Mental health crisis intervention for asylum seekers in the emergency department

AimsWith the advent of the COVID-19 Pandemic the NHS long term Plan commitments of January 2019 to improve crisis care nationwide became all the more pressing. The aim of this study was to thematically investigate what mental health crisis presentations might be diverted from the Emergency department to external crisis hubs in order to reduce the COVID-19 contamination risks.MethodAll referrals made to the Homerton University Hospital (HUH) mental health liaison service were looked at between 1/3/20-11/6/20 (n = 846), coinciding with the first peak of the COVID-19 Pandemic.Referral data was anonymised and sorted independently into naturally emerging thematic classes by two junior liaison doctors.Cases that did not clearly fit any of the 14 themes generated were further looked into to determine outcome of referral and discussed to try and match to an appropriate class.Result14 frequent themes for mental health crisis referrals were identified. The distribution of these ranged from most common (suicidality) to neurocognitive presentation and identified shifts in themes over the course of the pandemic peak such as increases of low mood, anxiety and intoxication requiring medical attention over the three month period.ConclusionAlthough themes for presentations may be identified in acute referrals to mental health liaison services it is problematic determining how these may be parsed safely to crisis hubs without risking overlooking cases that may require medical attention. The most common theme that was identified and remained throughout the first wave of the COVID-19 Pandemic was acute suicidal presentation. The remaining themes would require careful consideration around risk thresholds for what a service may wish to accept in devolving the emergency department liaison and balance these against future risks of repeat COVID-19 waves.

Download Full-text

Postpartum Puzzler

The Cognitive Autopsy ◽

10.1093/med/9780190088743.003.0014 ◽

2020 ◽

pp. 95-98

Author(s):

Pat Croskerry

Keyword(s):

Mental Health ◽

Emergency Department ◽

Postpartum Depression ◽

Vaginal Delivery ◽

Neurological Disorder ◽

Community Hospital ◽

Physical Exam ◽

Normal Vaginal Delivery ◽

Mental Health Crisis ◽

Health Crisis

In this case, a 24-year-old female presents to the emergency department (ED) of a community hospital late in the evening. At triage, she is weeping, distressed, very anxious, and complaining of paresthesias in her extremities. She had a normal vaginal delivery approximately 4 weeks ago and has been healthy since. The ED physician is asked to do a quick assessment as the ED is about to close. A consensus quickly develops among the staff that the patient probably has postpartum depression and could be managed through the mental health crisis team in daytime hours the following day. Her physical exam is normal other than some weakness in both legs. The physician feels uncomfortable with the patient’s presentation and considers the possibility of an uncommon neurological disorder. The neurology service reluctantly accepts the patient though doubting the physician’s diagnosis. He later learns that his zebra was correct.

Download Full-text

The Formation and Application of an Overseas Mental Health Crisis Intervention Team, Part II: Application

Military Medicine ◽

10.1093/milmed/156.9.445 ◽

1991 ◽

Vol 156 (9) ◽

pp. 445-447

Author(s):

Stephen A. Young ◽

Mark S. Holden

Keyword(s):

Mental Health ◽

Crisis Intervention ◽

Mental Health Crisis ◽

Crisis Intervention Team ◽

Health Crisis ◽

Intervention Team

Download Full-text

Mental health patients in emergency departments are suffering: the national failure and shame of the current system. A report on the Australasian College for Emergency Medicine’s Mental Health in the Emergency Department Summit

Australasian Psychiatry ◽

10.1177/1039856219852282 ◽

2019 ◽

Vol 27 (6) ◽

pp. 615-617 ◽

Cited By ~ 1

Author(s):

Simon Judkins ◽

Daniel Fatovich ◽

Nicola Ballenden ◽

Helena Maher

Keyword(s):

Mental Health ◽

Emergency Department ◽

Emergency Departments ◽

Current System ◽

Mental Health Crisis ◽

Health Crisis ◽

Care And Support ◽

Mental Health Support ◽

User Groups ◽

National Mental Health

Objectives: Inadequate capacity in Australia’s mental health system means that many people turn to emergency departments (ED) in crisis for care and support, often because it is the only service available. Australian Governments have set a 4-h target for all ED care, but the data shows that people presenting to an ED in a mental health crisis are the group most likely to wait more than 24 h for care. These long waits, seemingly with no end in sight, are harmful for patients and deeply frustrating for clinicians. Conclusions: In response, in 2018, the Australasian College for Emergency Medicine (ACEM) organised the national Mental Health in the Emergency Department Summit. Delegates from across clinical disciplines and user groups were unified in their deep concern at the unacceptable state of mental health support available to people seeking help through EDs. The Summit identified four priorities for urgent action and urged government to take immediate steps to improve this situation.

Download Full-text