; 33 65–71.
| CALM interventions: behavioral health crisis assessment, linkage, and management improve patient care.Crossref | GoogleScholarGoogle Scholar | 28693348PubMed |
[34] Harvey C, Brophy L, Tibble H, Killaspy H, Spittal MJ, Hamilton B, et al Prevention and recovery care services in Australia: developing a state-wide typology of a subacute residential mental health service model. Front Psychiatry 2019; 10
| Prevention and recovery care services in Australia: developing a state-wide typology of a subacute residential mental health service model.Crossref | GoogleScholarGoogle Scholar | 31998158PubMed |
[35] Mental Health Coordinating Council. Mental health matters future investment priorities for NSW. 2018. Available at: http://www.mhcc.org.au/wp-content/uploads/2018/11/MH-Matters-Future-Investment-Priorities-for-NSW.pdf. [verified 5 May 2020].
[36] Collins C, O’Shea MT, Cunniffe J, Finegan P. Health system changes needed to support people consulting general practice out of hours services in Ireland. Int J Ment Health Syst 2018; 12 56–62.
| Health system changes needed to support people consulting general practice out of hours services in Ireland.Crossref | GoogleScholarGoogle Scholar | 30344620PubMed |
