World Mental Health Day and Emergency Medicine

October 10th is World Mental Health Day

Have you ever wondered if we sometimes make things worse for patient with mental health problems coming to the ED?

Stigma in the general hospital setting is reported by patients to result in devaluation, social control, avoidance, rejection and failure to act. Perry et al.

Careless talk adds to poor attitudes and lack of understanding in our team – “It must be a new moon”, “not again” etc.

Our patients tell us they pick up on this, it may even prevent them coming for help.

What can we do to reduce this?

  • Describe the person, not the condition – “24-year-old with recurrent overdose” becomes “Ellie, a student with a background of complex trauma who is in crisis today and has taken an overdose.”

Remember that Ellie will hopefully be back to her studies next week and we may have kept her safe until then.

  • Challenge the poor language we hear in our departments.
  • Monitor our own thinking and attitudes.
  • Even during a brief ED assessment, we can actively listen to patients, choose to show respect, and deliberately voice empathy.

How can structural discrimination and stigma be reduced in EDs?

Adapted from

Ways to reduce stigmatisation at professional levelWays to reduce stigmatisation at organisational level
STEREOTYPES & LABELSDiscourage inappropriate labelling in staff handovers

Anti-stigma training
Avoid group-specific discriminatory policies
Avoid lists of problematic patients
Avoid ‘special codes’ on notes
DEVALUATIONStaff training focus on vulnerable patient groups
Audits of care to ensure equity
Patient feedback Specific training for triage nurses
Allow longer time to triage patients with complex needs
Provide low-stimulus patient waiting areas
Focus training curricula on vulnerable patient groups
SOCIAL CONTROLExposure to patient self-advocacy groups
Simulation training
Significant incident reviews
Emphasise mediation and de-escalation techniques
Minimise use of surveillance and security personnel
Minimise use of chemical, physical and legal restraints
AVOIDANCEStaff exposure to those with mental health conditions
Staff participation in Schwarz Rounds
Encourage reflective practice
Parallel input from physical and mental healthcare teams
Employment of experts by experience
REJECTIONTraining around awareness of diagnostic overshadowing
Increase knowledge about physical health inequalities and complex needs
Open access policy for patients
Avoid ‘front door’ mechanisms to turn patients away
FAILURE TO ACTIncrease knowledge of legal structures eg Mental Capacity Act (UK)
Serious case reviews
Improve access pathways to accessory services
Assess mental capacity in patients who decline treatment

The Royal College of Emergency Medicine Mental Health Sub-Committee

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