Emergency mental health care in Australia : policy and problems

In 1992, Australian Health Ministers adopted the Australian National Mental Health Strategy, the first National Mental Health Plan to come out of the strategy called for the deinstitutionalisation of clients with mental illness and the mainstreaming of mental health services into general health care facilities. This change resulted in annual increases of 13 to 35 percent of people presenting to emergency departments (ED’s) across Australia to access mental health care. In Australia, ED’s are staffed by general trained medical and nursing staff who are by and large poorly equipped to assess and manage clients with a mental illness. Since 1994 specialised mental health triage scales (MHTS) have been developed by ED staff with the specific aim of improving the capacity of ED staff to assess and mange clients with mental illness and despite there being one triage scale for clients with physical illness and injury there are now a number of MHTS in use around Australia. Simultaneously, various models of mental health service delivery been developed and independently implemented and the literature that demonstrates the effectiveness of any model at improving the responsiveness of mental health services to ED’s is scarce.The current ad hoc approach to emergency mental health care in Australia is a lesson to clinicians and policy makers planning changes to the provision of mental health care in the community and those in emergency departments faced with caring for clients with a mental illness.