THE BROTHER OF a man who died by suicide the same day he presented himself to an emergency department has described the Government’s new mental health implementation plan as a “failure”.

Earlier this week, the government published Sharing the Vision: A Mental Health Policy for Everyone Implementation Plan 2025 – 2027, which details 30 key priorities across seven areas that will be delivered over the next three years.

One of these key priorities is providing appropriate environments in all emergency departments for people who require a mental health assessment.

Eight hospitals currently lack a mental health assessment room.

And within emergency departments that are open 24/7, some 30% do not comply with PLAN standards. 

PLAN is a quality improvement and accreditation network for psychiatric liaison services and provides a comprehensive description of best practice.

The government’s plan also noted that “many emergency departments are in old buildings and not fit for purpose” and that capital funding is required to build new emergency departments which include mental health assessment rooms.

However, Joe Loughnane told The Journal that he believes there should be a separate general admission unit for those experiencing a mental health emergency and that they shouldn’t have to go through emergency departments at all.

Joe’s brother, Adam Loughnane (34) died by suicide in February – earlier in the day he had presented himself to hospital expressing suicidal ideation.

“If somebody has called their GP or the ambulance to express suicidal ideation, there should be another part of the hospital you’re brought into, whether it’s the mental health unit directly, or a mental health A&E,” said Joe Loughnane to The Journal at the time.

“There has to be a separate place for people who are suffering from physical health to those suffering from mental health.”

But while a letter on behalf of Mental Health Minister Mary Butler to Loughnane expressed “determination to ensure there are further alternatives to A&E for people in mental health crisis”, the plan published this week further commits people in this situation presenting to traditional emergency departments.

In a statement to The Journal, Butler said she agrees with the families about emergency departments being an inappropriate environment for people in a mental health crisis.

She added that she is “working hard to shift supports for those in crisis away from hospitals and into services in our communities”.

Meanwhile, a spokesperson for the Department of Health noted that Butler has overseen a new model of care for crisis resolution, which includes five out of hours teams meeting people who require interventions and a rollout of crisis cafes nationwide.

However, only five such cafés are in operation or due to open soon and Butler herself has expressed impatience with the pace of the project.

‘Waiting there for hours’

“We want an alternative for those who present in a mental health crisis, that they don’t have to go through A&E but that they go through a separate part of the hospital,” Loughnane told The Journal after the mental health implementation plan was published.

“There is a recommendation that when somebody is in an emergency, they still have to go through A&E and then they’d be accessed in a mental health assessment room.

“They’re still going through A&E, they’ll still have to end up in the waiting room like Adam did.”

Since Adam’s death, Joe said numerous people have made contact with him who have had similar experiences.

“There seems to be a systematic failure over the last 10 – 30 years of people going to A&E, saying they have a mental health problem or they’re suicidal, and then they end up waiting there for hours.

“I’ve spoken to a lot of these people, and they say that if their loved ones didn’t have to go through A&E, they’d still be alive now. This is a simple enough change.”

The HSE’s model of care for patients presenting to emergency departments with suicidal ideation recommends that all patients who present receive “a timely expert biopsychosocial assessment of need”.

It notes that “in some cases, those presenting may be reluctant to wait for such an assessment”.

Loughnane remarked that there is “no need to reinvent the wheel”.

“There are vacant buildings within many hospital campuses that could be used for this purpose.

“A mental health A&E would require less technical equipment than the general A&E, because it’s more about providing rooms for a psychiatrist or a counselor to engage with the person or to be able to secure them.

“Most hospitals have a mental health unit, and those mental health units, if they just became general admission, that’s where it changes.

“Adam should have presented at a mental health unit, instead of waiting in an A&E in an atmosphere where you’re surrounded by people with visible problems.

“Nobody seems to have any good experience of sitting there for hours on end with these suicidal thoughts going through your head, and you’re looking around you, and it’s just noisy and chaotic.”

‘Lip service’

He said the solution is “more people who can carry out an assessment in a facility that is purely just for mental health, rather than a psychiatrist working alongside a general nurse or doctor who is dealing with somebody’s broken arm”.

“You can’t build a mental health system off the back of our general healthcare system,” said Loughnane.

“It should be that the hospital, when you step on the grounds, you know there is a section of hospital that is purely for somebody in a mental health emergency.

“I read about significant progress and record budgets for mental health,” said Loughnane, “but how can they say that when they don’t even have these assessment rooms in eight hospitals.

“To me, it’s just constant lip service when it comes to mental health and in emergency situations, people shouldn’t have to go through A&E.”

Mental health and suicide awareness charity 3Ts, in partnership with Trinity College, undertook a study in 2020 on the personal experiences of 50 people who had presented to A&Es for self harm or suicidal behaviour within the preceding five years. 

3Ts said the research highlighted the need for a Mental Health Emergency Department, which should run alongside every A&E in Ireland.

“Negative experiences were largely focused on unhelpful interactions from staff, feeling unsafe in busy and noisy EDs, poor follow-up care and a lack of understanding around self-harm and suicidal behaviour,” the report stated.

In a statement to The Journal, the HSE said that “all patients who present following self-harm or with suicidal ideation to an ED undergo key steps as part of the emergency care pathway”.

This includes patient triage, an assessment from an emergency medicine doctor or nurse, tests, treatment, referrals to appropriate specialists and then a decision to admit or discharge the patient, with appropriate follow-up.

The HSE spokesperson noted that EDs “prioritise and treat the most unwell patients and those with life-threatening illnesses first”.

Meanwhile, Loughnane also said that mental health records should be immediately referenced, while also securing and monitoring them.

The government’s mental health implementation plan said there will be a phased roll-out of Electronic Health Records across mental health services.

An EHR system will move away from storing key patient records in a paper format across multiple healthcare providers, to an environment where electronic patient records are shared securely across care settings.

-With additional reporting from Christina Finn

*****

• Samaritans 116 123 or email jo@samaritans.org
• Text About It - text HELLO to 50808 (mental health issues)
• Aware 1800 80 48 48 (depression, anxiety)
• Pieta House 1800 247 247 or text HELP to 51444 – (suicide, self-harm)
• Teen-Line Ireland 1800 833 634 (for ages 13 to 19)
• Childline 1800 66 66 66 (for under 18s)