The Victorian Government provides specific funding for specialist mental health clinicians in emergency departments.
This is in keeping with the expectations for service delivery and clinical care in emergency departments outlined in Mental health care: Framework for emergency department services.
Improving the specialist mental health presence in emergency departments
As part of improving the specialist mental health presence in emergency departments, the Victorian Government has implemented initiatives to:
- improve care coordination for patients with mental health problems
- improve the skills of emergency department staff in responding to mental health presentations
- improve the suitability of the physical emergency department environment for the assessment and management of people who are acutely mentally unwell or who have behavioural disturbances.
- improve access for people who need short stays
- provide additional acute and subacute mental health beds to limit avoidable mental health presentations and to allow faster disposition from emergency departments
- improve responses to drug and alcohol intoxicated patients presenting with behavioural disturbance and/or intent to self-harm.
Many health services have improved their emergency care processes to reduce delays in mental health assessment, provide faster access to inpatient services and allow better discharge planning and management.
Requirements of mental health clinicians in emergency departments
The mental health clinician will be a registered nurse (Division 1 or Division 3), psychologist, social worker, occupational therapist, medical officer, psychiatrist or other professional qualified to meet the responsibilities of ‘mental health practitioners’ outlined in the Mental Health Act 2014.
Mental health clinicians will be physically located in or near the emergency department and will be available to that department at all times.
These staff are not normally available to attend crises in the community while rostered on duty in the emergency department.
The area mental health service will have in place an agreed protocol with the emergency department about the types of presentations that should be referred to mental health clinicians, and referral processes.
Mental health clinicians located in the emergency department provide the following services to people with a mental health illness:
- psychiatric assessment
- treatment, where appropriate
- care planning and linkage to other services for follow-up after discharge
- transfers to short stay or mental health inpatient units, where required.
Mental health assessment should not be delayed because the person has not been medically cleared.
Treatment will be provided in the least restrictive and most supportive and respectful manner possible.
Mental health clinicians will seek to involve patients and carers, to the greatest extent possible, in the treatment and care planning process.
All assessments of mental health patients in the emergency department will be fully documented. The clinical record will include details of relevant history, investigations, assessment outcomes, treatment, responses to treatment, disposition/arrangements for transfer of care, and plans for post-discharge care.