title: No longer 'flying blind': how access has changed emergency mental health care in rural and remote emergency departments, a qualitative study.
abstract: BACKGROUND
  Mental health presentations are considered to be a difficult aspect of emergency care. Although emergency department (ED) staff is qualified to provide emergency mental health care, for some, such presentations pose a challenge to their training, confidence, and time. Providing access to relevant and responsive specialist mental health care can influence care and management for these patients. The Mental Health Emergency Care-Rural Access Program (MHEC-RAP) is a telepsychiatry program that was established to improve access to specialist emergency mental health care across rural and remote western NSW, Australia.
  
  
  METHODS
  This study uses interviews with ED providers to understand their experience of managing emergency mental health patients and their use of MHEC-RAP. The lens of access was applied to assess program impact and inform continuing program development.
  
  
  RESULTS
  With MHEC-RAP, these ED providers are no longer 'flying blind'. They are also more confident to manage and care for emergency mental health patients locally. For these providers, access to specialists who are able to conduct assessments and provide relevant and responsive advice for emergency mental health presentations was valued. Assessing the fit between the consumer and service as a requirement for the development, evaluation, and ongoing management of the service should result in decisions about design and delivery that achieve improved access to care and meet the needs of their consumers. The experience of these providers prior to MHEC-RAP is consistent with that reported in other rural and remote populations suggesting that MHEC-RAP could address limitations in access to specialist care and change the provision of emergency mental health care elsewhere.
  
  
  CONCLUSIONS
  MHEC-RAP has not only provided access to specialist mental health care for local ED providers, but it has changed their practice and perspective. MHEC-RAP could be adapted for implementation elsewhere. Provider experience confirms that the program is accessible and offers insights to those considering how to establish an emergency telepyschiatry service in other settings.
authors.affiliation: Broken Hill University Department of Rural Health, University of Sydney, PO BOX 457, Broken Hill, NSW, 2880, Australia. emily.saurman@sydney.edu.au.
authors.forename: Emily
authors.initials: E
authors.lastname: Saurman
authors.affiliation: Broken Hill University Department of Rural Health, University of Sydney, PO BOX 457, Broken Hill, NSW, 2880, Australia. sue.kirby@health.nsw.gov.au.
authors.forename: Sue E
authors.initials: SE
authors.lastname: Kirby
authors.affiliation: Broken Hill University Department of Rural Health, University of Sydney, PO BOX 457, Broken Hill, NSW, 2880, Australia. david.lyle@health.nsw.gov.au.
authors.forename: David
authors.initials: D
authors.lastname: Lyle
mesh_terms: D000328:Adult; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration* / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data*; D008875:Middle Aged; D009517:New South Wales; D036301:Qualitative Research; D064694:Rural Nursing / Q000458:organization & administration / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data*