Widespread emergency department access block: a human rights issue in Australia?

Abstract

Objective:: There are increasing demands on emergency psychiatrists with higher numbers of mental health presentations, and longer stays in emergency departments (EDs). Australia, like other English speaking countries, funds considerably lower numbers of psychiatric beds than average for Organisation for Economic Co-operation and Development (OECD) countries. Consequently, acute bed occupancy is high, and a bed is frequently unavailable when a person needs admission. Patients with serious mental illness can wait days in busy and overstimulating EDs, become agitated and assaultive, and then require chemical and physical restraint. All patients have a right to safe high quality care, but the paucity of beds deprives patients of this right. The Australasian College of Emergency Medicine recommends reporting ED access block to health ministers, and human rights and/or health rights commissioners, and recommends increased funding for inpatient psychiatric care, emergency mental health and after-hours community services, together with more alcohol and other drug programs.

Conclusions:: It is challenging for emergency physicians and psychiatrists to provide optimal care for acutely unwell patients who stay extended periods in the ED. Increasing the availability of inpatient care must be considered as part of a comprehensive solution for minimising ED lengths of stay in Australia.

Keywords: emergency psychiatry; mental health policy; psychiatric beds.