Mental health patients report negative 'tick-box exercise' in hospital emergency departments

Mental health patients report negative 'tick-box exercise' in hospital emergency departments

According to the report, 25 of the participants reported having an overall negative experience of the ED, seven had a positive experience while 18 had a mix of positive and negative experiences. File photo.

Half of those presenting to an emergency department (ED) who had been self-harming or had suicidal ideation had a negative experience, with assessments at the hospital seen as a ‘tick-box’ exercise, and some said they would not return to an ED again if in distress.

The report, titled Accessing Help for Self-Harm and Suicidal Behaviour in the Emergency Department: The Experiences of Service Users and commissioned by 3Ts, focused on the personal experiences of 50 participants who had presented to the ED of hospitals for self-harm or suicidal behaviour within the preceding five years. 

The study was carried out by a team of mental health researchers from the Mental Health Nursing Team at the School of Nursing and Midwifery, Trinity College Dublin.

Just under half of the participants reported presenting with suicidal ideation without self-harm with the remainder presenting following self-harm incidents.

Just under half of those in the study (22) self-presented to the ED following a GP referral, while 14 self-referred and 11 came by ambulance. Two-thirds had someone accompany them.

According to the report, half of the participants (25) reported having an overall negative experience of the ED, seven had a positive experience while 18 had a mix of positive and negative experiences.

"All participants reported being seen by a triage nurse and many were seen by an ED doctor. Many were also seen by someone from the mental health team, most commonly the ‘self-harm nurse’; however there was a large degree of uncertainty among many participants about who exactly they saw from the mental health team," the report stated.

"Experiences of assessment were generally negative. It was viewed as being formulaic, a ‘tick-box’ exercise, rushed and mechanical."

Just under half of those in the study (22) self-presented to the ED following a GP referral, while 14 self-referred and 11 came by ambulance.
Just under half of those in the study (22) self-presented to the ED following a GP referral, while 14 self-referred and 11 came by ambulance.

It said many non-mental health staff did not seem comfortable carrying out assessments, with "an overarching focus on the physical injuries" of those who had self-harmed, while for those who had not self-harmed, "many perceived that there was little to be done for them and that the ED was not the right environment for their presentation".

"Many participants who were attending a mental health service were referred back to that service; however, in some cases there was no follow-up from the mental health team or the follow-up was a few weeks away", it said, adding "they perceived being labelled as a ‘mental health presentation’ and being set aside from other patients."

The negative experiences participants encountered had a deep impact on them.

The report added that "some participants described how the negative attitudes they experienced actually served to heighten their distress" and "these experiences left some participants wanting to leave the ED while others commented that they would not return to the ED if in distress again".

A range of measures was recommended, including better training and education of staff, the need for an ‘emergency mental health department’, and the greater availability of mental health staff to assess patients in the ED, as well as improved supports afterwards.

Dr Louise Doyle, Associate Professor of Mental Health Nursing at the School of Nursing and Midwifery, Trinity College Dublin and a co-author of the report, said the experiences of the participants may improve if the National Care Programme (NCP) for the management of self-harm in the ED was operating in all hospitals. 

At the moment, even in hospitals where it is in place, hours of delivery vary.

*samaritans.org - 116 123 

*3ts.ie

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