INVESTIGATION: Exponential rise in mental health A&E admissions

First published in the Western Morning News newspaper, November 2017

For accompanying video visit: http://www.devonlive.com/news/devon-news/huge-rise-people-attending-ae-908854

The UK has seen an exponential rise in the number of children and adults attending its hospitals’ emergency departments for mental health related issues in recent years, an investigation has revealed.

Figures obtained through Freedom of Information requests (FOIs) to every hospital trust with a major emergency department in the UK, lay bare the rising and unprecedented demand on front line hospital staff.

Out of 139 hospital trusts across England surveyed, around two thirds reported a rise in admissions. The majority of trusts in Wales and Northern Ireland reported an increase, with fluctuating figures across Scotland.

A mental health sufferer from Exeter, who has attended the Royal Devon & Exeter Hospital’s (RD&E) emergency department for treatment on numerous occasions, is calling for a more bespoke system of care, including more privacy while waiting for treatment and improved awareness among healthcare professionals.

Labour MP for Exeter Ben Bradshaw, a former Minister for Health who is on the Health Select Committee, described the figures as “shocking” and added that they “demolish the Government’s claim that mental health services are improving”. He cited a lack of community support as a reason to explain the sharp rise.

A spokesperson for the RD&E, which has a 24/7 Liaison Psychiatry team, said that the complexity and multi-agency nature required by some patients with mental health needs, means their “pathway” at the emergency department can be extended.

A Department of Health spokesperson said the government is investing £247m by 2021 for mental health support in hospital emergency departments. And in October a new £15m scheme was launched “to help develop and enhance” facilities for urgent and emergency mental healthcare.

At Derriford Hospital in Plymouth, the number of children and adolescents attending its emergency department for mental health related reasons has more than tripled between 2012 and 2016, while the number of adults who attended, doubled.

At the RD&E, the number of under-18s attending for mental health related reasons has more than tripled in five years, while the number of adults has more than doubled.

And at the Royal Cornwall Hospital Trust hospitals in Truro and Penzance, the number of under-18s attending the hospitals’ emergency departments for mental health related reasons has increased by more than 20 times over the last five years, while the number of adults attending for the same reasons has more than doubled.

NHS England’s target is that 95 per cent of people are admitted, transferred or discharged within four hours of arrival. Nationally, according to FOI data, there has been an increase in the percentage of patients with mental health related complaints waiting over four hours, with many hospitals reporting mental health patients waiting longer to be discharged or transferred than those with physical afflictions: for example at the Royal Cornwall Hospital in 2016, 24 per cent of the total number of patients waited longer than four hours, but for those presenting mental health issues it was 29 per cent.

The number of call outs to the South West Ambulance Service has also risen sharply by around almost 50 per cent in four years from 2012 to 2016.

Jane, 56, from Exeter, has attended the RD&E’s emergency department around a dozen times in the past for treatment for acute mental distress and self-harming. She said her experiences there did her “more harm than good” and claimed that she sometimes felt “judged” for attending with self-harm injuries and on one occasion was “forgotten about” when waiting.

Jane is calling for more privacy and mental health awareness training to be extended to all staff working in the emergency departments so they can best deal with people with mental health issues, and compassion focussed treatment.

“No one self harms for a hobby,” said Jane, whose surname is being withheld by the Western Morning News to protect her identity. “Going to the emergency department when you’re feeling so distressed you’ve hurt yourself, and then to stay there all that time and keep yourself calm, is a really hard and brave thing to do.

“But I wasn’t treated as if I was brave and doing a positive thing.

“By getting your wounds treated early, you’ll be saving on NHS resources in the long run; on one occasion when I didn’t go to hospital, because of the delay to dress my wounds properly, I ended up having to go my GP’s surgery every day for 10 days afterwards.

“Having to explain yourself to a receptionist in front of all these other people, and then sit in a room full of other people, is extremely difficult when you’re suffering from acute anxiety.

“On many occasions I felt there was no compassion from the doctors that treated me and I’ve been spoken to in a sarcastic way in the past, which made me feel embarrassed for being there.

“I feel like the emergency department is not an option for me anymore.

“A more compassionate approach to care is needed.”

An RD&E spokesperson said: “We are always sorry to hear when one our patients feel unhappy with the care they received at the RD&E. Our emergency department team places great emphasis on safe, compassionate care for all its patients.”

The spokesperson said that mental health related attendances to its emergency department (ED) have increased in recent years due to “a range of factors including greater public awareness of mental health and improved diagnosis by doctors, other health professionals and the emergency services”.

There is a Liaison Psychiatry team based at the emergency department which is available 24/7, to ensure patients with mental health needs are prioritised.

“Mental health related attendances can range from patients showing signs of anxiety and depression, drug and alcohol misuse through to severe mental health illness,” the spokesperson said. “Some of these cases can be complex and require a multi-disciplinary team approach, with input from mental health professionals as well as medical teams to ensure the patient receives safe, high quality care.

“In order to manage this increasing demand we have innovative joint working arrangements with Devon Partnership NHS Trust (DPT), including a nationally accredited Liaison Psychiatry team, which is fully integrated with the ED team and provides specialist mental health assessment and treatment for patients, families and carers.

“The complexity and multi-agency nature of some patients with mental health needs means that their pathway within ED can be extended. However, the focus on early assessment and diagnosis ensures these patients are managed in a safe and appropriate manner.

“We are continuing to discuss additional solutions with DPT and Northern, Eastern and Western Devon Clinical Commissioning Group (NHS NEW Devon CCG), such as further community based mental health services and alternatives to hospital admission.”

A spokesperson for NHS NEW Devon CCG, confirmed that the CCG has put a further £1m into commissioning mental health services this year which has enabled an increase in the number of hospital discharge coordinators to help ensure people have access to a psychiatric bed if they need it.

The spokesperson, added: “We have a major work programme across the Sustainability and Transformation Partnership to enhance support and services in the community for people with mental ill health, helping to avert the crises which see people attending emergency departments.

“We are also working to create a single point of access to the community mental health teams which will include a triage system, ensuring people get the care they need and helping them to avoid crisis.”

In Cornwall, a new 12-bed child and adolescent mental health unit is due to be constructed in spring 2018.

Kim O’Keeffe, Chief Nurse at Royal Cornwall Hospitals, which was nominated for three national awards this year for their work supporting people with mental health problems, said there are “many reasons” for the increase in mental health related attendances at its emergency departments, “including greater awareness and need, as well as capacity within the community”.

The hospital currently has a Liaison Psychiatry service at its Truro hospital from 8am to 10pm with plans to extend this to a 24 hour service by mid-2018.

“By working in partnership, we aim to offer fast, effective assessment for all patients with a mental health condition and to give the same priority to their care as anyone with a physical condition,” Ms O’Keeffe added.

“The biggest challenges in terms of improving care include increasing the size of the team to provide a high quality 24 hour service and providing the right facilities for mental health patients, which is why the new unit for young people in Cornwall is so welcome.

“We are absolutely committed to providing the best possible mental health service at Royal Cornwall Hospitals.”

Mr Bradshaw, said: “These are shocking figures, which demolish the Government’s claim that mental health services are improving. More people are turning up at hospitals’ emergency departments and staying much longer than they need in hospital because the community support is just not out there.

“If there were adequate mental health services in the community, fewer people would reach crisis point where their only option is to go to an emergency department.

“With the impact of Brexit making an already difficult situation in our NHS even worse, I am extremely worried that the system is fast approaching breaking point.”

A response from Health Minister Jeremy Hunt was requested; instead a Department of Health spokesperson, said: “We recognise that people with mental health problems need access to dedicated care 24 hours a day – that’s why we’re investing £247m by 2021 for mental health support in hospital emergency departments to treat people with immediate mental health needs.

 

“Earlier this month we also launched a new £15m scheme to help develop and enhance facilities for urgent and emergency mental healthcare, including places of calm and crisis cafes, which offer support to people who are at risk of mental health crisis.”

 

FACT FILE: Mental health related attendances at the region’s emergency departments, 2012 – 2016

N.B. Figures are not directly comparable between hospitals due to the differing ways each hospital records data and codes for mental health related conditions. Mental health related attendances can include anxiety and depression, drug and alcohol misuse, self harm, and severe mental health illness. Some hospitals may have included within its mental health data admissions for alcohol and substance abuse while others may not have. Figures for Plymouth’s Derriford Hospital for example, have not included alcohol and substance abuse admissions in its figures. In addition, some hospitals may have altered the way they record data part way throughout the time period.

Royal Cornwall Hospitals NHS Trust, Truro and Penzance hospitals

There has been a 20 fold increase in the number of under-18s’ attendances between 2012 and 2016; there were five attendances in 2012 and 116 in 2016.

The number of adult attendances has more than doubled; there were 478 attendances in 2012 and 1,043 in 2016.

In 2016, 29 per cent of patients attending for mental health related issues waited over four hours compared with 24 per cent of all admissions to the Royal Cornwall Hospital in Truro.

Plymouth Derriford Hospital

The number of under-18s’ attendances has more than tripled between 2012 and 2016; in 2012 there were around 70 attendances and 235 in 2016.

The number of adult attendances has more than doubled; in 2012 there were 998 attendances and 2,094 in 2016.

In 2016, 16 per cent of those attending for mental health related reasons waited more than four hours; this is on a par with the figure relating to all admissions.

The total number of patients waiting more than four hours has tripled in four years from 2012 – 2015; data was not requested for the total number of admissions, so this rise most likely reflects an overall rise in the number of admissions to the hospital’s emergency department.

The hospital was unable to respond to a request for a comment.

Royal Devon and Exeter Hospital

The number of under-18s’ attendances between 2012 and 2016 has tripled; in 2012 there were 52 attendances and 172 in 2016.

The number of adults attending has more than doubled; in 2012 there were 1,093 and 2,551 in 2016.

In 2012, just under eight per cent of children attending with mental health related issues waited over four hours, compared with 22 per cent in 2016.

And in 2012, 13 per cent of adults attending with mental health related issues waited over four hours, compared with 33 per cent in 2016.

In 2016 just over eight per cent of all admissions waited over four hours.

N.B. In 2015 there was a change in the way emergency department patients were reported which led to a significant increase in the number of mental health related patients being recorded as waiting more than four hours for admission or discharge.

Torbay Hospital

The number of under-18s’ attendances has more than doubled; in 2012 there were 178 attendances and 407 in 2016.

The number of adult attendances has increased by around a fifth; in 2012 there were 2,217 adults and 2,700 in 2016.

In 2016, just under 16 per cent of all admissions waited longer than four hours compared to 22 per cent of mental health admissions, up from five per cent in 2012.

North Devon District Hospital

The number of under-18s’ attendances has doubled; in 2012 there were 74 attendances and 147 in 2015.

Adult attendances have also increased but due to a discrepancy in figures provided, the exact percentage was indecipherable at the time of going to press.

Taunton and Somerset Foundation Trust: Musgrove Park Hospital

The number of under-18s’ attendances has almost tripled; in 2013 there were 64 attendances and 165 in 2016.

Adult attendances have more than doubled; there were 379 attendances in 2013 and 824 in 2016.

Yeovil District Hospital

The number of under-18s’ attendances has risen by 10 per cent; in 2012 there were 155 attendances and 170 in 2016.

The number of adult attendances has decreased by around 12 per cent; in 2012 there were 1,011 attendances and 893 in 2016.

In 2012, seven per cent of all patients waited over four hours which rose to 14 per cent in 2016, compared to just under eight per cent of all admissions in 2016 who waited over four hours.

Dorset County Hospital

The number of under-18s’ attendances has more than doubled; in 2012 there were 51 attendances and 117 in 2016.

Adult attendances have risen by around a third; in 2012 there were 603 attendances and 775 in 2016.

South West Ambulance Service

The number of call outs has risen sharply by 48 per cent from 13,033 in 2012/13 to 19,339 in 2015/16.

 

 

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