People with mental health problems often receive poor care in A&E, report reveals

Patients with mental health problems attending emergency departments (EDs) for physical conditions rarely receive good care, a major review has found.

According to the latest report from the National Confidential Enquiry into Patient Outcome and Death (NCEPOD), people with mental health problems receive poor treatment because hospital staff frequently lack the knowledge or confidence to care for them appropriately.

Fewer than half of those with physical conditions and mental health problems who visit hospital are given good care, according to the report Treat as One.

Researchers carried out detailed reviews of 552 cases from patients with mental health problems who presented at NHS hospitals in England, Wales and Northern Ireland for physical health conditions. Most patients were treated initially in EDs.

Mental health conditions are often unrecorded at triage or during senior reviews in EDs, the case reviewers found.

A total of 55 patients, including 19 with schizophrenia, who should have been referred to a liaison psychiatry team by ED staff were not. The NCEPOD report also suggests that the specialist teams requested by ED staff took too long to arrive.

Inpatient procedures

Previous studies have found that people with mental ill health attend EDs three times more than people without, and are more likely to undergo common inpatient procedures as emergencies.

The NCEPOD authors have called for hospitals to integrate physical and mental healthcare services, and to improve staff training as a matter of urgency.

‘Good care was provided to only 46% of patients in this study, showing patients who had mental health conditions experienced the double whammy of poor physical and mental healthcare,’ said report co-author Vivek Srivastava.

Failures to address poor physical care in patients with mental health problems can lead to them returning to ED swiftly. ‘They are often discharged into the community inappropriately, and then bounce back in and out of hospital if the underlying health condition is not treated properly,’ Dr Srivastava says.