61% increase in referrals to mental health hospitals

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Emergency services are back to pre-pandemic heights, with a continuing gap in mental health services leading to an increase in the number of patients at risk.

Many at-risk patients who present to hospital emergency departments have preventable health problems that could be treated with appropriate primary care.


Behavioral change triggered by the rise of COVID in 2019-2020 resulted in a 1.4% drop in emergency department referrals in public hospitals, in contrast to a steady annual average growth of 3.2% between 2014-15 and 2018-19.

But new data from the Australian Institute of Health and Welfare (AIHW), encompassing national, state and territorial data, the local hospital network and hospital-specific data on the MyHospitals platform, suggests that this reduction will likely be a one-year anomaly.

Strong border policies, public health measures and the introduction of effective vaccines have once again allowed Australia to open up in 2020-2021, but increased freedoms have also been accompanied by an increase in emergency room appearances. – this time by 6.9% – in a return to the trend observed in the pre-pandemic years.

In 2020-2021, there were 8.8 million hospital emergency department referrals, up from 8.2 million in 2019-2020. The majority of these presentations were made up of children aged 0-4 (10%) and people over 65 (21%), with men accounting for 49% of all presentations and women 51%.

While many of these presentations were due to physical illnesses, an increase in mental health issues has also meant that hospitals in downtown Melbourne and Sydney are reporting an ‘influx’ of people with mental illness, addiction. to drugs and alcohol and homelessness.

And according to a report released by St Vincent’s Hospital, a gap in mental health services and community care is contributing to the increase, with many at-risk patients seen at St Vincent’s Hospitals in Melbourne and Sydney with health problems. preventable health that “could be treated with primary care tailored and specific to needs”.

The report, which followed the presentations and findings with a focus on vulnerable ‘at risk’ populations in its Sydney and Melbourne hospitals, shows that emergency department mental health referrals have increased by 61% over the years. eight years until 2020 in this cohort, against 11% among the other patients.

At both hospitals, about one in five patients and one in three of all patient interactions during the eight-year period were related to someone from an “at risk” group.

‘[These patients] do not receive the appropriate care they need in the community, and subsequently there is often no place to go other than a hospital – although a hospital may not necessarily be the best place to them to receive the medical care they need, ”Dr. Rachel Zordan, co-author of the report, said.

“There is clearly a gap in current services. We need to make sure that we have the right health services in place to meet the unique needs of “at risk” groups, so that they receive the right care before they need to go to an emergency hospital.

“At the same time, hospitals need to re-examine their models of care to ensure that what they offer is doing the job needed for vulnerable people.”

RACGP President Dr Karen Price said the cost and lack of community support services prevent this vulnerable population group from seeing their GP.

Dr Cathy Andronis, President of the RACGP in Psychological Medicine of Special Interest, said gp news that linking emergency departments to general practice is a key method in reducing unnecessary hospital referrals.

‘It is unfortunate that [some] doctors in emergency departments, especially in cities, do not have local knowledge of general practitioners in their neighborhood with whom a close working relationship and an understanding of the [general practice] The context would allow them to refer patients to local general practitioners, where a good longitudinal relationship of work and trust could be established, ”she said.

“People come to the emergency room when they feel they need immediate action or symptom relief, and they want to see a doctor face to face.

“Unfortunately, a lot of people don’t have a regular GP, so they don’t see primary care as the first port of call.

“General practitioners should be encouraged to get in touch with the emergency department of their local hospital and let them know about our valuable work and our ability to manage patients with all kinds of conditions, and especially mental health. . “

The recent submission of the RACGP to the draft national strategy for the mental health workforce reiterates the central role of general practitioners in the delivery of mental health care.

However, Dr Andronis believes there has also been a mistaken belief that general practitioners now use telehealth “primarily”.

“If a person doesn’t have an established relationship with a GP, they may feel too eager to access healthcare with a ‘stranger’ they can’t see,” she said.

“Humans are not virtual beings; we are true physical beings who obtain the comfort of human touch and the ability of a caring professional to provide social regulation of our emotional state of distress. ‘

Mental health problems were among the top 20 most common diagnoses of emergency room presentations in 2020-2021, according to the AIHW.

There were 309,657 emergency room presentations classified as “mental and behavioral disorders” as the primary diagnosis. Among these, the proportion of admitted patients was 35%.

The most common primary diagnosis, accounting for 2.1 million emergency room presentations, was “symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified.”

This was followed by the primary diagnosis of “injury, poisoning and certain other consequences from external causes”.

In the first months of the COVID-19 pandemic in Australia, the average number of daily emergency room presentations in Australia declined significantly, the lowest point being 16,200 presentations on average each day during the week starting on the 30th. March 2020, compared to 26,000 daily presentations in the week starting March 9.

In June 2021, the average number of daily presentations increased to 25,700.

“A lot of people were too scared to look after their health because of their perception of hospitals as dangerous and posing a risk of COVID,” said Dr Andronis.

“Now that most people are vaccinated, that fear has been dispelled, but not the backlog of health problems, both physical and mental.

“There is a lot of catching up needed and GPs are perfectly suited to handle it. “

St Vincent’s report identified that people belonging to risk groups interact across the general health system, rather than using only specialized services.

Dr Andronis said this highlights the role of GPs in providing mental health care and managing appropriate referral pathways.

“General practitioners must remain at the center of the health care system by being recognized by local hospitals and state and federal governments,” she said.

“We are accessible, affordable, available, capable and efficient, and understand the health system as a whole better than any other health care professional.

“We understand people and their needs holistically and are able to engage with people for the long term. “

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