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Monday, 27 December, 1999, 13:38 GMT
A&E and the mentally ill
Heart attack or panic attack?
Because it's open 24 hours a day and because it doesn't require appointments, the range of people and problems visiting the average accident and emergency department is vast.

Accident and Emergency
The numbers of people passing through the doors of A&E of course increases over the festive holidays - and with millennium celebrations in full swing, health staff are expecting the biggest turn-out ever.

Which will make it all the more difficult to identify and appropriately treat people with complex psychological problems and mental illness.

Mind, the mental health charity says that because GPs sometimes refuse to treat people with "difficult" behaviour, people with mental illness quite often go to their local accident and emergency department for non-emergency treatment.

Different picture at different hospitals

Dr Andrew Cope, accident and emergency consultant at Peterborough District Hospital, says it can be "quite difficult" to spot psychological and psychiatric conditions.

He estimates that on an average day, his department sees 150 new patients, of which about 10 will have psychological problems. Of those 10, maybe one or two will be referred to a psychiatrist.

He said: "The picture is different from hospital to hospital - and I am sure that those proportions would be very different in big cities."

Doctors and nurses are trained to be aware of, and bear in mind the possibility, of psychological, as well as physical problems.

He said: "Here, two of our nurses are trained psychiatric nurses. The recommendation is that A&E departments have at least one psychiatric nurse, but that isn't a statutory requirement."

But even then, if someone in A&E appears disoriented and is behaving in an unconventional manner, they could just as easily have had a bump on the head as be in the episodic throws of a mental illness.

First port of call for people with all manner of illness
Dr Cope said: "We assess patients' physical condition, and if it is thought they are presenting psychological problems, then we will assess their psychological condition.

"There is a standard format for doing that. Depending on how disturbed a person is, we might refer the patient to an appropriate professional."

He said that in some situations, however, a patient who complained of physical problems, may actually be experiencing them as part of a psychiatric condition.

So if a person has chest pains, they may be having a heart attack - or a panic attack, or their mind might just be telling them the pain is there, when in fact there is nothing physically wrong.

Sue Baker, of Mind, said that people with mental illness often though that they were being discriminated against by health care providers.

Avoidable surgery

She said: "Typically this will be by primary health care providers, like GPs, who may attribute all of a patient's symptoms to a psychiatric condition.

"That particularly applies if a patient has something like 'anxiety' written on their notes.

"This has lead to people needing to have surgery when an earlier diagnosis could have prevented it.

"We have done no research on accident and emergency departments, but people with mental illness do sometimes get there because they cannot get satisfaction from their GPs."

See also:

16 Apr 99 | Health
Mentally ill 'denied crisis care'
13 Oct 99 | Health
Mentally ill 'need more rights'
18 Mar 99 | Health
Police on mental health frontline
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