This report supersedes the previous joint report (Council
Report CR43) from the Royal College of Psychiatrists and the
British Association for Accident and Emergency Medicine. Since the
publication of the original report, new demands have been placed on
both mental health services and A&E departments. The
requirement that 90% of patients must have been discharged from
A&E departments within 4 hours of arrival (Department of
Health, 2001) will have a major impact on the interaction between
mental health services and A&E departments.
The main report examines the common mental health scenarios
that occur in the A&E department, issues affecting patients
from ethnic minorities, specific problems in the A&E
department, personnel issues and the organisation of
services.
Summary of recommendations:
- There is a joint responsibility for commissioners, mental
health service managers, and acute service managers to ensure that
the input of mental health services to A&E departments is not
overlooked in negotiations.
- A consultant psychiatrist should be named as the senior member
of staff in the local mental health services responsible for
liaison with the A&E department.
- A&E department personnel should have adequate knowledge of
mental health issues, and feel confident in making an initial
assessment of people with mental health problems.
- A&E department staff training should include the
recognition of common mental health problems, and the appropriate
responses to that recognition.
- Mental health staff training should include training from
A&E department staff regarding what is helpful. Equally,
A&E department staff require training from mental health staff
about what is practicable.
- Common training initiatives involving both staff groups not
only address training issues, but also can lead to major
operational benefits.
- Local policies should be agreed regarding common mental health
problems that arise in the A&E department.
- The A&E department should include facilities and resources
for the assessment of patients with mental health problems. This
should include an interview room with adequate safety
features.
- Staff training should include safety issues.
- A Liaison Group, with representatives from the A&E
department and from mental health services, should review issues of
joint working between the two services, and ensure that the
recommendations contained within this report are considered and
implemented.