Accident and emergency departments must no longer be used as a “designated place of safety” for people experiencing a mental health crisis, because such environments cause distress and their staff do not have the specialist skills required, nurses have warned.
At the Royal College of Nursing’s annual congress in Liverpool today, nurses said patients in some cases had to wait up to 12 hours in “busy” and “chaotic” emergency departments until specialist crisis teams arrived to help them.
“A&E can treat the immediate physical harm if there is any but we cannot help them with their mental wellbeing”
They said patients should instead be referred to other places deemed “safe” under mental health legislation, which would ensure they received the care they needed.
However, during a debate at the conference, some nurses warned that if this happened measures would need to be taken to ensure mental health patients did not feel stigmatised and unable to attend emergency departments.
Others noted that community nursing teams often had no other option that to refer patients experiencing mental health episodes to A&E, because they believed it was better than referring them to a police station, also often used as a place of safety under the Mental Health Act.
One emergency department nurse said “a corner of A&E with two curtains where two police officers wait with somebody” was “not the quiet and peaceful” space that was needed for patients in crisis.
“These patients that the police have brought in to this so-called safe space then end up in busy departments often up to 12 hours at a time”
“A&E can treat the immediate physical harm if there is any, but we cannot help them with their mental wellbeing and provide them with holistic intervention. We are not the best place to sit and wait for the crisis team. We are not the best place to sit and wait for a mental health bed,” said Stuart Young.
Another A&E nurse said using emergency departments as a place of safety was doing vulnerable patients a disservice.
“Emergency departments are busy and at times chaotic places. It’s stressful for us, so imagine how stressful it is for our patients,” said Nikki Williams, from the RCN’s Outer North West London branch.
“These patients that the police have brought in to this so-called safe space then end up in busy departments, often up to 12 hours at a time,” she told the conference.
She said it was also stressful for staff, because many nurse had “little to no training” in mental health.
“EDs are busy, noisy and very frightening places…if you’ve got a mental health issue they can be quite scary places”
Emergency nurse Neil Evans from Glamorgan echoed her comments, saying: “EDs are busy, noisy and very frightening places…if you’ve got a mental health issue they can be quite scary places.”
“Unless you’re a mental health nurses, staff don’t have the skills to deal with complex mental health issues. That’s why you need a place of safety with appropriate mental health treatment,” he added.
Following the debate, college members passed a motion submitted by the RCN’s Emergency Care Association and its Mental Health Forum agreeing to lobby to “ensure that emergency departments are no longer designated places of safety for the purposed of mental health legislation”.
Later on Tuesday, a mental health campaigner urged the government to back a separate call from the RCN for “parity of esteem” for mental health with physical conditions at the union’s annual conference.
Addressing the RCN congress, Jonny Benjamin MBE, who now campaigns to raise awareness of and improve services for mental health, said he could not believe that in 2017 there is still no parity of esteem.
Resolution – RCN Emergency Care Association and RCN Mental Health Forum
That this meeting of Congress asks RCN Council to lobby to ensure that Emergency Departments are no longer designated places of safety for the purposes of Mental Health legislation.