Understanding the reasons for mental health attendances at Royal Blackburn Hospital Emergency Department

Healthwatch Blackburn with Darwen engaged with patients attending Emergency Department for their mental health during September 2024. They carried out surveys with 21 individuals through this engagement. They also made a log of the referrals made to the Mental Health Liaison Team across a two week period in September to understand the themes for attendance, prevalence of alcohol and substance misuse as a factor and whether patients were known to Lancashire and South Cumbria Foundation Trust as their local mental health provider. They then triangulated patient feedback with a survey of LSCFT crisis services staff to understand from them why they felt patients were attending Emergency Department for their mental health.

Over half of the patients Healthwatch spoke with at Emergency Department reported being suicidal or had taken an overdose and three quarters of the patients had spoken to a mental health professional prior to attending the department. Several had been sent to Emergency Department by another professional including Initial Response Service (IRS), Community Mental Health Teams (CMHT) and Home Treatment teams, or just did not know where else to go because they felt they were in crisis.

 A third of the patients were currently receiving mental health support in the community but with mixed experiences of this support. Just under half of the patients  had not accessed the Initial Response Service phoneline due to mainly not knowing about it or because they prefer not to call a mental health service. The majority of patients stated that they would be most comfortable talking about their mental health face to face with a professional.

Healthwatch reviewed a log of attendances across a 2 week period in September whilst they were carrying out interviews with patients. These highlighted that about 80% of patients seen by the Mental Health Liaison team during this time were known to Lancashire and South Cumbria Foundation Trust. It also highlighted the level of patients with dual diagnosis seen by the team in Emergency Department, with approximately 30% having alcohol misuse as a factor for their attendance and 22% having substance misuse as a factor for their attendance. The main reasons for attendance were ‘overdose’, ‘self-harm’ and ‘suicidal’.

Staff generally felt that people attended Emergency Department because they wanted to be seen both quickly and face to face, with no real alternative perceived to be available in the community, perhaps due to lack of communication about these services or a community offer which was not meeting patients’ needs. 

There were mixed views amongst staff about residents feeling comfortable to talk on the phone about the state of their mental health and the majority did not think that patients would feel comfortable ringing IRS once they were in Emergency Department because they could then be seen face to face. 

IRS was seen by staff as a triage and signposting service, however some felt there should be face to assessments delivered by this team for urgent referrals. There were mixed responses from staff as to whether they would make a referral to the Mental Health Liaison team at Emergency Department and there was a perceived lack of information being provided in referrals to the team. Some felt that referrals were made because there was a lack of ‘an appropriate safe place’ in the community. 

Factors impacting on numbers of residents attending Emergency Department included lack of support in the community, social issues combined with lack of support and an expectation of an urgent response from patients coupled with a lack of awareness of community services.

Improvements to help reduce Emergency Department attendances included increased face to face appointments through IRS, increased offer from Community Services, an increased primary care offer and reconfiguration of the support for mental health within Emergency Department.