• mental health, assessment
• mental health
• mental health, management

Emergency mental health is part of our core business, although emergency department (ED) staff may have varying levels of comfort with this. We need to be as competent with the initial management of a patient with a mental health crisis as we are with trauma, sepsis or any other emergency. To do this, we need compassion and empathy underpinned by systems and training for all our staff. Our attitudes to patients in crisis are often the key to improvements in care. If we are honest, some ED staff are fearful and worry that what they say may make a patient feel worse. Others may resent patients who come repeatedly in crisis. It helps to consider these patients just as we would patients with asthma or diabetes who may also come ‘in crisis’. Our role is to help get them through that crisis, with kindness and competence.

A detailed look at Hospital Episode Statistics (HES) for England 2013/2014 by Baracaia et al in EMJ show that 4.9% of all ED attendances were coded as having a primary mental health diagnosis.1 Cumulative HES data have shown an average increase in mental health attendances of 11% per year since 20132 (figure 1) far in excess of total ED attendance increase (figure 2). National data from the USA show a 40.8% increase in ED visits for adult with a mental health presentation from 2009 to 2015.3 US paediatric visits for the same period rose by 56.5%3 and a worrying 2.5-fold increase over 3 years in the USA is reported for adolescents ED …