Interventions for people presenting to emergency departments with a mental health problem: a systematic scoping review

Dr. AmyNB Johnston1,2,3, Ms Melinda  Spencer4, Prof Marianne Wallis4,5, Prof Stuart Kinner6,7, Dr Marc Broadbent5, Dr Jesse Young6,7,8,9, Prof Ed Heffernan10, Prof Gerry Fitzgerald11, Dr Emma Bosley12, Prof Gerben Keijzers2,13,14, Prof Paul Scuffham4, Dr Ping Zhang4, Prof Melinda Martin-Khan15, Prof Julia Crilly2,4

1Princess Alexandra Hospital, Department Of Emergency Medicine And Sonmsw University Of Queensland, Brisbane Woolloongabba, AUSTRALIA, 2Gold Coast Health, Department of Emergency Medicine, Southport, AUSTRALIA, 3University of Queensland, Brisbane Woolloongabba, AUSTRALIA, 4Griffith University, Menzies Health Institute Queensland, Gold Coast, AUSTRALIA, 5University of the Sunshine Coast, Sunshine Coast Health Institute, Sippy Downs, AUSTRALIA, 6Murdoch Children’s Research Institute, Centre for Adolescent Health, Melbourne, AUSTRALIA, 7University of Melbourne, Centre for Health Equity, Melbourne School of Population and Global Health, Melbourne, Parkville, AUSTRALIA, 8University of Western Australia, Centre for Health Services Research, School of Population and Global Health, Perth, AUSTRALIA, 9Curtin University, National Drug Research Institute, Perth, AUSTRALIA, 10Queensland Centre for Mental Health Research, Queensland Forensic Mental Health Services, Brisbane, Wacol, Australia, 11Queensland University of Technology, School of Public Health and Social Work, Brisbane, Kelvin Grove, Australia, 12Emergency Services Complex, Queensland Ambulance Service, Brisbane, Kedron, Australia, 13Griffith University, School of Medicine, Gold Coast, Australia, 14Bond University, School of Medicine, Gold Coast, Australia, 15University of Queensland, Centre for Health Services Research, Brisbane, Woolloongabba, Australia

Nearly half (45%) of Australians aged 16-85 will experience a common mental disorder in their lifetime[1], and a proportion of these will present to emergency departments (EDs) with mental health problems (MHP). To enhance and promote the delivery of safe and efficient healthcare, it is important to understand what interventions can be effectively delivered in the ED for adults presenting with MHP, to improve health and social outcomes for this vulnerable group.

This scoping review aimed to identify and evaluate current research on interventions delivered or initiated in the ED for people presenting with a MHP.

A systematic search of eight databases using search terms relating to ED, mental health, psyc*, and interventions, with additional reference chaining, was undertaken. For included studies, the level of evidence was assessed using the NHMRC research guidelines and existing knowledge was synthesised to map key concepts and identify current research gaps.

A total of 277 papers met the inclusion criteria. The interventions identified were grouped thematically into seven domains by consolidating the wide range of primary intervention types examined. These seven domains included pharmacological (n=43), psychological/behavioural (n=25), triage/assessment/screening (n=28), educational/informational (n=12), case management (n=28), referral/follow-up (n=36), and mixed interventions (n=105). There was large heterogeneity in the quality of evidence within each domain. Interventions were focused on either staff, patient, or institutional level processes. Few studies focused on multiple level processes (n=64) and/or included the patient’s family (n=1). The effectiveness of interventions varied. There is considerable, yet disconnected, evidence regarding ED interventions to support people with MHP. The unique care requirements for these patients contributes to the variety of interventions used. The lack of inclusion of carers, and a lack of coherent, integrated, multifaceted, person-centred interventions, are important barriers to providing effective care for this vulnerable population who present to the ED.

[1].Available from: http://www.abs.gov.au/ausstats/abs@.nsf/mf/4326.0


Biography:

Dr Amy Johnston currently holds a conjoint position between Metro South Hospital & Health Service, Department of Emergency Medicine (based at Princess Alexandra hospital) and the School of Nursing, Midwifery and Social Work, University of Queensland. For the past 5 years she has worked across the academic and ED healthcare environments to conduct her own research as well as supporting clinicians, particularly nurses, to develop the skills and confidence to participate in and conduct research projects relevant to their clinical work. She has a heartfelt and passionate commitment to evidence-based practice in emergency departments and to helping clinicians describe and evaluate the amazing innovations they implement. Her wide experience has helped her develop a broadening national and international profile. She has co-authored in excess of 80 publications and supported 3 PhD candidates to completion with another 7 currently working towards their PhD qualifications. Her H-index is 17 (Scopus), google scholar is 21, with i10 index of 27.