Table 5 Subthemes identified for the main theme – availability of Mental Health expertise in the ED

A. Lack of Mental Health expertise in ED affects system efficiency

I think it reassures the patient as well, being seen by someone who is a mental health worker…They can give them a bit of an idea about what’s going on, whereas for the most part, all we tell them is ‘We’ll wait for the interview at [nearby regional centre]’. [Nurse 1]

There’s no psych registrar, no psychiatrist, no-one on the ground that can assist... so when I have to come back and make the calls, having someone that can sit with mental health consumers, be with them and talk to them and calm them down, that would be helpful … If there was a mental health social worker that we have access to that we could sort of - weekends and after hours, we have a lot of presentations for D&A come in. It sort of lands back on mental health…and patients have to wait. [Nurse 2]

Designated mental health workers in EDs are an absolute essential because they understand the schedules, the legal requirements. They are constantly educating us on how we’re supposed to go about a job and guiding and directing us as to where we’re going, and the junior doctors as well. [Nurse 4]

B. Critical Need for Mental Health liaison nurse in the ED

I think there’s a big gap when there’s no liaison nurse, no mental health liaison nurse. When they’re not here, there’s a massive gap in the mental health services that we provide. In essence, we provide none. [With the MHCL] the big difference if that you have a plan much much earlier. [Nurse 1]

I think because they’re so qualified in mental health and de-escalation. They set a tone and they give such guidance with their level of experience and exposure, understanding their patient history. [Nurse 4]

We’ve actually got three of them [MHCLs] that are brilliant and they’re very quick at picking up things … I really appreciate their input and they’re very experienced. [Nurse 7]

Because they’re [MHCL] a specialist in that field. They’ve got the resources. They’ve got the contacts. It’s like me talking to ICU, or me talking to admin. I know exactly who I’ve got to talk to, what I’ve got to do, what I’ve got to do to get that resource. Same with the mental health side of things. [Nurse 5]

C. Afterhours patient management

It’d be nicer to have them [MHCL] a bit longer rather than have to get onto the video link-up because when you get onto the video link-up, you have to wait. You have to get in a queue because they [MHEC-RAP] do a third of the state. [Nurse 7]

They’re [MHEC-RAP] not always available immediately to do assessments, patients have to wait, patients get annoyed with waiting. [Nurse 2]

Sometimes our mental health patients can sit there for three/four hours, depending on how busy MHEC is. And, you can imagine having an agitated, maybe paranoid– trying to reassure someone like that for four hours…it’s very, very difficult … they’re all waiting for the same camera in the same room with the same person based out of [nearby regional centre] [Nurse 1]

It’s harder to get them assessed afterhours, especially on evening or night shift when there’s no cover, or weekends. [Nurse 6]

There are people who work in the Department who are really great in assessing patients but afterhours it’s not so great in terms of staff and referral especially when you’re facing them [mental health patients] more then. [Doctor 2]

D. Need for on-call psychiatrist

The buck stops here kind of thing … with no psychiatrist seeing them. I talk to them on the phone and they’re going purely off what I’ve seen, so it’s not like they’re seeing the patient… so that to me is concerning. [Nurse 2]

Because they could see the patients and assess them here and then they wouldn’t need to be transferred anywhere, they could deal with them here and go home or something. [Nurse 3]

No because the psychiatrist themselves is never going to come and see the patient. You still need your liaison nurse to physically see the patient. [Nurse 1]

We sort of do with the telephone. Would I love it if we had one here? Absolutely. Would it be an appropriate use of resources? No. When you consider the presentations of MH compared to medical, we couldn’t justify having a psychiatrist on site here, not just for the ED, possibly in the community section. [Nurse 4]