What are the experiences and the perceptions of service users attending Emergency Department for a mental health crisis? A systematic review

Abstract

Historically, dualistic healthcare systems have resulted in limited mental healthcare provision within physical health settings, with service users reporting poor care specifically while attending emergency departments (EDs) in a mental health crisis. Modern approaches to healthcare recognize these inequalities and are moving towards integrating healthcare systems that allow more holistic and seamless experiences for service users. This mixed-method review examines the experiences and perceptions of service users attending EDs for a mental health crisis. Systematic searches of eight databases on two platforms (EBSCO, OVID) and grey literature databases (Open Grey, Base) were conducted. Studies were systematically screened for inclusion based on predetermined eligibility criteria and quality assessed using the Mixed Methods Appraisal Tool. Findings were tabulated and synthesized using thematic synthesis. Ten studies consisting of qualitative and mixed-method designs were included in the review. Five overarching themes emerged from the synthesis: social constructs, service provider, service provision, effectiveness, and emotional impact. The findings from this review show that service users continue to have negative experiences in EDs due to stigmatizing attitudes and low skill in managing mental health needs, whereas more positive experiences are attributed to the availability of mental health liaison services. Tackling stigma, improving communication and staff training, providing calm environments, and addressing structural issues that promote better interagency working and reduce gaps in services are needed to improve mental health service user experience. Future research should focus on trauma-informed approaches in EDs to improve person-centred care for service users experiencing a mental health crisis.

Patient and Provider Perspectives on Emergency Department Care Experiences among People with Mental Health Concerns

“…This review demonstrates that a majority of ED experiences are perceived as negative by people with MH concerns. These findings align with recent literature describing predominantly negative experiences of people accessing the ED for mental health crises [ 48 , 49 ]. Similarly, this review highlights challenging provider experiences when caring for people with MH concerns in the ED, which is reflective of recent literature summarizing the perspectives of providers of MH care in the ED [ 21 ].…”

I have not come here because I have nothing better to do: The lived experience of presenting to the emergency department for people with a psychosocial disability and an NDIS plan—A qualitative study

“…(2022) supports the findings of this study that negative experiences in the ED occur when people's expectations are not met due to negative staff attitudes, minimisation of distress, long wait times and denial of treatment. Conversely, positive experiences occur when people receive care from mental health trained staff (Sacre et al., 2022). The results of this study centre on people with a PSD and an NDIS plan yet concur with previous studies reporting on the broader mental health population (Carstensen et al., 2017; Johnston et al., 2019; Roennfeldt et al., 2021; Sacre et al., 2022).…”

“…A systematic review by Sacre et al. (2022) supports the findings of this study that negative experiences in the ED occur when people's expectations are not met due to negative staff attitudes, minimisation of distress, long wait times and denial of treatment. Conversely, positive experiences occur when people receive care from mental health trained staff (Sacre et al., 2022).…”

“…A recovery-focussed therapeutic engagement requires a person-centred approach (Picker, 2013) which can be a challenge within the ED setting (Happell et al, 2019) with its biomedical model focus. A systematic review by Sacre et al (2022) supports the findings of this study that negative experiences in the ED occur when people's expectations are not met due to negative staff attitudes, minimisation of distress, long wait times and denial of treatment. Conversely, positive experiences occur when people receive care from mental health trained staff (Sacre et al, 2022).…”

“…Most participants stated very strongly that they did not present to the ED unless it was critical, and they would not return voluntarily due to their previous experiences in the ED of feeling a burden or not good enough to be treated (Roennfeldt et al., 2021). As alternative services to the ED, for those in mental distress, are emerging and there is nowhere else to go (especially after hours) except the ED, this leads to the conclusion that many will be left in a state that defies comprehension (Sacre et al., 2022).…”