A&E mental health care in crisis

Published

Credit: Kirsten Colligan

Laurie Clarke, Georgina Hayes & Jen Bowey
Editors & Deputy Editor

Content Warning: This article contains references to self-harm, suicidal ideation and suicide attempts

A Glasgow Guardian survey has revealed that 68.2% of students who visited A&E for a mental health-related issue felt that the treatment they received was not appropriate or adequate for the situation. Of the respondents, 54.5% went to A&E for suicidal ideation or a suicide attempt and 63.6% went to A&E for self-harm.

In response to these statistics, The Glasgow Guardian spoke to six newly qualified nurses on their access to mental health training. None of the respondents believed that their mental health training had been adequate. When asked to specify any mental health training they had received, one respondent answered: “We had an optional mental health module but there were other options that were more popular.” Other respondents answered “a few hours in my first year of simulated practice”, and “two lectures in my final year”.

Shannon Higgins, a nursing student at Glasgow Caledonian University, said: “Unfortunately, I don’t get any training on it [mental health] which is really bad. Because obviously you’re dealing with patients that will have mental health issues but we receive no training on how the care should be carried out in certain situations. It’s really quite bad.”

However, she added that they did gain valuable experience on placement: “We learned and experienced on the job various different mental illnesses manifesting in different ways in our patients. Although we might not have had specific classes on the different mental illnesses like we did for other common illnesses, we did experience things like depression, paranoia, personality disorder and many other things in practice.”

All of the nursing respondents, however, believed that they should have received more mental health training, with one participant suggesting “a whole module and a placement in mental health.”

Patients who attended A&E for a mental health issue interviewed by The Glasgow Guardian all indicated that their experience of A&E failed to meet acceptable standards. One anonymous participant reported arriving at A&E “having self-harmed” and “experiencing particularly intense suicidal ideation”. They said: “The nurse who dealt with us for the majority of the stay was, quite frankly, horrible. He clearly had no training for dealing with mental health-related issues and had no sympathy for any of us, even when I was crying heavily.” After receiving medical attention, the respondent was told to go home with no further guidance: “The entire time I was not a person but someone who had tried to kill themselves, and therefore someone who had given up his right to compassion and humanity.”

Another interviewee described two encounters with A&E following an overdose: “After my bloods were taken, I was left with a cannula in my left arm overnight (in case they needed to administer treatment). It was clear at that point that I wasn’t going to need that treatment so I went up to the nurse at the front desk and I asked if someone could take it off, as it was getting increasingly painful, to which she said something along the lines of ‘if you choose to overdose, this is how we’re going to have to treat you’. I was drained and didn’t have it in me to say anything back, baffled at how cold the nurse had been.” In a subsequent incident, the interviewee described how she was “locked in a ward with no idea what was going to happen next (except that I would be having an ECG scan done for my heart in the next couple of hours) and my boyfriend was not even allowed to stay with me. I thought I was being sectioned and no one was answering any of my questions. My anxiety levels soared and I was up all night pacing around my room, wondering what was coming next and why no one was answering any of my questions.”

Another interviewee described being treated at A&E due to an incident of self-harm: “The nurse was sympathetic but did not seem to know what to do with me. She glued my wound and asked if I felt it was safe for me to return home. I remember not being sure and part of me was hoping I’d be kept in because I knew that I was a danger to myself. However, the nurse seemed to consider this for a moment then told me I would be okay to go home anyway.

“She gave me a phone number for, if I remember correctly, a community mental health nurse and I was relieved that I was being referred for help because I knew I was not coping at all on my own and believed myself to be on a road towards suicide. I phoned this number in the following days and was told that the mere fact that I was contacting them was enough for them to know that I didn’t require their help because they cared for people who were unaware of their own mental deterioration. The conversation probably lasted about two minutes, after which I was left with no support.”

Survey participants reported similar concerns: 54.5% were not urged to stay at the hospital, however 52.4% believed they would have benefited from being kept for observation. A further 50% were not directed to any mental health resources on leaving the hospital, and of those who were only 13.3% felt that they were useful. These negative experiences had lasting results, with 77.8% of those who had to return to A&E after the first incident feeling uncomfortable returning, and a further 52.4% who felt too uncomfortable to return to A&E due to a previous negative experience.

The Glasgow Guardian looked into the training standards that equip NHS nurses to handle mental health-related issues. The NMC (Nursing and Midwifery Council) has confirmed that nursing students must meet base mental health competencies in order to qualify, however, the NMC standards are “not prescriptive” and the number of hours dedicated to mental health training may vary depending on the institution. Universities and learning institutions are required to meet these learning outcomes at their own discretion and there is no mandatory number of hours dedicated to mental health training.

Discrepancies in terms of mental health training hours were evident with regard to specific institutions throughout Scotland. Some institutions, such as Edinburgh University and Edinburgh Napier University, stated that their nursing programmes include mandatory mental health courses and training hours. In comparison, the University of Glasgow responded that there are a “number of compulsory elements but they are not hours based – they tend to be more based on outcomes rather than inputted hours”, explaining that “some students will achieve in less time than others so setting hours is not as meaningful as showing successful outcomes”. When asked what the compulsory training areas were, they listed topics including cardiopulmonary resuscitation, manual handling, prevention and management of violence and aggression and more, but there was no mention of mental health. The University of Glasgow specifically referenced the mental health learning outcomes set by the NMC, which included treating patients with “compassion and dignity”, an ability to “recognise and respond to the needs of all people who come into their care including […] people with mental health problems”, and “to recognise and interpret signs of normal and deteriorating mental and physical health”.

Editor’s note: This article does not seek to criticise the role of NHS medical professionals, but to highlight the ongoing obstacles faced by people with mental illnesses due to a lack of standardised care and funding.