[NYAPRS Enews] ER Staff Attitudes to Patients in MH Crisis 'Often Shocking' in UK

[Briana Gilmore]

NYAPRS Note: This article refers to emergency room staff and their perceptions of mental health crisis in the UK. Though there isn't a precisely similar study from the US, we do know that stigma and bias exists amongst emergency healthcare professionals in this country. But when stigma creates attitudes that are disruptive to appropriate treatment-let alone a person-centered, trauma informed approach-a new framework for approaching emergency mental health situations is necessary. How can new models of care not only present alternatives to emergency rooms, but shift attitudes of "traditional" care staff to appreciate the complexities of mental health crises?

A&E Staff Attitudes to Patients in Mental Health Crisis 'Often Shocking'
The Guardian; Dennis Cambell, 6/11/2015
A&E staff are often unsympathetic to patients suffering a mental health crisis and judgmental about injuries they have inflicted on themselves, the NHS<http://www.theguardian.com/society/nhs> watchdog has said in a report published on Friday.
Unhelpful attitudes among doctors and nurses towards people having delusions or panic attacks or contemplating suicide compounds their mental distress, theCare Quality Commission (CQC)<http://www.theguardian.com/society/care-quality-commission> found.
Widespread failings in the NHS's response to such patients "result in the most vulnerable people in society being abandoned at a time of crisis", said the CQC's deputy chief inspector of hospitals Dr Paul Lelliott.
The behaviour of emergency department staff in particular is "quite shocking", as they should know much better, added Lelliott..
While some parts of England treat people experiencing a crisis well, "far too many people in crisis have poor experiences due to service responses that fail to meet their needs and lack basic respect, warmth and compassion. This is unsafe, unfair and completely unacceptable," an inquiry by a CQC team concluded.
Although the National Institute for Health<http://www.theguardian.com/society/health> and Care Excellence introduced guidelines for treating people who have self-harmed a decade ago, "many services are still failing to provide a caring, empathetic response when presented with a person who may have harmed themselves", said Lelliott, who is also a former NHS consultant psychiatrist.
Delays in accessing quick and compassionate help mean that risks to the health of patients undergoing a crisis, including of self-harm, are increased, the CQC warned.
The worrying picture emerged from evidence submitted by more than 1,750 people who had been through a crisis, and inspections of services to help them in 12 areas of England.
Just one in seven (14%) of the patients surveyed said the care they received provided the right response and helped to resolve their mental health crisis. Another 42% said it had helped a bit. But two in five (40%) said the care they had received was not right and had not helped them resolve their crisis.
"This report makes for painful reading, and seems to suggest an upside-down world in which patients feel they get the worst care where they should be getting the best," said Brian Dow, the director of external affairs at the charity Rethink Mental Illness<http://www.rethink.org/>.
"We need a more sympathetic response: sympathy, understanding and good quality care when a patient walks in the door of A&E, and a sympathetic system where health and social care teams along with charities work in partnership to support the person properly after they are discharged."
Many survey respondents told the CQC that the police and ambulance services were much better at helping them than the three key types of NHS teams that are trained to do so, namely A&E staff, community mental health teams and crisis resolution home treatment teams. GPs, however, received good ratings.
Campaigners said the findings once again underlined the huge gap in standards between the care received by those with mental as opposed to physical ill-health. The report also identified an increasing difficulty getting patients undergoing a crisis into hospital because of an acute shortage of beds.
As a result some patients end up being placed in a hospital a long way from their home, "which can in turn make a crisis worse", the CQC noted.
Katherine Rake, the chief executive of the patient watchdog Healthwatch England<http://www.healthwatch.co.uk/>, said its recent research involving 3,000 people with mental illness echoed the CQC's findings.
"We have heard reports from people that helpline staff were hanging up on them because they were seen as 'difficult' callers. Many others told us they constantly have to explain their circumstances to a chain of professionals because notes cannot be accessed out of hours.
"In one shocking case a female patient ringing late at night was told to 'do a crossword or something' for five hours until the morning when the crisis team would be back in," Rake said.
Alistair Burt, the minister for community and social care, said: "It is clear that there is still a long way to go to make sure everyone is treated compassionately in the right place and at the right time."
http://www.theguardian.com/society/2015/jun/12/ae-staff-attitudes-to-patients-in-mental-health-crisis-often-shocking
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