Mental health patients in emergency departments are suffering: the national failure and shame of the current system. A report on the Australasian College for Emergency Medicine's Mental Health in the Emergency Department Summit.

OBJECTIVES: Inadequate capacity in Australia's mental health system means that many people turn to emergency departments (ED) in crisis for care and support, often because it is the only service available. Australian Governments have set a 4-h target for all ED care, but the data shows that people presenting to an ED in a mental health crisis are the group most likely to wait more than 24 h for care. These long waits, seemingly with no end in sight, are harmful for patients and deeply frustrating for clinicians. CONCLUSIONS: In response, in 2018, the Australasian College for Emergency Medicine (ACEM) organised the national Mental Health in the Emergency Department Summit. Delegates from across clinical disciplines and user groups were unified in their deep concern at the unacceptable state of mental health support available to people seeking help through EDs. The Summit identified four priorities for urgent action and urged government to take immediate steps to improve this situation.

An Australian hospital's training program and referral pathway within a multi-disciplinary health-justice partnership addressing family violence.

OBJECTIVE: An innovative health-justice partnership was established to deliver legal assistance to women experiencing family violence who attended an Australian hospital. This paper reports on a multifaceted response to build capacity and willingness of health professionals to identify signs of family violence and engage with referral pathways to on-site legal assistance. METHODS: A Realistic Evaluation analysed health professionals' knowledge and attitudes towards identification, response and referral for family violence before and after training; and use of referral pathways. RESULTS: Of 123 health professionals participating in training, 67 completed baseline and follow-up surveys. Training improved health professionals' self-reported knowledge of, and confidence in, responding to family violence and understanding of lawyers' roles in hospitals. Belief that patients should be referred to on-site legal services increased. Training did not correspond to actual increased referrals to legal assistance. CONCLUSION: The program built capacity and willingness of health professionals to identify signs of, and respond to, family violence. Increase in referral rates to legal assistance was not shown. Potential improvements include better data capture and greater availability of legal services. Implications for public health: Strong hospital system supports and reliable recording of family violence referrals need to be in place before introducing such partnerships to other hospitals.