Emergency department clinicians, managers and commissioners are being urged to commit to a five-point plan to improve mental health care for patients and place it on an even footing with physical health care.
The CLEAR campaign, launched by the Royal College of Emergency Medicine, calls for co-location of liaison mental health services, liaison services that are available around the clock, and education for all emergency department staff about mental health crisis.
“Parity of care for patients with mental health problems presenting to A&E is the goal of this campaign”
It also wants to ensure adequate access for young people to crisis services as well as a “right person to the right place of safety” approach, recognising that emergency departments should not always be the default option for patients in crisis.
Endorsed by the Royal College of Psychiatrists, the plan is aimed at all emergency departments in England and Wales. Sir Simon Wessely, president of the Royal College of Psychiatrists, described liaison psychiatry as “core business” for medicine.
He noted that 30% to 60% of mental disorders were diagnosed in hospital when patients present with another problem.
“[Liaison psychiatry services] comprise multidisciplinary teams, skilled to integrate mental and physical healthcare in people whose mental health problems arise as a result of, or impact on the management of, physical illness,” he said.
“The aims of the CLEAR campaign, if realised, would transform liaison psychiatry for the better for all who need it and deliver it – in acute care, child and adolescent services and in critical situations, providing expertise around the clock,” he added.
Dr Clifford Mann, president of the Royal College of Emergency Medicine, said: “Parity of care for patients with mental health problems presenting to A&E is the goal of this campaign.
Dr Clifford Mann
“[It] seeks to build on the momentum achieved by others to ensure that for those with acute problems, prompt expert help is provided,” he said.
“Working with our colleagues in mental health services and mental health charities a CLEAR response to patients in crisis must become a reality not an aspiration,” he added.
The campaign launch comes after official figures showed the number of psychiatric nurses in England has fallen by 10% in the past five years, from 41,320 in 2010 to 36,870 in 2015.
Mental health academic Alan Simpson, professor of collaborative mental health nursing at City University London, warned mental health provision had returned to the crisis point it was 30 years ago.
The CLEAR campaign steps set out in detail
C – Co-location of Liaison Mental Health Services
Combining services reduces the fragmentation of care that makes care confusing and difficult for both patients and staff. Shared targets encourage collaborative working
L – Liaison Services 24/7
Liaison psychiatry services are extremely effective at supporting patients, reducing admissions and risk. We have shown that patients present throughout the 24 hour period and services need to be tailored to this demand
E – Education of all ED Staff
Patient experience surveys consistently describe a poor patient experience in emergency departments. All clinical staff need to be trained how to respond compassionately and knowledgably to patients suffering a mental health crisis
A – Adequate Access for Adolescents
Assessment and admission, where required, should not be delayed for children and adolescents. These are a group who are often poorly served by crisis services. Children and adolescents should be responded to with the same urgency as children with a physical health problem. There should be sufficient capacity locally for the occasional adolescent who needs admission
R – Right Person to the Right Place of Safety
A police cell is a poor place for a person suffering a mental health crisis, however a busy and uncontrolled emergency department is also a poor place for some patients. An emergency department should not be the default position for all mental health crises. RCEM believes that the phrase ‘Health Based Place of Safety’ is an unhelpful term as it does not indicate whether patients are receiving the right care