• Healthcare Safety Investigation Branch publishes interim bulletin into mental healthcare for adults at A&Es
  • The safety watchdog has flagged up safety concerns into how mental health patients are assessed in emergency departments
  • It said a lack of access to appropriately trained mental health professionals may have “severe consequences”
  • HSIB will continue its investigation and publish a full report in due course

A shortage of trained staff to assess mental health patients in emergency departments is leading to inconsistent care and could have “severe consequences” safety investigators have warned.

The Healthcare Safety Investigation Branch has published its interim bulletin into the provision of mental healthcare to adults in the emergency department.

It forms part of one of the first investigations launched by the branch, which was set up by health secretary Jeremy Hunt to investigate and provide system wide learning from errors.

The bulletin, published today, said a lack of access to appropriately trained mental health professionals may have “severe consequences”.

HSIB’s preliminary investigation into the death of a patient who had attended an accident and emergency department before committing suicide found a lack of consistency in how the risk around mental health patients was being assessed.

The report added: “When adult patients experiencing a mental health crisis present at an emergency department, their condition, for a variety of reasons, can be difficult to assess.

“Thereafter, lack of timely access to an appropriately trained mental health professional during the patient’s stay may have severe consequences on the outcome and duration of their treatment and may also impact upon the care of other patients.

“The preliminary investigation identified disparity across the NHS in England in the level of risk assessment for adult patients with mental health problems on presentation at emergency departments and their subsequent care management.”

The safety watchdog also flagged up a series of safety issues as part of the investigation:

  • The appropriateness of assessment tools to identify patients at risk;
  • Difficulties in the sharing of patient information within the emergency department;
  • The emergency department may not be a place of safety for a patient experiencing a mental health crisis;
  • Access to psychiatric liaison services

The patient whose case sparked the investigation was not referred to a psychiatric liaison team by A&E staff and left. The patient then committed suicide.

HSIB has not named the patient or the trust, but is looking at system wide problems highlighted by the particular case.

It will publish a full report with recommendations on how these safety concerns can be addressed in due course.

The report added: “This investigation will seek to identify improvements in how the mental healthcare needs of adult patients can be effectively assessed and then how treatment can be appropriately and safely managed after presentation at the emergency department.”

But HSIB did also acknowledge that “effort” has gone into improving mental health services in A&Es following the publication of the Five Year Forward View for Mental Health.

However, it said that despite more effort to treat patients in the community, many were still attending A&E.

It added: “The commissioning and delivery of mental healthcare in this clinical area is complex.

“Despite various initiatives designed to encourage patients to use sources of urgent mental healthcare other than emergency departments, many patients with mental health problems continue to present at emergency departments.” 

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