Psychiatric services to accident and emergency departments

This report supersedes the previous joint report (CR43) from the Royal College of Psychiatrists and the British Association for Accident and Emergency Medicine. Since the publication of the original report, new demands have been placed on both mental health services and accident and emergency (A&E) departments. The requirement that 90% of patients, rising to 100% by the end of this year, must have been discharged from A&E departments within 4 hours of arrival (Department of Health, 2001) will have a major impact on the interaction between mental health services and A&E departments.

The main report examines the common mental health scenarios that occur in the A&E department, issues affecting patients from ethnic minorities, specific problems in the A&E department, personnel issues and the organisation of services.

The principal recommendations in this report are as follows:

Summary of recommendations

• There is a joint responsibility for commissioners, mental health service managers, and acute service managers to ensure that the input of mental health services to A&E departments is not overlooked in negotiations.

• A consultant psychiatrist should be named as the senior member of staff in the local mental health services responsible for liaison with the A&E department.

• A&E department personnel should have adequate knowledge of mental health issues, and feel confident in making an initial assessment of people with mental health problems.

• Mental health problems should be included in the triage process.

• A&E department staff training should include the recognition of common mental health problems, and the appropriate responses to that recognition.

• Mental health staff training should include training from A&E department staff regarding what is helpful. Conversely, A&E department staff require training from the mental health staff about what is practicable.

• Common training initiatives involving both staff groups address not only training issues, but also can lead to major operational benefits.

• local policies should be agreed regarding common mental health problems that arise in the A&E department.

• The A&E department should include facilities and resources for the assessment of patients with mental health problems. This should include an interview room with adequate safety features.

• Staff training should include safety issues.

• A liaison group, with representatives from the A&E department and from mental health services, should review issues of joint working between the two services, establish joint working protocols, and ensure that the recommendations contained within this report are considered and implemented.

• The liaison group should be authorised by, and have agreed reporting structures to, the respective Trust boards.