Disparity between physical and mental healthcare

Two patients attend the ED, one with a broken arm and one with a self harm wound. They get treated the same right? Although I like to think that I would treat them the same, the answer from my patients would say there are significant differences between staff members.

I like to get to know my patients and I like to find out about some of their experiences with accessing healthcare. Patients attending the ED with mental health problems have told me all sorts of experiences over time. A patient with a self harm wound was told by a doctor she didn’t need local anaesthetic because she deserved to have pain when he was stitching her up, a patient having parvolex after an overdose was left on their own while in distress and vomiting, she felt ignored by the nursing staff. A distressed patient had security and the police called while she was distressed instead of someone talking to her.

I find it incredibly sad that a patient can attend the ED with a broken arm, they get some pain relief, something to support their arm, an x-ray to find out what was wrong and some prompt treatment, and a patient with a mental health problem can be put in a cubicle, ignored, have the police called. I’ve always known there is stigma around mental health conditions but I didn’t expect to find the stigma in the ED. It is like ED staff don’t always know what to do with a patient in mental health crisis. Maybe the ED isn’t the right place for someone in a mental health crisis? Although it is the one place where you can go with absolutely anything wrong and they can point you in the right direction. I think that initial contact with someone has the ability to be able to calm a crisis or exacerbate it.

One in four people will have a mental health crisis at some time in their life. Many of those will attend the ED, whether right or wrong, usually patients I meet are reluctantly in the ED, either because a friend relative or police have made them. Or because there just aren’t enough availability of services in the community.

I think we need to change how we approach mental health conditions all round. So how could that be done? Offer training to ED staff in emotional first aid? Or address the stigma related to mental health? https://www.time-to-change.org.uk Put mental health nurses in the ED, to help support the ED staff.

So a patient comes to the ED with a soft tissue injury are told to RICE the injury, so Rest, Ice, Compression, Elevation for the injury to improve. Could we use a similar principle with mental health, so could we help patients to RICE their injury:

  • Risk assess, Refer if required
  • Investigate causes, Could there be a medical reason?
  • Chat
  • Explore ways of coping

Maybe it is time to think of the patients differently instead of treating their specific  conditions and treat them from a holistic viewpoint.