The Royal Hobart Hospital's emergency department had more than 1,800 patients wait longer than 24 hours in the last financial year, compared to just two patients at Victoria's four biggest hospitals in the same period, an inquest has heard.

Key points: An inquest into a man's suicide attempt at Royal Hobart Hospital hears the facility has a shortage of psychiatric nurses

An inquest into a man's suicide attempt at Royal Hobart Hospital hears the facility has a shortage of psychiatric nurses The head of emergency estimates there has been an 80pc increase in mental health patients admitted to ED over the past two years

The head of emergency estimates there has been an 80pc increase in mental health patients admitted to ED over the past two years More than 1,800 patients waited more than 24 hours in the Royal's emergency department last financial year

The inquest into the death of Joseph Aaron Lattimer, who attempted to take his life in a toilet at the hospital in 2016, has been told there have been more suicide attempts in the emergency department since his death.

Emergency Department (ED) director Emma Huckerby laid bare cultural workplace issues at the hospital, the urgent need for more psychiatric nurses and the systemic recruitment problems which plague Tasmania's major hospital.

The inquest has heard there were no beds available for the mentally ill Mornington man who was experiencing thoughts of serious self harm.

The only nurse on duty that morning triaged Mr Lattimer as needing urgent treatment within 30 minutes.

She had been monitoring Mr Lattimer via visual checks and briefly had her back turned to him as she triaged another patient only to later realise he had disappeared from the waiting room area.

Dr Huckerby said the hospital's ED had seen an 80 per cent increase in mental health patients, remained "in a bad state" and was in the grips of a recruiting and resourcing crisis.

She said the number of mental health patients admitted to the ED waiting room for treatment in September-October was up 80 per cent compared to the same six-week period in 2017.

She also said there was "very limited space in ED for suicidal patients" and while there were 14 suitable beds at the time Mr Lattimer presented, they were unavailable.

"The access block at the Royal is disproportionate to that of the rest of Australia," she said.

Dr Huckerby told the inquiry that since Mr Lattimer's death there had been more suicide attempts and self harm in the ED, access to the main section of the ED had "dramatically worsened" and there had been an increase in mental health patients with far more complex conditions.

She told the hearing of a recent example in which a patient experiencing suicidal ideation absconded from ED and was brought back from a known high-risk location.

The inquiry heard the hospital was "still extremely under recruited" with psychiatric nurses in huge demand on every shift but only able cover about half of all shifts.

The inquest heard a study of Victoria's four biggest hospitals in the past financial year showed just two patients waited more than 24 hours in ED last financial year.

The Royal's ED had more than 1,800 patients wait longer than 24 hours over that same period.

The state's chief psychiatrist Aaron Groves told the inquest there were "systemic problems", including an ageing workforce and national shortages.

'Calmer' unit needed

A new facility is due to be built within two years as part of the emergency department's redevelopment.

Dr Huckerby told the hearing a separate, purpose-built unit was greatly needed to cater for mental health patients — one that is a calmer and more relaxing "so patients didn't feel they were being watched".

She said the hospital's new K block would make way for seven additional beds, which should be available by next March, but more were needed.

"We [nursing staff] feel frustrated because we know the moment that a mental health patient is triaged that we're not able to contribute to most of their care," she said.

"We can give them medication for agitation but we can't properly treat them so they can go home."

Dr Huckerby also outlined the need for cultural changes in the workforce and described the "friction" that exists between ED staff and those on the wards.

She told the hearing that as mental health conditions became more complicated, medical teams sometimes felt uncomfortable taking on a patient with multifaceted needs, resulting in delays for patients to be admitted.

"[We need] a lot of time and a lot of money to go into fixing this," she said.

"A whole chain management process [is needed], which would be a team working very effectively to address the issue."