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Emergency departments should not be default option for people with mental health crisis, says report

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g6873 (Published 17 November 2014) Cite this as: BMJ 2014;349:g6873
  1. Jacqui Wise
  1. 1London

Hospital emergency departments should not be seen as the default option or “holding pen” for vulnerable people experiencing a mental health crisis, the College of Emergency Medicine has said, after a survey highlighted poor service provision for people detained under section 136 of the Mental Health Act.1

Recently the plight of people experiencing a mental health crisis who are detained in police cells has received much attention.2 3 The college pointed out that an emergency department was also a poor environment for such people, as the noise and bustle can be agitating, frightening, and disorienting to vulnerable people. In addition, confidentiality is usually compromised, and stretched staff are unable to provide adequate support to these patients.

The college has recommended that these patients should have access to a dedicated section 136 suite (in hospitals) at all hours that has enough capacity and staffing, so that they are not diverted to the emergency department, and the police can return to duties promptly.

The college surveyed all emergency departments in England and Wales between July and August 2014, of which 104 departments responded (52% response rate). Half the departments said that they routinely received patients detained under section 136 without any physical health problem. One in seven said there was no dedicated section 136 suite in their area.

Many of the respondents expressed concern that the section 136 suites did not have sufficient capacity and that people were brought to the emergency department when these facilities were full or closed. And half of the departments said that police did not usually or always follow local agreements. For example, they brought a patient without paperwork or chose to bring them to an emergency department rather than to a designated section 136 suite.

One respondent said that the police had become increasingly reticent about issuing a section 136 and just brought people to the emergency department under the guise of a need for medical assessment and then left them there. The report said, “Emergency departments continue to be used by all services as their ‘holding pen’ which is inappropriate and detrimental to the care of all patients not just those with Mental Health and or behavioural issues as well as contributing to overcrowding in emergency departments and often exposing staff to verbal and physical abuse risks.”

Another respondent expressed concern about the care of children who had been detained under section 136. The respondent said, “We have instances where the police ‘dump and run’ with patients who ideally should be on a 136. There are also understandable frustrations from the police as there are unacceptable delays in getting people assessed. There is currently no agreement as to where children on a 136 should go.”

Two thirds of the respondents said that they were usually satisfied or very satisfied with the response from their local mental health teams to a patient with a mental health crisis who arrived in working hours. However, out of working hours the picture was less positive, with 75% of respondents saying that they were “somewhat dissatisfied” or “very dissatisfied” with the response from their local mental health teams.

Notes

Cite this as: BMJ 2014;349:g6873

References

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