Mental Health in Emergency Departments - A toolkit for improving care
Service provision for patients with mental health issues can be very challenging to resolve. Frequently ED and mental health are provided by discrete organisations, and offering a seamless service to the patient can seem impossible. Much of the commissioning structure for mental health is based around different geographical and logistical domains when compared to acute services. This often results in sub-optimal or absent services to patients attending the ED with mental health needs.
The toolkit provides several resources that EDs can use to develop and improve the care provided to patients with mental health issues. Resources include guidelines, example assessment aids, example business cases and standards for EDs.
APEx fact sheet - Acute Psychiatric Emergencies
The Acute Psychiatric Emergencies Course (APEx) is run by the ALSG and is recommended by the Mental Health Sub-committee as a useful way of gaining and maintaining knowledge and skills when caring for an acutely unwell psychiatric patient presenting to an Emergency Department. The course covers a variety of presentations and serves to give candidates improved confidence in dealing with some challenging scenarios. It is suitable for all grades of EM doctors and nursing staff, as well as psychiatry liaison team members.
National Survey on Mental Health Services for Children and Young People in the ED
RCEM conducted an online survey to find out more about the services provided by EDs to children and young people presenting with mental health problems.
ED Mental Health Leads
RCEM would love to make contact with ED clinicians who are passionate about good mental health care or perhaps are the frustrated Mental Health Lead in their department! Please contact us
if you are the Mental Health Lead for your ED so we can keep up up to date with any important news.
Learn about Liaison Psychiatry Services
Central and North West London NHS Foundation Trust have produced an excellent video explaining what liaison psychiatry does and how it benefits patients. Watch the video here
NHS & Mental Health
Read general information about Mental Health on the NHS Choices website.
Staff/self care during COVID19
Help for doctors with more severe current anxiety or depression symptoms now
BMA - 24/7 counselling service (0330 123 1245)
BMA - counselling and peer support
Papyrus - Hopeline
Resilience and wellbeing
RCEM has put together 2 posters to display in our staff areas with advice about individual and team (herd) wellbeing:
Individual wellbeing and resilience during COVID-19
Herd wellbeing and resilience during COVID-19
EMPOWER: A Wellness Compendium for EM (Updated June 2019)
RCEM Wellbeing App (March 2020)
COVID-19 Experiences from doctors in UK and Australia - a conversation (May 2020)
Post-Traumatic Stress Disorder: a personal story (St. Emlyn's, March 2018)
The joyful doctor - 6 min podcast on covid, doctors stress and anxiety
Supporting doctors - 45 min podcast on how to manage our stress and anxiety through the crisis
Top tips from the podcast:
- Limit exposure to information on social media, e.g. check it twice per day only.
- Connect with your usual network of friends and family people by phone or social media, check in with people, start using support.
- Maintain normal day to day activity as much as possible, exercise, eat well, sleep etc.
- Anxious thoughts are normal and we cannot stop them coming, but we can either follow them down into a worse place or we can practice
- Taking small breaks, controlled breathing and focussing on a small absorbing task
Headspace - COVID19 specific
Headspace - main website
Sleepio - free access for all NHS staff throughout the COVID-19 response
Daylight- free access for all NHS staff throughout the COVID-19 response
MIND - personal wellbeing to deal with anxiety and isolation
BMJ blog - self care during COVID-19 pandemic
BMJ - tips on sleep for health workers
AoMRC - Mental wellbeing during COVID-19
WHO - Mental health and psychosocial considerations during COVID-19 outbreak
Intensive Care Society - Wellbeing resource library
Living Life to the Full (LLTTF) - Coronavirus Health Worker
Living Life to the Full (LLTTF) - Proposal for NHS and Social Care Staff
Back to the main COVID19 page.
Mental Health Crisis Care Concordat
What is the Mental Health Crisis Care Concordat?
The Mental Health Crisis Care Concordat is a national agreement between services and agencies involved in the care and support of people in crisis. It sets out how organisations will work together better to make sure that people get the help they need when they are having a mental health crisis.
Improving outcomes for people experiencing mental health crisis
On 18 February 2014 the Government published a joint statement about how public services should work together to respond to people who are in mental health crisis. The Royal College of Emergency Medicine is a signatory to the concordat and welcomes and supports this commitment to work together to improve the system of care and support so people in a crisis because of a mental health condition are kept safe and helped to find the support they need, whatever the circumstances in which they need help and form whichever service they turn to first. Find out more about the concordat here: Mental Health Crisis Care Concordat.
The national bodies involved in health, policing, social care, housing, local government and the third sector came together and signed the Crisis Care Concordat. It focuses on four main areas:
- Access to support before crisis point – making sure people with mental health problems can get help 24 hours a day and that when they ask for help, they are taken seriously.
- Urgent and emergency access to crisis care – making sure that a mental health crisis is treated with the same urgency as a physical health emergency.
- Quality of treatment and care when in crisis – making sure that people are treated with dignity and respect, in a therapeutic environment.
- Recovery and staying well – preventing future crises by making sure people are referred to appropriate services.
Although the Crisis Care Concordat focuses on the responses to acute mental health crises, it also includes a section on prevention and intervention. The Concordat builds on and does not replace existing guidance. Current service provision should continue while the Action Plan is being devised.
A dedicated website has been established by the charity Mind and the government that provides information about the concordat, what organisations are doing to implement mental health care improvements and details of actions you can take, see more here.
How can I find out more about the Concordat?