Disparities in experiences of emergency department care for people with a mental health condition

Corscadden, Lisa; Callander, Emily; Topp, Stephanie M.; Watson, Diane E.

doi:10.1016/j.auec.2020.05.008

Cited by 4 publications

(5 citation statements)

References 19 publications

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“…Concerning the crisis care received, the study adds weight to existing research showing a predominance of adverse mental health crisis care in EDs, 19–21 with participants feeling dismissed and objectified based on their experience, which they felt was not considered as worthy of care as a physical health crisis. Through narrative accounts of responses in ED, participants portrayed mental health crises as the creation of the ‘other’.…”

Section: Discussionmentioning

confidence: 93%

“…There is mounting evidence of the negative impact of involuntary treatment on future help‐seeking 18 . More broadly, ineffective responses to mental health crises in EDs are well documented, including long wait times and poor outcomes 19–21 . The responses received in the ED may even exacerbate the mental health crisis, contributing to maintaining a cycle of crisis and repeated presentations to the ED, sometimes referred to as ‘frequent flyers’ or people repeatedly accessing the ED in need of acute support 22 …”

Section: Introductionmentioning

confidence: 99%

“…18 More broadly, ineffective responses to mental health crises in EDs are well documented, including long wait times and poor outcomes. [19][20][21] The responses received in the ED may even exacerbate the mental health crisis, contributing to maintaining a cycle of crisis and repeated presentations to the ED, sometimes referred to as 'frequent flyers' or people repeatedly accessing the ED in need of acute support. 22 To date, the limited qualitative literature on how crisis care is experienced has been predominantly situated within EDs, 23,24 providing significant knowledge on experiences of crisis specific to this context, particularly challenges accessing ED.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Exploring the lived experience of receiving mental health crisis care at emergency departments, crisis phone lines and crisis care alternatives

Roennfeldt,

Hill,

Byrne

et al. 2024

Health Expectations

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BackgroundMental health crisis care includes emergency departments (EDs), crisis phone lines and crisis alternatives. Currently, there is an overreliance on EDs to provide mental health crisis care, with evidence that responses are often inadequate to meet the needs of people experiencing mental health crises. However, the complexities of how individuals experience crisis care across the varying contexts of EDs, crisis phone lines and crisis alternatives remain underresearched.MethodThis study used a hermeneutical phenomenological approach to understand the lived experience of accessing care during a mental health crisis. Thirty‐one Australian adults who had accessed crisis services at ED, phone lines and/or crisis alternatives participated in in‐depth interviews.ResultsThe findings are organised across the temporal narratives of participants' experiences from (1) point of contact, (2) positive and negative care experiences and (3) enduring impacts. Several themes were generated during these phases. The findings demonstrate the interrelated nature of care experiences and enduring impacts. With some exceptions, care received within EDs was harmful, resulting in lasting adverse effects. Responses from crisis phone lines were mixed, with participants appreciating the accessibility of after‐hour phone support but finding standardised risk assessments unhelpful. Responses from crisis alternatives to ED were promising, aligning with the need for validation and human connection, but were not always accessible or easy to mobilise during a crisis. Notably, across all settings, positive effects were firmly attributed to the quality of the relationship with specific crisis providers.ConclusionThe findings bring into sharp focus the lived experience of people accessing crisis care and contribute to the shortage of literature on subjective experiences. Providers may better meet the needs of those experiencing mental health crises by understanding the enduring impact of these interactions and the role of human connection beyond a focus on risk assessment, thereby providing opportunities for a joint understanding of risk and meaning‐making. Furthermore, understanding the subjective experience of crisis care can guide reforms to ED and develop crisis alternatives to better meet the needs of people in crisis.Patient or Consumer ContributionThe first author and the third author are in designated lived experience (Consumer) roles. The first author conducted the interviews and was explicit regarding their lived experience when engaging with participants. Service users were involved as advisors to the study and provided input into the design.

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Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Exploring the lived experience of receiving mental health crisis care at emergency departments, crisis phone lines and crisis care alternatives

Roennfeldt,

Hill,

Byrne

et al. 2024

Health Expectations

View full text Add to dashboard Cite

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“…Although pharmacy services are often well regarded, this may be in part due to low expectations or poor understanding of what a high-quality pharmacy service should deliver ( Murphy et al, 2016 ). In ED, people with MHSUC commonly report diagnostic overshadowing, discrimination and not being listened to, with time and throughput pressures, a busy, uncomfortable environment, lack of collaborative care and changing staff all being factors that reduce positive experiences in this setting ( Clarke et al, 2014 ; Corscadden et al, 2021 ; Navas et al, 2022 ; Van Nieuwenhuizen et al, 2013 ).…”

Section: Discussionmentioning

confidence: 99%

“…People with MHSUC often report lower satisfaction with physical healthcare ( Kilbourne et al, 2006 ). While satisfaction has been measured in different healthcare settings including primary care (general practice [GP] and pharmacy; Cabassa et al, 2014 ; Kilbourne et al, 2006 ; Pitrou et al, 2020 ), emergency departments (EDs; Clarke et al, 2014 ; Corscadden et al, 2021 ; Navas et al, 2022 ), hospitals ( Chen et al, 2019 ) and maternity care ( Corscadden et al, 2020 ), studies comparing patient experiences across settings are lacking. These are needed to help target interventions at different settings.…”

Section: Introductionmentioning

confidence: 99%

Experiences of physical healthcare services in Māori and non-Māori with mental health and substance use conditions

Cunningham,

Imlach,

Haitana

et al. 2024

Aust N Z J Psychiatry

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Objectives: Inequities in physical health outcomes exist for people with mental health and substance use conditions and for Indigenous populations (Māori in Aotearoa New Zealand). These inequities may be partly explained by poorer quality of physical healthcare services, including discrimination at systemic and individual levels. This study investigated the experiences of people with mental health and substance use conditions accessing physical healthcare and differences in service quality for non-Māori relative to Māori. Methods: A cross-sectional online survey of people with mental health and substance use conditions in New Zealand asked about four aspects of service quality in four healthcare settings: general practice, emergency department, hospital and pharmacy. The quality domains were: treated with respect; listened to; treated unfairly due to mental health and substance use conditions; mental health and substance use condition diagnoses distracting clinicians from physical healthcare (diagnostic and treatment overshadowing). Results: Across the four health services, pharmacy was rated highest for all quality measures and emergency department lowest. Participants rated general practice services highly for being treated with respect and listened to but reported relatively high levels of overshadowing in general practice, emergency department and hospital services. Experiences of unfair treatment were more common in emergency department and hospital than general practice and pharmacy. Compared to Māori, non-Māori reported higher levels of being treated with respect and listened to in most services and were more likely to report ‘never’ experiencing unfair treatment and overshadowing for all health services. Conclusion: Interventions to address discrimination and poor-quality health services to people with mental health and substance use conditions should be tailored to the physical healthcare setting. More needs to be done to address institutional racism in systems that privilege non-Māori.

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Missed nursing care in emergency departments: A scoping review

Duhalde

Bjuresäter

Karlsson

et al. 2023

International Emergency Nursing

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Disparities in experiences of emergency department care for people with a mental health condition

Cited by 4 publications

References 19 publications

Exploring the lived experience of receiving mental health crisis care at emergency departments, crisis phone lines and crisis care alternatives

Exploring the lived experience of receiving mental health crisis care at emergency departments, crisis phone lines and crisis care alternatives

Experiences of physical healthcare services in Māori and non-Māori with mental health and substance use conditions

Missed nursing care in emergency departments: A scoping review

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