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This page is an AI-assisted Turkish summary of the study presented at the 26th World Congress of Psychiatry. The study belongs to the presenting authors; please refer to the original source when citing it.

EV0539

Multilevel barriers to the timely assessment and management of mental health crises in the emergency department: a systematized review

MULTI-LEVEL BARRIERS TOWARDS TIMELY ASSESSMENT AND MANAGEMENT OF MENTAL HEALTH CRISES IN THE EMERGENCY DEPARTMENT: A SYSTEMATISED REVIEW

Barriers to mental health crisis care in emergency departments are multifactorial and multilevel; the most frequently recurring subtheme is inadequate staff training, lack of preparedness, and role dependency.

The study aims to identify and synthesize multilevel barriers to the timely assessment and management of mental health crises in the emergency department (ED). As background, it notes that, according to 2024 NHS Confederation data, mental health presentations account for 3 to 5 percent of all ED attendances in England, although this proportion is substantially underreported. A systematized literature search was conducted in PubMed, PsychInfo, and EmBase, with no date filter applied to the initial search to maximize retrieval. Studies published in 2016 or later that provided primary data on adult mental health crisis presentations to the ED and described barriers were then included. Eligible studies underwent quality appraisal using the Mixed Methods Appraisal Tool, thematic data extraction was performed, and findings were synthesized narratively by barrier domain. Of the 2,614 articles identified in the initial search, 8 met the criteria for thematic extraction; these studies came from 4 countries (Australia, South Africa, Türkiye, and the USA). The thematic analysis identified four main domains: systemic and resource barriers (patient flow and triage, understaffing and workload, shortages of psychiatric beds, ED crowding, and access block); environmental and ED design barriers (physical layout, observation and environmental safety, suitability and accessibility, privacy and a therapeutic assessment environment, violence, aggression, and restrictive practices); clinical assessment and management barriers (delays in assessment, diagnosis, and risk assessment, delays in management and intervention, and fragmented referral and signposting pathways); and workforce and interdisciplinary barriers (poor communication and multidisciplinary coordination, inadequate staff training and lack of preparedness, compassion fatigue and burnout, and stigma and negative perceptions toward psychiatric patients). The most frequent subtheme, reported in 5 studies, was inadequate staff training, lack of preparedness, and role dependency; other recurring themes included ED crowding and inadequate assessment spaces. Limitations include the heterogeneity of the studies (with presentations ranging from self-harm alone to broader psychotic presentations), the small number of included studies (n=8), and the possibility that the qualitative nature of the barriers may not adequately capture patient experiences or service outcomes. The review concludes that barriers in the ED are multifactorial, that staff-related barriers should be addressed within the context of broader systemic constraints, that staff training is a feasible area for improvement, and that consultation-liaison psychiatry teams and telepsychiatry services may help alleviate the burden.

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