There is an urgent need to improve the provision of acute mental health services at hospital emergency departments, a new report has said.
The analysis, from the Mental Health Commission, found substantial variations in the services provided at such locations and said steps need to be taken to enhance access to care, especially for those presenting "out of hours".
It has estimated that more than 50,000 people try to access mental health services, for the first time, through hospital emergency departments, each year.
The report, from the Inspector of Mental Health Services, showed many facilities do not have adequate staff or resources to meet that demand.
Professor Jim Lucey’s survey examined the services available across 35 emergency departments and minor injury units nationwide.
The report showed substantial delays when it came to assessing patients and said there is also a lack of proper space in most emergency departments in which to provide supports to those seeking urgent care for mental health issues.
Services for children are especially problematic, with many often facing "prolonged and inappropriate" waits.
Particular need to reduce pressure in larger hospitals
Prof Lucey also referenced persistent failures around the country, when it came to ensuring timely access to child and adolescent mental health services.
The report said there is a particular need to reduce the pressure in larger Model 4 hospitals, which are generally located in larger metropolitan areas, by improving the services available in other health care settings.
Prof Lucey said this would help to better distribute demand and assist in the effort to improve the services provided.
The emergency departments in Model 4 hospitals were found to be "overburdened", with thousands of presentations each year, compared to hundreds at smaller hospitals.
At many departments, overcrowding led to concerns for those seeking care, as well as for staff and others attending the units.
We need your consent to load this rte-player contentWe use rte-player to manage extra content that can set cookies on your device and collect data about your activity. Please review their details and accept them to load the content.Manage Preferences
Report describes 'revolving door system'
In turn, the lack of services, staff and facilities is leading to a "revolving door system", where many seeking care return to the same emergency department, over and over again.
The inspector said the present reliance on emergency departments for acute mental health care is unlikely to decline, without investment in primary and community services, as well as in all emergency departments.
Prof Lucey said there needed to be a national standard of care when it comes to accessing mental health services in such environments.
He recommended the immediate rollout of enhanced community services and better resources in Model 3 hospitals to help redistribute demand.
Stressing the need to prioritise early intervention, the report also said community mental health teams need to be empowered to provide more acute, unscheduled care.
Mental Health Commission Chief Executive John Farrelly said the report highlighted how all 24-hour emergency departments should have sufficient staff in place, so that patient needs can be addressed, regardless of the time people present for care.
This would entail the rostering of sufficient senior clinicians and decision-makers on-site "to swiftly triage, treat or refer people who are unwell into appropriate services".
Mental Health Commission Inspector of Mental Health Services Professor Jim Lucey says there are no adequate staff and resources to meet demand on services
Speaking on RTÉ's Morning Ireland, Prof Lucey said that mental health issues are the most common cause of death for people under the age of 50 in the country.
There is a stark difference between day and night mental health service cover, he said, adding that many hospitals have no services after 5pm.
He said: "Mental health issues are not insignificant ... The response to a surgical issue in an emergency room would be an emergency surgical response.
"If you go in with a fracture, you get a surgical answer to the fracture.
"But if you have a fractured mind and you present yourself to an emergency room, you may be waiting.
"You may have to take a ticket. And we found a huge difference between the day and night during the day.
"In most hospitals, there's some degree of response much greater in the big university hospitals."
Prof Lucey said there are many instances where there is no private room to discuss the patient’s mental health issues.
"Those conversations are happening on the corridor. Presumably, they're happening in an inappropriate place."
He said what is needed is a place that is appropriate to personal, private, intimate discussions "and is conducive to a compassionate response to somebody who is in crisis and is safe. Those rooms are not available in all 24/7 emergency rooms."
Read more: Call for change to ED mental health services after report
Minister impatient over 'pace of change'
Minister of State with responsibility for mental health Mary Butler said she has "expressed" her "impatience to the HSE at the pace of change".
In a statement, she said: "People experiencing mental health distress and illness often find" that emergency departments are "the wrong setting for their needs".
"My priority is that people in mental health crisis are provided with timely assessment and support in an appropriate environment that keeps them safe," she said.
"Our ambition is to develop real alternative care pathways and therapeutic environments" including crisis resolution teams and crisis cafés "working out-of-hours and in the community to enable recovery," she added.
Helplines
If you have been affected by issues raised in this story support is available
