Released 13 June 2024
Request:
Initial request received 01 May 2024 (FOI240096):
- Please provide the number of patients who attended A&E primarily with mental health complaints (i.e. anxiety, depression, other mental health concerns) for each month in 2022 and 2023, and January, February and March 2024.
If possible, please indicate how many of these patients were adults (18 or over) or children (under 18). - Of these patients, please provide the number who spent under 12 hours in A&E in total, between 12 and 24 hours in total, between 24 and 48 hours in total, between 48 and 72 hours in total, between 72 and 96 hours in total, and the number who spent longer than 96 hours in A&E.
2a. For those who spent longer than 96 hours, please specify how long they spent in A&E.
3. Please indicate what proportion of people attending A&E with mental health complaints were ultimately admitted, transferred to another provider (please list the relevant providers), or sent home (please specify the proportion of these who were sent home with or without follow-up plans)
4. Please specify what plans the trust has in place to mitigate risks from rising numbers of patients attending A&E with mental health concerns.
Assistance provided to applicant under section 16 [duty to assist] on 16 May 2024:
The Trust’s Business Intelligence service who report on patient attendance and admission data would like to clarify your request before they proceed with extracting the relevant information from our administration systems. This is to ensure that we provide the most appropriate data relevant to your request.
With regard to question 1, when patients attend A&E the reason for their attendance is recorded on our patient administration systems. When reporting mental health activity in A&E we can audit the complaint or diagnosis free text fields on our systems and report on the complaint or diagnosis descriptions listed below.
Please can you confirm that the below are relevant to your request, or if there are specific complaints/diagnoses that you would like us to report on? We will then include these in our reporting.
Chief Complaint: ‘Alcohol intoxication delirium’; ‘Drug / alcohol intoxication or withdrawal’; ‘Alcohol withdrawal syndrome’; ‘Suicidal thoughts’; ‘Feeling suicidal’; ‘Depressive disorder’; ‘Feeling anxious’; ‘Anxiety’; ‘Anxiety disorder’; ‘Self-harm’; ‘Suicidal thoughts’; ‘C/O – feeling depressed’; ‘Depressive feelings’; ‘Delusions’; ‘Hallucinations / delusions’
Diagnosis: ‘Adjustment disorder’; ‘Alcohol (ethanol) intoxication’; ‘Alcohol dependence syndrome’; ‘Alcohol withdrawal seizure’; ‘Alcohol withdrawal syndrome’; ‘Anticoagulant overdose’; ‘Antidepressant overdose’; ‘Antihypertensive overdose’; ‘Anxiety disorder’; ‘Benzodiazepine overdose’; ‘Beta blocker overdose’; ‘Bipolar affective disorder’; ‘Calcium channel blocker overdose’; ‘Delirium (acute confusion)’,’Dementia’; ‘Dependence on opioids’; ‘Dependence on sedatives or hypnotics’; ‘Depressive disorder’; ‘Dissociative (conversion) disorder’; ‘Dissociative disorder’; ‘Drug-induced seizure’; ‘Eating disorder; ‘Factitious disorder’; ‘Ingestion of methanol / ethylene glycol’; ‘NSAID overdose’; ‘Obsessive compulsive disorder’; ‘Opiate overdose’; ‘Panic attack’; ‘Paracetamol overdose’; ‘Personality disorder’; ‘Psychotic disorder’; ‘Recreational drug use’; ‘Schizophrenia’; ‘Somatisation disorder’; and ‘Somatoform pain disorder’.
For question 2a, you are seeking data relevant to a single patient. Whilst we fully appreciate the public interest in the information you are seeking, since you have requested this information under the terms of the FOI Act we are obligated to consider the legitimacy of disclosure to the world at large which allows unrestricted access to this data, free from any obligation of confidence.
Where there are concerns that the disclosure of data may lead to the identification of patients, it will be necessary for us to apply section 40(2) [personal information] exemption as appropriate under the FOIA.
We are happy however, to provide a median or average figure for the longest 5 or more waits in order to best fulfil this part of your request.
Could you please confirm that you are happy to receive this alternative data?
With regard to question 3, information relevant to whether the patient was discharged with or left the premises with a follow-up plan will only be recorded within their notes. The Trust does not have an electronic patient record system that would facilitate this type of reporting. Any attempt to compile data in the format you are seeking would require the manual audit of all the relevant patient records, which would require an unreasonable level of staff resources to complete. Section 12 provision [cost limit] of the FOIA is applicable at this time.
We appreciate the public interest in the information you are seeking and would like to assist you in progressing your request with us. We are therefore writing to you under section 16 of the Act [duty to assist] to offer you the opportunity to reconsider and revise or clarify your request following the advice provided above.
For example, we could provide the information relevant to the diagnosis and complaint descriptions listed above, and average or median longest wait totals.
Reply received from applicant on 16 May 2024:
With regards to the list of conditions you provide, those are fine for the request.
With regards to question 2a ( where you say “We are happy however, to provide a median or average figure for the longest 5 or more waits in order to best fulfil this part of your request. Could you please confirm that you are happy to receive this alternative data?”) please provide an average figure (mean, not median).
Please omit question 3 if it will take too long to perform.
In line with the section 45 FOI Code of Practice, following receipt of clarification the statutory deadline associated with the request was reset and a new reference number (FOI240154) was allocated.
Information disclosed:
1, 2 and 2a. Please refer to the attached PDF document FOI240154 Data.pdf
3. Omitted as requested; section 12 [cost limit] provision is applicable, as advised above.
4. All patients presenting with mental health (MH) problems are assessed on Symphony.
If a ‘risk’ is identified, an Emergency Department (ED) Mental Risk assessment form is completed. If the patient is intoxicated with drugs or alcohol, or there is other physical issue the patient is reviewed by the ED medical team and a plan made.
The Mental Health Liaison Team (MHLT) will be made aware that the patient is in the department but is not medically fit for MHLT review. If required or appropriate the patient will have a 1 to 1 observation. If the patient is medically fit, the patient will be referred to MHLT, and receive an initial 15 minute MH triage, followed up with a full MH assessment which lasts approximately 1 hour. A plan will then be formulated for the patient’s MH care. If the patient requires ‘Specialing’, this is provided to keep the patient safe.