Managing psychiatric emergencies in persons with mental health issues at a primary care clinic

Abstract

Background: Psychiatric emergencies are commonly encountered by the emergency room team where non-mental health specialists are often the first care providers.

Materials and Methods: The study took place at the University of Ibadan Health Service, it was a descriptive cross-sectional study and participants were health care staff of the clinic who were attending a seminar on Management of Psychiatric emergencies in Persons with Mental Health Issues. Knowledge questionnaires were administered prior to the commencement of the seminar. Data analysis was done with SPSS 21.

Result: A total of 26 health care staff of the clinic participated in the study, of which 18 (69.2%) were female and 8 (30.8%) were male. The mean age of the participants was 40.5 (±10.4) years while the mean number of years as a professional health care worker was 15.5 (±10.5) years. Only 6 (23.1%) of the participants had had specialist training in mental health while 19 (73.1%) of the participants indicated that they were directly involved in the management of persons with mental health issues. Out of a possible total score of 40 points the minimum knowledge score was 13 (32.5%), the maximum knowledge score was 36 (90%) while the mean knowledge was 22.2 (±4.6) points. Only 2 (7.7%) of the participants had full knowledge of all the goals of intervention, 12 (46.2%) knew that psychiatric emergencies had other causes apart from psychiatric conditions, and 16 (61.5%) were unable to name any physical cause of psychiatric emergencies even if 24 (92.3%) believed there could be co-morbid psychiatric and physical causes of psychiatric emergencies. Eighteen (69.2%) participants wrongly indicated that emergency management of psychiatric emergencies involved immediate application of physical restraint while only 2 (7.7%) knew that the de-escalation technique was an effective means of managing psychiatric emergencies. Nineteen (73.1%) participants had knowledge of the appropriate personal safety measures to adopt during a psychiatric emergency.

Discussion: This study revealed an average level of knowledge about the management of psychiatric emergencies among health care workers in a primary care center. This is a fairly worrisome finding considering the fact that psychiatric emergencies are common presentations at the emergency units of primary care hospitals, and also considering the fact that majority of the study participants are directly involved in the management of mentally ill persons presenting with psychiatric emergencies.

Conclusion/Recommendation: This study highlighted the relatively average level of knowledge of healthcare workers on the management of psychiatric emergencies. A well-structured intervention program that encompasses all the domains of learning is hereby advocated. In addition, retraining of staff should be done periodically.

Keywords: mental health, psychiatric emergency, primary care, de-escalation