Overview

TITLE
Parkes Mental Health and Drug and Alcohol Service Emergency Department Pathway

LEAD AGENCIES 
Western Local Health District Mental Health and Drug and Alcohol Service (WLHD MHDA), Parkes

PROJECT OVERVIEW
WLHD MHDA enhanced the experience in waiting rooms and assessment rooms in the Parkes Emergency Department (ED), based on feedback from people with lived experience of mental health issues. MHDA first improved the physical environment. Peer workers trained clinical and non-clinical staff. The project received strong, visible senior leader support for process changes. Together, these changes support a cultural change to improve understanding and support of people experiencing mental health issues and their carers, in the unit and ward. Emotional support is a focus of WLHD and is supported by trauma-informed care and incidental counselling training.

Lived Experience Framework: Actions to achieve change

  • Focus: Shift how we do things, our assumptions, cultures we foster, and stories we tell
  • Co-design health service environments: with people with lived experience of mental health issues and caring, families and kinship groups to provide care in a most respectful environment 
  • Culture change: Undertake and document mandatory staff training on holistic, person-centered, recovery-oriented and trauma-informed care in all mental health and social services
  • Leadership inclusion: Leaders are committed to collaboration, transparency, shared power in leadership and shared responsibility.

Challenge

Users of the Parkes ED noted waiting times, a lack of privacy, location and the general environment of the safe assessment room (across from the resuscitation bay) as challenging. Triggers identified in the safe assessment room included the clinical bed, trolley, plain/bland white walls with nothing to look at, and a lack of instruction on filling out a details form on arrival.

People noted they found it difficult to express to staff why they are presenting when feeling highly anxious and how a busy ED can be quite traumatising. Does the Triage “Rating Scale” allow for people presenting with a mental health issue? Are staff attitudes subjective and/or driven by this rating? People felt ED triage staff often underrated mental health issues and did not prioritise their issues with the same urgency as physical health issues.

Response

The project aimed to change the systems and culture of the Parkes Emergency Department. It involved people who use the MHDA service, MHDA staff, a peer worker, TAFE NSW and the Parkes Health Service management. The project focused on improving the ED physical environment, staff training and internal advocacy. This was done by:

  1. Surveying people with lived experience of mental health issues about how and where to improve the waiting environment and amenities, staff support in the waiting area, cultural appropriateness and more sensitive ED processes
  2. Co-designing and delivering training to support a positive culture shift in the care of people with mental health issues who present to the ED
  3. Promoting the value of lived experience to advocate against stigma and discrimination through providing emotional support in ED waiting room. Staff were trained to provide practical support with required forms, drinks, sensory items, non-clinical therapy, monitoring environmental safety and distraction for families and patients. This support promotes and models person-led, person-centred care and support. 

Evaluation process

  • Surveys evaluated clients and staff before and after completion of the project
  • Round table discussions were held with hospital management regarding ED assessment and waiting room environments, following implementation of the environment co-design.

Outcomes

  • Physical environment improvements: The ED safe assessment room was transformed with comfortable furniture, furnishings and artwork. Waiting room amenities were designed to assist emotional regulation. These included drinking water and tissues, signage, earplugs and mindfulness resources and prompt cards for staff to reduce anxiety, ear plugs or headphones to reduce distracting ED sounds. Activity packs can distract children and improve ED comfort 
  • Process changes: these were implemented thanks to the visible support of service managers
  • Increased support by senior management of lived experience framework process changes
  • Training to change staff attitudes about lived experience of mental health issues: for clinical and non-clinical staff, with peer worker co-design to enhance the consumer experience.

Key learnings for the service:

  • There is a lack of staff awareness of mental health issues and trauma-informed care
  • Emergency Department triage needs to be reviewed to improve consistency and transparency
  • People feel more acknowledged if they can access tissues and water amenities when waiting, though providing these amenities diverts staff from clinical duties
  • People noted waiting areas were not culturally friendly; Aboriginal staff or volunteers may help.

Leadership:

  • Recognition that there is a stigma in the Emergency Department about people with lived experience of mental health issues
  • Management support ensured the adoption of project recommendations.

Challenges to the project:

  • Despite being reassured that their feedback was confidential, some people were anxious about providing their views for fear of repercussions from ED staff
  • Volunteers need a Police Check, Working With Children Check and full, current immunisation list which has a financial cost and may take 3-4 months to complete (in NSW Health facilities), which can impact recruitment of willing volunteers and TAFE students
  • Providing volunteers with the right level of care and capacity to work without supervision.

Project benefits for other organisations:

  • A replicable approach to improve the ED experience through co-designed improvements to the physical environment
  • Training from this project could be shared and rolled out across health services at low cost
  • A framework could be developed to introduce TAFE students with lived experience to ED environments, or in smaller hospitals, to provide valuable work experience to complete training requirements. Building on the peer workforce, provide good role models and practical support to improve advocacy of people with lived experience and reduce stigma of mental health issues.

Next steps

  1. Assess the safe assessment room environment including furniture, painting and sensory items.
  2. Conduct a gap analysis to co-facilitate/co-design with staff, to support a culture shift.

References

  1. Parkes MHDA Lived Experience Framework Project report.