Mind matters

Joining the dots between mental health and triage.

For the past year, Tim Wand has been running a pilot mental health nurse practitioner outpatient service in the emergency department of the Royal Prince Alfred Hospital.

“It’s a clinical orientated role,” Wand says of his position, which is the focus of his PhD at the University of Sydney.

Wand originally joined the Faculty of Nursing and Midwifery as an undergraduate student, went on to do his masters and is now undertaking his PhD at the university.

“The emphasis is to see the patient as close to the point of triage as possible. I don’t stray far from the emergency department. The aim is to provide prompt mental health interventions. The outpatient service developed from the realisation that patients’ needs are not always met by the current mental health system.

“If someone presents after hours, with panic for example, the doctor can refer them to me for a follow up session. If they went to see a private psychologist it could take two weeks to get an appointment. So it reduces the waiting time.”

The 12 month pilot service, which began taking referrals in June last year, saw 111 outpatients, ranging from 13 to 72 years of age. There were 199 occasions of service.

The service is session limited, with three to five sessions available for each patient. “Most patients need only one or two follow up sessions,” says Wand.

“The pilot was very successful. People have found it very useful and there is a high level of satisfaction. emergency department staff have been very receptive to the service, they like the easy referral and close proximity. It’s still ongoing, there’s no reason for it to stop,” says Wand.

The outpatient service is a collaborative research project undertaken between the Sydney South West Area Mental Health Service, RPA Emergency Department and the Faculty of Nursing and Midwifery at the University of Sydney.

Some 101 patients have consented to post pilot formal evaluation. “We’re now looking at the pilot data. We’ve started another aspect, which is in-depth interviews with a number of selected participants. We will also be interviewing the emergency department staff to determine how the service assisted them and their practice.”

Combining the outpatient service role with that of senior clinical lecturer in mental health at the University of Sydney has been demanding, Wand admits.

“It has not been easy. My schedule is pretty tight. I try and sandwich everything together. Usually I’m running from the Emergency Department to the faculty, or vice versa. Generally I see patients in the morning, tutor for a few hours, and then see more patients in the afternoon. Because it’s an appointment service, I can book patients at times that suit both them and me.”

Wand says the outpatient service model could be replicated in other hospitals, and not just in Emergency Departments. It could be applied in settings such as community care.

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