Improving the Assessment and Triage of Patients with Mental Illness ...

with mental health issues, who present to the emergency department, are generally in this
state of severe psychological distress and are therefore anxious to access the appropriate
services as swiftly as possible However due to long waiting times, inappropriate facilities e.g.
quiet rooms and the shortage of frontline specialist care such as mental health nurse
practitioners the individuals crisis is greatly enhanced.
Mental illness is an umbrella term which encompasses an extensive range of mental
and emotional conditions, including schizophrenia, bipolar disorder, depression, anxiety
disorders. Suicidal behaviour in the form of self-harm or self poisoning, (defined by the
National Institute of Clinical Excellence (N.I.C.E., 2004:7) as “self-poisoning or injury,
irrespective of the apparent purpose of the act”) is one of the most common, and most
obvious manifestations of mental illness in patients presenting to the ED. According to the
National Suicide Research Foundation (2009) almost 12,000 presentations of self-harm are
treated annually in hospitals around Ireland.
It is recognized throughout much of the literature that those individuals with a history
of self-harm are a high risk for suicide (McCann et al., 2006, Keogh et.al. 2007). For example
in a study carried out by Hickey et al. (2001) suggests that up to 4% of those that habitually
self harm will eventually go on to commit suicide. This may not necessarily be intentional but
rather, occurred as a result of them “going too far”. The issue of self harm is often looked
upon as a cry for help or a relief of the individual’s psychological pain (Howson et al, 2008)
From an Irish point of view, the statistics for completed suicide make for very sombre
reading. Information obtained from the Health Service Executive’s (HSE) National Office for
Suicide Prevention states that 527 people took their lives in Ireland in 2009 an increase from
2008 when 424 people took their lives.
Much has been done to counteract and attempt to reduce the number that die by
suicide. In 2006 a comprehensive framework for mental illness was introduced by the Irish
Government titled “A Vision for Change”, examines mental illness in a holistic fashion based
on biological, psychosocial and social aspects. There was a National Office of Suicide
Prevention set up by the Health Services Executive (H.S.E) with responsibility for the
implementation of ‘Reach Out’ which is a National Strategy for Action on Suicide Prevention
2005-2014. While there is no denying the work that is being done to improve services for
those with mental illness, far more investment of time, resources and finances must occur
7