Triage reform: developing consistency in the emergency triage of clients with a mental illness in Australian Emergency Departments

Purpose: This presentation outlines the responses by emergency clinicians to increased presentations of clients with a mental illness to Australian emergency departments. Methods: A comprehensive literature search reviewing the years 1995 to 2010 was conducted using Proquest, Cinahl and Google Scholar. 1995 was chosen as the earliest date as this is year that the first report of changes to ED triage practice in regards to assessment of clients with a mental illness was published. The key terms used to conduct the search were mental health, mental illness, triage, emergency nursing, mental health nursing and emergency departments. These were entered and combined for the process of the search. Articles selected for use in this presentation were chosen using the following criteria, published in peer-reviewed journal within the time frame specified and direct relevance to the Australian context. Other literature such as textbooks and reports known to the authors were also used. Results: In Australian emergency departments the triage of people with physical illness and injury is well developed and supported by the Australasian Triage Scale. The Australasian Triage Scale contains brief descriptors of mental illness and the poor interrater reliability in triage decision-making using these descriptors by emergency triage nurses indicates a need for reform in this area of triage practice. Specialist mental health triage scales have been developed to cater for this deficit and to aid emergency staff who have lacked training in the assessment and management of people with a mental illness. Despite this there is no consistent national approach to the emergency triage of people with a mental illness. This presentation describes the policy framework that has lead to increased use of EDs by clients with a mental illness to access mental health care, the ad hoc development and use of mental health triage scales and the overall lack improvements in ED service provision to this client group as a result of the use of a mental health triage scale. Conclusion: This presentation will describe how despite the intentions of the National Mental Health Strategy, and the development of specialised mental health triage scales a lack of equity remains in emergency departments in the provision of care to people with a mental illness who make up one in four of adult Australians.