When Renai Buchanan felt desperately suicidal, hospital emergency departments were both the best and worst place to be.

Mental health crisis services directed her there for treatment, because EDs are deemed best at dealing with life-threatening situations.

But Ms Buchanan said the long waits for assessment and treatment for mental health patients — which can take days — made her feel worthless and even more distressed.

Amid the bright lights, noise and constant high-stress atmosphere, the Perth woman would watch children with respiratory symptoms or people with broken limbs being treated before her and feel that her problem was less important.

"They are there for a multitude of reasons that are not life-threatening, but mine was," she said.

"You are waiting for help thinking, what in this hospital can I use to kill myself?"

A common tale of trauma

Ms Buchanan is not alone in her experience of EDs.

More than a year ago, she took a friend with intense suicidal thoughts to a Perth hospital ED at 9am on a Sunday morning, only to find out she was unlikely to get a bed until at least lunchtime the next day.

Her friend was traumatised by having to explain her complex psychological history in the less-than-private surrounds of an ED.

It was also upsetting to be shifted around the department to make way for patients with a physical impairment.

"She was sitting in a hallway for four hours, while she was a sobbing, hysterical mess," Ms Buchanan said.

Eventually, her friend's father offered to pay for her to receive treatment in a private hospital and they walked out of the ED.

While she acknowledged hospital staff do their best in the situation, Ms Buchanan said she believed that EDs are not the right place for people with mental health emergencies to spend many hours and days.

"We need to be treated faster and have more privacy and support," she said.

Wait times reaching crisis point

The long waits in emergency departments for WA's mental health patients are reaching what some advocates are privately calling a crisis point.

Data released last month by the Australasian College for Emergency Medicine (ACEM) found two in three WA patients were waiting for more than eight hours in EDs after presenting with acute mental health issues.

Long waits in emergency departments are common for mental health patients. ( ABC News )

There have been stories of agitated patients being physically restrained and then chemically re-sedated while waiting up to six days for a hospital bed.

But the day the data was collected — it was recorded simultaneously at 10:00am on Monday, December 4 from 72 EDs across Australia and New Zealand — was a quiet one, according to the state's chief mental health advocate.

That morning in WA, 34 people were waiting for a bed, including four children who had waited between two and six days.

"This is clearly unacceptable health care and not an isolated occurrence," Debora Colvin wrote to the WA Government's key health managers.

"The day ACEM conducted its spot check was in fact a very light mental health day in the EDs, and yet WA came out as the worst state."

Ms Colvin wrote that she believed the problem was due to several factors:

A shortage of beds for mental health patients in hospitals

A shortage of beds for mental health patients in hospitals A lack of community mental health services

A lack of community mental health services Bureaucratic problems in managing beds for mental health patients, caused by the restructuring of government health services.



More mental health patients are presenting to emergency departments, Roger Cook says. ( Jeanette E. Spaghetti/flickr.com/CC-BY-NC-ND-2.0 )

Consumers of Mental Health WA chief executive Shauna Gaebler said better community services which helped stop people becoming unwell were needed.

"It's around working within the community to keep people at home in the community, but then having back-up at the hospital which is timely and supports their recovery when that's needed," she said.

In a written statement, Health Minister Roger Cook said an increasing number of people were presenting to EDs with mental health problems.

He said the new mental health observation area at Joondalup Hospital was designed to improve the patient care and flow in its ED, with similar units planned for Royal Perth Hospital and Geraldton Hospital.

Violent patients released back onto the street

The problem is exacerbated by lower-needs patients being released by community mental health services before they are fully recovered, and then relapsing with more acute problems.

A leaked report into the City East Community Mental Health Service in East Perth revealed one violent patient with a psychotic illness was released too early and soon ended up in prison at the Frankland Centre, the high-security inpatient unit at Graylands Hospital.

A review found "a deeper systemic failure" at one Perth mental health clinic. ( Unsplash: Louis Blythe )

As part of the report — sparked by an anonymous letter about the service to the chief psychiatrist — psychiatrist Dr Geoff Smith and psychologist Theresa Williams examined the case files of 10 people treated by the service.

It found two patients with psychotic illnesses were released into the care of a GP, even though it was known they did not have a GP and were likely to relapse.

"However, it is important to emphasise that this is a cohort of people with multiple complex needs and, in many instances challenging behaviour, who are consequently difficult to treat in the community," the reviewers wrote.

"The lack of appropriate models of care and treatment options points to a deeper systemic failure."

The review found that the City East service often did not meet national mental health standards or the chief psychiatrist's standards around patient recovery, including discharge, handover and follow-up.

In response to the findings, Mr Cook said the East Metropolitan Health Service had been working to implement some of the recommendations of the report, trying to improve its patient discharge processes and looking at how patients could be better supported in the community.