Access to care for people with mental health presentations to Auckland emergency departments

Abstract

Emergency Department (ED) specific mental health care utilisation and access data within the New Zealand context are limited. The aim of this thesis is to describe the utilisation patterns and identify unwarranted variations in access to acute ED mental health care. This was a retrospective quantitative study involving data of all visits in the five EDs within the Auckland Region between July 2018 and June 2019. Descriptive analysis of ED mental health visits was performed. Variations in the access to care were evaluated using total ED length of stay (LOS) as a process measure. Total ED LOS was compared between mental health and non-mental health groups, by dispositions and factor variables. 9,171 (2.4%) of 375,096 ED visits, or 2.8% of adults and 1.4% of paediatrics, were mental health related. Females and Māori were over-represented while Pacific Peoples and Asian were under-represented in mental health visits. Māori and Pacific Peoples were over-represented in the subgroup arriving under Section 109. Mental health patients had higher urgency to be seen, were more likely to present after-hours, and by ambulance or police escort compared to non-mental health patients. The police were involved in 15.9% of mental health presentations. One-third of mental health visits had a primary mental and behavioural diagnosis. 15.2% of mental health presentations required an inpatient mental health bed and a further 3.5% required a community respite bed. This study revealed several unwarranted variations in access to ED mental health care. The DHB of presentation was the predominant factor in determining total ED LOS. The afternoon and overnight shifts were associated with longer total ED LOS. Mental health ward admissions had longer wait for ED departure after mental health assessment than the routine discharges. The longer first seen time in triage four and triage five mental health visits compared to non-mental health visits were clinically important. Warranted access to care variations included the variations between mental health and non-mental health visits, in age groups, gender, and overall triage category. The challenge now is to reduce the unwarranted access to ED mental health care variations through an ongoing quality improvement process.