Better data could lead to ‘win-win’

Better emergency department data would help create a "win-win" situation for mental health clients and the health system, a University of Otago Wellington study has found.

The researchers believed improving how mental health data was captured was among the changes needed to ensure ED staff could better meet the often complex needs of mental health patients.

Published last week in the New Zealand Medical Journal, the study found almost one in five ED presentations were by mental health clients.

It used ED data from Wellington Regional Hospital in 2017 and 2018.

Lead author Dr Silke Kuehl said Dunedin Hospital was likely to be facing similar challenges with the struggle to recruit and retain mental health staff.

However she was unsure if a study of Dunedin’s ED would yield similar results, due to unknown factors such as the speed of mental health transfers and support available elsewhere.

Health New Zealand Te Whatu Ora (HNZ) Southern Group Director of Operations Hamish Brown said 895 people sought help from the ED between Monday and Sunday last week.

However HNZ could not provide an estimate of how many of these were mental health clients.

"A patient is triaged on their presentation which may or may not include a mental health concern.

"This may be recorded at the time of triage or later on during their assessment and care.

"Therefore, we are unable to easily provide data on the number of Mental Health presentations and referrals."

An ED triage nurse would refer people with mental health concerns to the Emergency Psychiatric Service who would provide a mental health triage, he said.

Dr Kuehl said the number of people trying to access mental health and addiction services had risen dramatically both here and overseas, leaving health services struggling to meet demand.

Compared to others who went to the ED, mental health clients were often younger, female, and Māori; they also required more urgent care, waited longer, and were often admitted under the emergency department.

The researchers found many attended for mental health concerns, pain or trauma, but data did 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 believed improving how mental health data was captured, along with improvement to systems and processes, was needed to ensure ED staff could 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 was 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."