In a busy emergency department faced with a kaleidoscope of presentations, it is important that staff feel confident in treating every patient.
In 2020, the Australasian College for Emergency Medicine commissioned the Nowhere Else to Go Report, which highlighted that urgent reforms were needed to better support people presenting to the emergency department (ED) for mental health-related issues. Between 2019 and 2020 there were 310,471 presentations to public Australian EDs for mental health-related concerns.
The report revealed that rural and remote areas of Australia faced a ‘unique contribution of factors that impact upon the availability and accessibility of mental health services’. It also stated there was a shortage of psychiatric leadership and trained mental health professionals, and that new workforce measures were urgently needed to attract and retain these professionals across the public mental health system.
The College was quick to respond, undertaking several initiatives – including the Mental Health in Rural Emergency Department project (MHrED) project. The project’s aim – bolster the confidence and competence of ED staff to respond to and manage mental health-related presentations.
Partnering up with CONEXUS Research, led by Associate Professor Lana Williams, and funded by the Federal Department of Health, the College set out in 2021 to create a tailored website that would house a range of guidelines, articles, tools and resources for ED staff.
‘CONEXUS Research’s role was to develop a clinician decision aid package to support ED staff to identify what referral/management options exist outside the ED for patients presenting with a mental health-related issue,’ Assoc. Prof. Williams says.
‘This tool is a way of addressing the needs of staff members and increasing their confidence in managing mental health presentations in the emergency department.
‘Emergency departments are generally 24 hours and people in crisis are those who present – having staff feeling confident with everyone who presents is obviously of the utmost importance.’
Completing the CONEXUS Research team was Dr Bianca Kavanagh and Dr Shae Quirk. Together, the researchers completed several research phases to develop the decision aid tool, which included a component that could be tailored to the specific area of rural Australia.
‘The development of the decision aid was guided, in part, by the International Patient Decision Aid Standards – IPDAS,’ Assoc. Prof. Williams says.
‘A literature scan was conducted to identify existing relevant aids and their development processes and decision options. A prototype of the aid was developed and to ensure appropriateness, a series of initial and follow-up interviews were conducted with a sample of ED staff including those in rural settings.’
Assoc. Professor Williams said her team were writing a manuscript to be published in the college’s journal, which will outline how they developed the decision aid.
‘The project ran over the year and at the end of it we were able to present to them a decision aid tool that they will upload on their website for emergency physicians to utilise in their practice,’ she says.
‘We succeeded in delivering what we set out to achieve and it is expected to be rolled out Australia wide this year.’