title: Barriers to the operation of mental health legislation in Australian emergency departments: a qualitative analysis.
abstract: This study aimed to describe the perceived barriers faced by emergency clinicians in utilising mental health legislation in Australian hospital emergency departments. A semi-structured interview methodology was used to assess what barriers emergency department doctors and nurses perceive in the operation of mental health legislation. Key findings from the interview data were drawn in accordance with the most commonly represented themes. A total of 36 interviews were conducted with 20 members of the Australasian College for Emergency Medicine and 16 members of the College for Emergency Nursing Australasia representing the various Australian jurisdictions. Most concerning to clinicians were the effects of access block and overcrowding on the appropriate use of mental health legislation, and the substandard medical care that mental health patients received as a result of long periods in the emergency department. Many respondents were concerned about the lack of applicability of mental health legislation to the emergency department environment, variation in legislation between States and Territories causing problems for clinicians working interstate, and a lack of knowledge and training in mental health legislation. Many felt that clarification of legislative issues around duty of care and intoxicated or violent patients was required. The authors conclude that access block has detrimental effects on emergency mental health care as it does in other areas of emergency medicine. Consideration should be given to uniform national mental health legislation to better serve the needs of people with mental health emergencies.
authors.affiliation: Emergency Practice Innovation Centre, St Vincent's Hospital, Melbourne, PO Box 2900, Fitzroy, Vic 3065, Australia. Melbourne, Australia. George.jelinek@gmail.com
authors.forename: George
authors.initials: G
authors.lastname: Jelinek
authors.forename: Claire
authors.initials: C
authors.lastname: Mackinlay
authors.forename: Tracey
authors.initials: T
authors.lastname: Weiland
authors.forename: Nicole
authors.initials: N
authors.lastname: Hill
authors.forename: Marie
authors.initials: M
authors.lastname: Gerdtz
mesh_terms: D001291:Attitude of Health Personnel; D001315:Australia; D003134:Commitment of Persons with Psychiatric Disorders / Q000331:legislation & jurisprudence*; D004636:Emergency Service, Hospital; D006801:Humans; D007407:Interviews as Topic; D008505:Medical Staff, Hospital; D020380:Needs Assessment; D009741:Nursing Staff, Hospital