The influx of patients with mental health concerns in Australian Emergency Departments (ED) has become increasingly evident. From October 2022 to September 2023, the Royal Hobart Hospital has consistently witnessed steady numbers in mental health-related presentations to the ED, with suicidal Ideation ranking as the second-highest reason for admission, only behind chest pain. Persistent challenges, such as access block and staffing shortages, have contributed to prolonged waiting periods for these patients. On average, admitted mental health patients spend 15.5 hours waiting for a bed on the ward in the ED, with some enduring up to 72 hours within these confines.

The ‘Umbrella Project’ aims to improve the experience and care received by patients presenting to the emergency department with mental health concerns, and their experience whilst waiting within the department. It is a four-tiered project, addressing several areas of concern.

The first is education, which has so far been the main area of focus for the project. Improving staff levels of education, understanding and confidence with mental health patients should be a top priority for our ED. The project is currently undertaking further research in this area in partnership with the University of Tasmania. The second tier is the introduction of a clinical pathway which will provide staff with a structured and clear evidence-based direction of care. The third tier involves the introduction of distraction resources for patients such as books, video or music library as well as hygiene care packs for those whose stays extend over 12 hours. The final tier will focus on a feedback mechanism to ensure continuous improvement in the project.

Whilst we cannot change the patient flow and waiting times, we can improve the experience for patients presenting to ED with mental health issues. This project sets the foundation for that change.