An A&E for Mental Illness

05/09/2013 11:26 BST | Updated 04/11/2013 10:12 GMT

Accident and emergency. Even the term is in conflict, since an accident is not necessarily an emergency, and vice versa. You know the stereotype - waiting rooms stretched to capacity with sprained ankles, upset stomachs and flu. The flipside of the so-called 'time wasters', who visit A&E when a GP appointment would suffice, is a barrage of schoolyard horror stories; the cardiac arrest dismissed as a bad case of indigestion, or the headache that instigated an early bedtime, never to wake.

Obviously it's important to seek a professional opinion when an injury or illness occurs, and there are avenues for those medical conditions which are not serious or immediately life-threatening, albeit inadequate for some. But when a person presents themselves to an emergency department in crisis and suicidal, or otherwise fearing for their own safety or that of others, should the response be so different to that awarded complaints of breathing difficulty or sudden inexplicable pain?

The NHS recognises, on paper at least, that a rapid decline in a person's mental or emotional state can be treated as a mental health emergency; 'It's important to get help as soon as possible.' In practice, however, I would question what commitment exists in our hospitals to help people experiencing genuine mental health emergencies, and even those with ongoing mental illness requiring hospitalisation and long-term care.

Of course, it would be naïve to act with the expectation that a psychotic episode is regarded as equally serious to head trauma sustained in a car crash, for instance. In a general hospital A&E department, it simply isn't so. Triage is designed to determine which patients are seen by a doctor first, but physical rather than emotional pain is arguably prioritised. Complex and at times contradictory symptoms of mental illness can be easily missed or overlooked, and with the added and irrefutable presence of social stigmas toward mental health problems, not everyone is treated appropriately.

A recent review of UK police interventions, where mental illness (or the perception of mental illness) played a part in serious injury and even death, showed that calls to emergency services were wrongfully interpreted as concerning strictly criminal affairs. The Independent Commission on Mental Health and Policing found these calls might have best been treated as medical emergencies because behaviors described - displayed by suspects, victims, or witnesses - were in fact symptomatic of a mental health crisis. This highlights that it is not only hospitals that struggle to address mental illness, then.

A similar account of A&E interventions in mental health would be a positive step towards properly addressing the needs of yet another marginalised section of the community. The Care Quality Commission (CQC) has already revealed sub-standard emergency practices for the mentally ill, the worst cases occasioning death. And there are extreme cases; one Fletchers client claimed successfully against an NHS trust that neglected her husband to the point he died in hospital in a state of starvation. While the cause of his death remains a strictly physiological account, it's impossible to rule out how stigma surrounding his severe depression and threats of self-harm might have influenced his care, even subconsciously.

We know that mental illness is real, and that people can suffer in serious and life-threatening ways. The very nature of an emergency demands pace and immediate help, so it is vital that emergency services are trained and supported but also expected to appropriately manage mental health.