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Examining Mental Health Act usage in an urban emergency department
Kate Derrick1, Justin Chia2, Sarah O'Donovan3
1Transitional Nurse Practitioner, Mental Health Liaison, Emergency Department, Royal Prince Alfred Hospital Sydney, Camperdown, NSW, Australia kate.derrick@sswahs.nsw.gov.au.
Insights
Mental Health Act (MHA) certifications by police and ambulance in the Emergency Department (ED) poorly predicted admission, with least restrictive measures often used. Ongoing MHA training is recommended for all professionals.
Area of Science:
- Emergency Medicine
- Psychiatry
- Health Law
Background:
- The Emergency Department (ED) is a critical access point for individuals experiencing mental health crises.
- Understanding the patterns of Mental Health Act (MHA) usage within the ED is crucial for effective patient care and resource allocation.
- Previous research has highlighted variability in MHA application across different settings.
Purpose of the Study:
- To investigate the characteristics and outcomes of Mental Health Act (MHA) certifications within the ED of an urban teaching hospital.
- To analyze the sources of MHA certificates and their subsequent impact on patient disposition.
- To evaluate the role of authorized medical officers in facilitating least restrictive measures.
Main Methods:
- A retrospective audit of all MHA certificates issued in the ED over a 12-week period in 2013.
- Review of individual medical records using a standardized audit tool.
- Consensus-based resolution of any uncertainties regarding case data.
Main Results:
- A total of 172 MHA certificates were collected, with contributions from police (n=67), ambulance (n=45), medical officers (n=54), and accredited persons (n=3).
- A significant proportion of police (70%) and ambulance (60%) MHA certifications did not lead to hospital admission.
- Over one-third of MHA certificates were revoked by ED physicians, and 32.4% of voluntary presenters were subsequently detained under the MHA.
Conclusions:
- MHA certification by police and ambulance personnel demonstrated a low predictive value for hospital admission.
- The predominant outcome of MHA interventions in the ED was the application of least restrictive measures.
- Empowering ED physicians with authorized medical officer status facilitated the implementation of less restrictive care pathways.
- Continuous education and training on MHA legislation are essential for all involved healthcare professionals.
Objective:
In this study we aimed to examine the characteristics of Mental Health Act (MHA) usage in the Emergency Department (ED) of an urban teaching hospital in Sydney.
Methods:
All MHA certificates written on individuals in the ED over a 12-week period in 2013 were collected. The medical record of each individual was reviewed by a member of the research team using an audit tool developed for the study. Any uncertainty over individual cases was addressed through research team consensus.
Results:
A total of 172 MHA certificates were collected; 67 were written by police, 45 by ambulance, 54 by medical officers and three by accredited persons. Three magistrate orders for assessment were also received. Seventy percent of police and 60% of ambulance MHA certificates did not result in admission. Over a third were revoked by ED physicians. Forty-five people (32.4%) who presented voluntarily were subsequently detained.
Conclusions:
Police and ambulance MHA certification was a poor predictor of admission. Least restrictive measures were predominantly the outcome. Delegating ED physicians with authorised medical officer status assisted in facilitating this process. Formalised education and training on the principles and practicalities of MHA legislation should be ongoing for all professionals involved.
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