Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-09T01:32:50.587Z Has data issue: false hasContentIssue false

Chapter 23 - Emergency Department Psychiatry

Published online by Cambridge University Press:  04 January 2024

By
Alex Thomson  and
Rikke Albert
Edited by
Rachel Thomasson ,
Elspeth Guthrie  and
Allan House
Rachel Thomasson
Affiliation:
Manchester Centre for Clinical Neurosciences
Elspeth Guthrie
Affiliation:
Leeds Institute of Health Sciences
Allan House
Affiliation:
Leeds Institute of Health Sciences
Get access

Summary

The emergency department (ED) is at the heart of the health system for responding to urgent health needs. In addition to patients with psychiatric emergencies, many patients attending ED with medical emergencies have concurrent mental health needs. Given the urgency, variety and need for clinical skills and systems leadership in a fast-paced environment, this area of liaison psychiatry is both challenging and rewarding as a field in which to develop specialist expertise.

Type
Chapter
Information
Seminars in Consultation-Liaison Psychiatry , pp. 373 - 388
Publisher: Cambridge University Press
Print publication year: 2024

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Sands, N, Elsom, S, Colgate, R, Haylor, H, Prematunga, R. Development and interrater reliability of the UK Mental Health Triage Scale. Int J Ment Health Nurs. 2016;25(4):330–6.CrossRefGoogle ScholarPubMed
Brown, S, Eales, S, Hayhurst, C et al. Side by side: A UK-wide consensus statement on working together to help patients with mental health needs in acute hospitals. The Royal College of Psychiatrists, The Royal College of Nursing, The Royal College of Emergency Medicine and The Royal College of Physicians. 2020, p. 8. www.rcpsych.ac.uk/docs/default-source/members/faculties/liaison-psychiatry/liaison-sidebyside.pdf.Google Scholar
Shah, SJ, Fiorito, M, McNamara, RM. A screening tool to medically clear psychiatric patients in the emergency department. J Emerg Med. 2012;43(5):871–5.CrossRefGoogle ScholarPubMed
Carstensen, K, Lou, S, Groth Jensen, L et al. Psychiatric service users’ experiences of emergency departments: A CERQual review of qualitative studies. Nord J Psychiatry. 2017;71(4):315–23.CrossRefGoogle ScholarPubMed
The National Confidential Enquiry into Patient Outcome and Death. Treat as one. London; 2017.Google Scholar
Happell, B, Ewart, SB, Bocking, J, Platania-Phung, C, Stanton, R. ‘That red flag on your file’: Misinterpreting physical symptoms as mental illness. J Clin Nurs. 2016;25(19–20):2933–42.CrossRefGoogle ScholarPubMed
Thornicroft, G, Rose, D, Kassam, A. Discrimination in health care against people with mental illness. Int Rev Psychiatry. 2007;19(2):113–22.CrossRefGoogle ScholarPubMed
Shefer, G, Cross, S, Howard, LM, Murray, J, Thornicroft, G, Henderson, C. Improving the diagnosis of physical illness in patients with mental illness who present in emergency departments: Consensus study. J Psychosom Res. 2015;78(4):346–51.CrossRefGoogle ScholarPubMed
Quinlivan, LM, Gorman, L, Littlewood, DL et al. ‘Relieved to be seen’: Patient and carer experiences of psychosocial assessment in the emergency department following self-harm – Qualitative analysis of 102 free-text survey responses. BMJ Open. 2021;11(5):e044434.CrossRefGoogle ScholarPubMed
NHS Protect. Meeting needs and reducing distress: Guidance on the prevention and management of clinically related challenging behaviour in NHS settings . London; 2013. www.crisisprevention.com/CPI/media/Media/Blogs/Meeting-needs-and-reducing-distress-NHS-Protect-CB.pdf.Google Scholar
National Institute for Health and Care Excellence. Violence and aggression: Short-term management in mental health, health and community settings . London; 2015. Report no. NG10. www.nice.org.uk/guidance/NG10.Google Scholar
Strömmer, EMF, Leith, W, Zeegers, MP, Freeman, MD. The role of restraint in fatal excited delirium: A research synthesis and pooled analysis. Forensic Sci Med Pathol. 2020;16(4):680–92.CrossRefGoogle ScholarPubMed
Locker, TE, Baston, S, Mason, SM, Nicholl, J. Defining frequent use of an urban emergency department. Emerg Med. 2007;24(6):398–401.Google ScholarPubMed
Burton, C, Stone, T, Oliver, P, Dickson, JM, Lewis, J, Mason, SM. Frequent attendance at the emergency department shows typical features of complex systems: Analysis of multicentre linked data. Emerg Med. 2022;39(1):3–9.Google ScholarPubMed
Fuda, KK, Immekus, R. Frequent users of Massachusetts emergency departments: A statewide analysis. Ann Emerg Med. 2006;48(1):9–16.CrossRefGoogle ScholarPubMed
Shefer, G, Henderson, C, Howard, LM, Murray, J, Thornicroft, G. Diagnostic overshadowing and other challenges involved in the diagnostic process of patients with mental illness who present in emergency departments with physical symptoms: A qualitative study. Dekel, S, editor. PLoS ONE. 2014;9(11):e111682.CrossRefGoogle ScholarPubMed
Thomson, AB, McAllister, E, Veale, D. Frequent attendance with self-harm: What might you be missing? Emerg Med. 2020;37(6):331–44.Google ScholarPubMed
Pines, JM, Asplin, BR, Kaji, AH et al. Frequent users of emergency department services: Gaps in knowledge and a proposed research agenda. Acad Emerg Med. 2011;18(6):e64–9.CrossRefGoogle Scholar
Anonymous. The crime of wanting to die: My story from Scotland. Recovery in the Bin. 2020. https://recoveryinthebin.org/2020/10/09/the-crime-of-wanting-to-die-my-story-from-scotland.Google Scholar
NHS Improvement Scotland. Patient experience Anticipatory Care Planning Team (PACT): Scalability assessment. Edinburgh; 2019. https://ihub.scot/media/6477/lwic-pact-report.pdf.Google Scholar
The StopSIM Coalition. StopSIM Coalition consensus statement. 2021. https://stopsim.co.uk/2021/04/21/stopsim-coalition-consensus-statement.Google Scholar
Eales, S, Molodynski, A, McAllister, E, Thomson, AB. Responsibility, judgement and ethics: Suicide and criminal justice. Edinburgh; 2022. www.rcpsych.ac.uk/events/congress.Google Scholar
National Institute for Health and Care Excellence. Self-harm: Assessment, management and preventing recurrence. London; 2022. www.nice.org.uk/guidance/indevelopment/gid-ng10148/documents.Google Scholar
Thomson, AB, Eales, S, McAllister, E, Molodynski, A. Criminal sanctions for suicidality in the 21st century UK. BJPsych. 2022;221(5):653–4.Google Scholar
Soril, LJJ, Leggett, LE, Lorenzetti, DL, Noseworthy, TW, Clement, FM. Reducing frequent visits to the emergency department: A systematic review of interventions. Gupta, V, editor. PLoS ONE. 2015;10(4):e0123660.CrossRefGoogle Scholar
Chandler, A. Self-Injury, Medicine and Society: Authentic Bodies. London; 2016.CrossRefGoogle Scholar
Sullivan, P. Epistemic injustice and self-injury: A concept with clinical implications. Philos Psychiatr Psychol. 2019;26(4):349–62.CrossRefGoogle Scholar
BBC News. Nurse jailed for raping patient at east London hospital. 2018. www.bbc.com/news/uk-england-london-44730147.Google Scholar
Care Quality Commission. Right Here Right Now: People’s Experiences of Help, Care and Support during a Mental Health Crisis. London; 2015.Google Scholar
DrEm_79. Self harm and the emergency department. BMJ. 2016;353:i1150.Google Scholar
McDonald, V. Hospital security staff ‘abused’ vulnerable patients. Channel 4 News. 2021. www.channel4.com/news/hospital-security-staff-abused-vulnerable-patients.Google Scholar
Barber, S, Gronholm, PC, Ahuja, S, Rüsch, N, Thornicroft, G. Microaggressions towards people affected by mental health problems: A scoping review. Epidemiol Psychiatr Sci. 2019;29:e82.Google ScholarPubMed
Anonymous. I am more than a body to stitch up and label. BMJ. 2021;n1003.CrossRefGoogle Scholar
Thomson, AB. Testimonial and hermeneutical injustices in adult protection and patient safety: Practical lessons for psychiatrists. In Philosophy Special Interest Group Biennial Conference. London; 2021.Google Scholar
Thomson, AB, Nyein, C, Clarke, M. Protection and safeguarding of vulnerable adults and children from violence. In Tyrer, P, Khwaja, M (eds.), Prevention and Management of Violence: Guidance for Mental Healthcare Professionals, 2nd ed. Cambridge; 2021.Google Scholar
Geulayov, G, Kapur, N, Turnbull, P et al. Epidemiology and trends in non-fatal self-harm in three centres in England, 2000–2012: Findings from the Multicentre Study of Self-harm in England. BMJ Open. 2016;6(4):e010538.CrossRefGoogle ScholarPubMed
Stone, H, Barrett, K, Beales, D et al. Self-harm and suicide in adults: Final report of the Patient Safety Group. London; 2020. Report no. CR229. www.rcpsych.ac.uk/improving-care/campaigning-for-better-mental-health-policy/college-reports/2020-college-reports/cr229.Google Scholar
Beale, C. Magical thinking and moral injury: Exclusion culture in psychiatry. BJPsych Bulletin. 2021;14:1–4.Google Scholar
Department of Health. No health without mental health: A cross-government outcomes strategy. London; 2011. www.gov.uk/government/publications/no-health-without-mental-health-a-cross-government-outcomes-strategy.Google Scholar
Walsh, DAB, Foster, JLH. A call to action: A critical review of mental health related anti-stigma campaigns. Public Health Front. 2021;8. www.frontiersin.org/article/10.3389/fpubh.2020.569539.Google ScholarPubMed
Gask, L, Thomson, AB. Suicide prevention in clinical practice. In Khan, M, Poole, R, Robinson, C (eds.), Preventing Suicide: An Evidence Based Approach, 1st ed. Cambridge; in press.Google Scholar
Care Quality Commission. How CQC identifies and responds to closed cultures. 2021. www.cqc.org.uk/guidance-providers/all-services/how-cqc-identifies-responds-closed-cultures.Google Scholar
Mujal, GN, Taylor, ME, Fry, JL, Gochez-Kerr, TH, Weaver, NL. A systematic review of bystander interventions for the prevention of sexual violence. Trauma Violence Abuse. 2021;22(2):381–96.CrossRefGoogle ScholarPubMed
Rowe, BH, Channan, P, Bullard, M et al. Characteristics of patients who leave emergency departments without being seen. Acad Emerg Med. 2006;13(8):848–52.CrossRefGoogle ScholarPubMed
Rathlev, NK, Visintainer, P, Schmidt, J, Hettler, J, Albert, V, Li, H. Patient characteristics and clinical process predictors of patients leaving without being seen from the emergency department. West J Emerg Med. 2020;21(5):1218–26.CrossRefGoogle ScholarPubMed
DrEm_79. Commentary: ‘I’ve lost count of the times my door has been broken by the police’. BMJ. 2017;356. www.bmj.com/content/356/bmj.j1165.Google Scholar
Hallett, N, Duxbury, J, McKee, T et al. Taser use on individuals experiencing mental distress: An integrative literature review. J Psychiatr Ment Health Nurs. 2021;28(1):56–71.CrossRefGoogle ScholarPubMed
Cardinal, RN, Bullmore, E, Bullmore, ET. The Diagnosis of Psychosis. Cambridge; 2011.CrossRefGoogle Scholar
Han, JH, Shintani, A, Eden, S et al. Delirium in the emergency department: An independent predictor of death within 6 months. Ann Emerg Med. 2010;56(3):244–52.e1.CrossRefGoogle ScholarPubMed
Healthcare Improvement Scotland. SIGN 157. Risk reduction and management of delirium: A national clinical guideline. 2019. www.sign.ac.uk/media/1423/sign157.pdf.Google Scholar
Oliveira, JE, Silva, L, Berning, MJ et al. Risk factors for delirium in older adults in the emergency department: A systematic review and meta-analysis. Ann Emerg Med. 2021;78(4):549–65.Google Scholar
National Institute for Health and Care Excellence. Dementia: Assessment, management and support for people living with dementia and their carers. London; 2018. www.nice.org.uk/guidance/ng97.Google Scholar
Burry, L, Mehta, S, Perreault, MM et al. Antipsychotics for treatment of delirium in hospitalised non‐ICU patients. Cochrane Database of Systematic Reviews. 2018;6. www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005594.pub3/full.Google ScholarPubMed
Dark, T, Flynn, HA, Rust, G, Kinsell, H, Harman, JS. Epidemiology of emergency department visits for anxiety in the United States: 2009–2011. Psychiatr Serv. 2017;68(3):238–44.CrossRefGoogle ScholarPubMed
Palombini, E, Richardson, J, McAllister, E, Veale, D, Thomson, AB. When self-harm is about preventing harm: Emergency management of obsessive-compulsive disorder and associated self-harm. BJPsych Bulletin. 2021;45(2):109–14.CrossRefGoogle ScholarPubMed
Fuller-Thomson, E, Carroll, SZ, Yang, W. Suicide attempts among individuals with specific learning disorders: An under-recognized issue. J Learn Disabil. 2018;51(3):283–92.CrossRefGoogle Scholar
Neale, J, Parkman, T, Day, E, Drummond, C. Socio-demographic characteristics and stereotyping of people who frequently attend accident and emergency departments for alcohol-related reasons: Qualitative study. Drugs Educ Prev Policy. 2017;24(1):67–74.CrossRefGoogle Scholar
Freeman, L, Stewart, H. Epistemic microaggressions and epistemic injustices in clinical medicine. In Sherman, BR, Goguen, S (eds.), Overcoming Epistemic Injustice: Social and Psychological Perspectives. London; 2019.Google Scholar
Tracy, DK, Rix, KJB. Malingering mental disorders: Clinical assessment. BJPsych Adv. 2017;23(1):27–35.CrossRefGoogle Scholar
Khalifeh, H, Johnson, S, Howard, LM et al. Violent and non-violent crime against adults with severe mental illness. BJPsych. 2015;206(4):275–82.Google ScholarPubMed
Khalifeh, H, Moran, P, Borschmann, R et al. Domestic and sexual violence against patients with severe mental illness. Psychol Med. 2015;45(4):875–86.CrossRefGoogle ScholarPubMed
National Institute for Health and Care Excellence. Domestic violence and abuse. London; 2016. Report no. QS116. www.nice.org.uk/guidance/qs116.Google Scholar
Royal College of Psychiatrists. Parents as patients: Supporting the needs of patients who are parents and their children . London; 2011. Report no. CR164. www.rcpsych.ac.uk/improving-care/campaigning-for-better-mental-health-policy/college-reports/2011-2013-college-reports.Google Scholar
Homeless Link. Homeless health needs audit. www.homeless.org.uk/our-work/resources/homeless-health-needs-audit.Google Scholar
Rahman, MS, Kapur, N. Quality of risk assessment prior to suicide and homicide. Psychiatr Bull. 2014;38(1):46–7.CrossRefGoogle ScholarPubMed
Dorney-Smith, S, Schneller, K, Swift, A, Phelan, H, Khan, Z. Meeting the needs of homeless people attending the emergency department. Emerg Nurse. 2020;28(4):31–9.CrossRefGoogle ScholarPubMed
Pathway. Providing legal advice to destitute homeless patients in London: Evaluation report. London; 2019. www.pathway.org.uk/publication/providing-legal-advice-to-destitute-homeless-patients-in-london-evaluation-report.Google Scholar
Timms, P, Drife, J. Mental health services for single homeless people. BJPsych Adv. 2021;27(2):104–14.CrossRefGoogle Scholar
Waterman, LZ, Katona, C, Katona, C. Assessing asylum seekers, refugees and undocumented migrants. BJPsych Bull. 2020;44(2):75–80.CrossRefGoogle ScholarPubMed
Baugh, C, Blanchard, E, Hopkins, I (eds.). Quality Standards for Liaison Psychiatry Services, 6th ed. London; 2020. www.rcpsych.ac.uk/improving-care/ccqi/quality-networks-accreditation/psychiatric-liaison-accreditation-network-plan/plan-standards.Google Scholar
Tadros, G, Salama, RA, Kingston, P et al. Impact of an integrated rapid response psychiatric liaison team on quality improvement and cost savings: The Birmingham RAID model. Psychiatrist. 2013;37(1):4–10.CrossRefGoogle Scholar
Care Quality Commission. Assessment of mental health services in acute trusts. London; 2020. www.cqc.org.uk/publications/themed-work/assessment-mental-health-services-acute-trusts.Google Scholar
Aitken, P, Robens, S, Emmens, T. Liaison psychiatry services: Guidance. Strategic Clinical Network for Mental Health, Dementia and Neurological Conditions South West. 2014. https://mentalhealthpartnerships.com/category/innovation/severe-mental-illness/liaison-psychiatry-services.Google Scholar
Parmar, N, Bolton, J. Alternatives to emergency departments for mental health assessments during the COVID-19 pandemic. London; 2020. www.rcpsych.ac.uk/docs/default-source/members/faculties/liaison-psychiatry/alternatives-to-eds-for-mental-health-assessments-august-2020.pdf?sfvrsn=679256a_2.Google Scholar
NHS Health Education England, University College London, National Collaborating Centre for Mental Health. Self-harm and suicide prevention competence framework: Adults and older adults. London; 2018. www.hee.nhs.uk/our-work/mental-health/self-harm-suicide-prevention.Google Scholar
Trigwell, P, Kustow, J, Santhouse, A et al. Framework for routine outcome measurement in liaison psychiatry (FROM-LP). London; 2015. Report no. FR/LP/02.Google Scholar
NHS England, National Collaborating Centre for Mental Health, National Institute for Health and Care Excellence. Achieving better access to 24/7 urgent and emergency mental health care – part 2: Implementing the evidence-based treatment pathway for urgent and emergency liaison mental health services for adults and older adults – Guidance. London; 2016. www.england.nhs.uk/publication/achieving-better-access-to-247-urgent-and-emergency-mental-health-care-part-2-implementing-the-evidence-based-treatment-pathway-for-urgent-and-emergency-liaison-mental-health-services-for–2.Google Scholar
National Institute for Health and Care Excellence. Service user experience in adult mental health: Improving the experience of care for people using adult NHS mental health services. London; 2011. Report no. CG136. www.nice.org.uk/guidance/cg136.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×