Canadian National Standards for Emergency Rooms
Changed Following WPA Anti-Stigma Survey
Angus H. Thompson
Roger C. Bland
Department of Psychiatry and
Alberta Centre for Injury Control &
Research, University of Alberta
Department of Psychiatry
University of Alberta
Presented at the first International Congress on Reducing Stigma & Discrimination
Because of Schizophrenia, World Psychiatric Association, Leipzig, September 3, 2001.
WPA CAMPAIGN AGAINST THE STIGMA OF
SCHIZOPHRENIA: ALBERTA PILOT PROJECT
Local Advisory Committee, Sub-Committee on Health Professions
Julio Arboleda Florez, MD, PhD
Chair, Psychiatry Queens University
Laurie Beverly, MN
Cont Care Mgr
Roger Bland, MB
Chair, Psychiatry University of Alberta
Ruth Dickson , MD
Dir., Psychiatry
P. Lougheed Hospital
Beth Evans, BA
Pr. Coordinator
Alberta MH Board
Marion Ewing, RPN
ER Manager
Drumheller Health Reg.
Michelle Misurelli
Consumer
Calgary
Angus Thompson, PhD, Chair
Psychologist
University of Alberta
Elizabeth Anderson
Consumer
Calgary
Calgary Health Reg.
Pilot Site for the WPA Campaign Against the Stigma of
Schizophrenia
ALBERTA
WPA Pilot
Sites
METHODS
Phase 1 Methods
1. The Sub-Committee identified Emergency Room
(ER) services at general hospitals as a problem
for the mentally ill because of attitudes,
behaviours and facilities.
Phase 1 Methods
1. The Sub-Committee identified Emergency Room
(ER) services at general hospitals as a problem for
the mentally ill because of attitudes, behaviours and
facilities.
2. The Sub-Committee prepared a questionnaire
covering privacy/security, restraints, patient
rights, training of staff, patient satisfaction, and
planned changes.
Phase 1 Methods
1. The Sub-Committee identified Emergency Room
(ER) services at general hospitals as a problem for
the mentally ill because of attitudes, behaviours and
facilities.
2. The Sub-Committee prepared a questionnaire
covering privacy/security, restraints, patient rights,
training of staff, patient satisfaction, and planned
changes.
3. The questionnaire was completed by the ER
program managers in Calgary (3) & Drumheller(1).
World Psychiatric Association Anti-Stigma Campaign
EMERGENCY ROOM QUESTIONNAIRE (Item Content)
• Adequacy of interview space (safety, security & privacy).
• Availability of security staff.
• Formal patient rights policy (Existence and provision to patients/family).
• Restraints policy (Existence).
• Availability of specialist (mental health emergencies) staff on-site.
• Adequacy of ER staff training (CME, in-service) in managing mental health crises.
• Evidence for equal access/quality of treatment for the mentally ill (e.g. wait times).
• Adequacy of evaluation of services.
• Plans for any changes in the above areas.
• Additional comments pertaining to the mentally ill in Emergency Departments.
Survey Findings
•3 (of 4 ERs) had adequate access to security staff
Survey Findings
•3 (of 4 ERs) had adequate access to security staff
•2 had adequate rooms for security & privacy
Survey Findings
•3 (of 4 ERs) had adequate access to security staff
•2 had adequate rooms for security & privacy
•3 had formal patient rights policies, one will
provide these to patients/families on request
Survey Findings
•3 (of 4 ERs) had adequate access to security staff
•2 had adequate rooms for security & privacy
•3 had formal patient rights policies, one will provide
these to patients/families on request
•3 had specialist MH staff on site for limited
hours, with “on call” availability for other times.
The rural hospital had difficulty with staffing.
Survey Findings
•3 (of 4 ERs) had adequate access to security staff
•2 had adequate rooms for security & privacy
•3 had formal patient rights policies, one will provide
these to patients/families on request
•3 had specialist MH staff on site for limited hours,
with “on call” availability for other times. The rural
hospital had difficulty with staffing.
•CME for psychiatric emergencies was not
required, & the rural hospital had no formal
inservice training.
Survey Findings
•3 (of 4 ERs) had adequate access to security staff
•2 had adequate rooms for security & privacy
•3 had formal patient rights policies, one will provide
these to patients/families on request
•3 had specialist MH staff on site for limited hours,
with “on call” availability for other times. The rural
hospital had difficulty with staffing.
•CME for psychiatric emergencies was not required,
& the rural hospital had no formal inservice training.
•None had outcome or satisfaction data
Phase 2 Methods
1. A Report of the findings was distributed to the
ER Managers and to the Regional Patient Care
Manager.
Phase 2 Methods
1. A Report of the findings was distributed to the ER
Managers and to the Regional Patient Care Mgr.
2. Discussions were held with the Canadian
Council on Health Services Accreditation
(CCHSA) -- the national hospital accreditation
body.
Phase 2 Methods
1. A Report of the findings was distributed to the ER
Managers and to the Regional Patient Care Mgr.
2. Discussions were held with the Canadian Council
on Health Services Accreditation (CCHSA) -- the
national hospital accreditation body.
3. The Sub-Committee, upon invitation, proposed
changes to the CCHSA accreditation protocol.
PROPOSED ER GUIDELINES FOR
PATIENTS WITH A MENTAL ILLNESS
PROPOSED ER GUIDELINES
General Headings
P1.0 The examination and interview process and
space are adequate for the safety, security, and
privacy of patients and staff
PROPOSED ER GUIDELINES
General Headings
P1.0 The examination and interview process and space
are adequate for the safety, security, and privacy of
patients and staff
P2.0 There is a client/pt. /family rights policy that
defines its application to mentally ill individuals
PROPOSED ER GUIDELINES
General Headings
P1.0 The examination and interview process and space
are adequate for the safety, security, and privacy of
patients and staff
P2.0 There is a client/pt. /family rights policy that defines
its application to mentally ill individuals
P3.0 Staff will be available who have competence in
the management of mental health emergencies
PROPOSED ER GUIDELINES
General Headings
P1.0 The examination and interview process and space
are adequate for the safety, security, and privacy of
patients and staff
P2.0 There is a client/pt. /family rights policy that defines
its application to mentally ill individuals
P3.0 Staff will be available who have competence in the
management of mental health emergencies
P4.0 The quality of services to psychiatric patients
will be evaluated
CONSEQUENCES
Consequences
1. The Report led some ERs to seek funding to
remedy individual deficiencies, and there was
an expressed wish to have more clearly defined
standards.
Consequences
1. The Report led some ERs to seek funding to
remedy individual deficiencies, and there was an
expressed wish to have more clearly defined
standards.
2. The report was used by the hospitals for their
local reviews and in preparation for the next
round of accreditation surveys by the CCHSA.
Consequences
1. The Report led some ERs to seek funding to
remedy individual deficiencies, and there was an
expressed wish to have more clearly defined
standards.
2. The report was used by the hospitals for their local
reviews and in preparation for the next round of
accreditation surveys by the CCHSA.
3. The CCHSA considered the Sub-Committee
recommendations (& those from other sources).
• All but one were completely adopted
• The exception (a private interview room)
was partially endorsed.
DISCUSSION
Discussion
Consumer input can lead to a change in
national hospital service standards, dependent
on:
Discussion
Consumer input can lead to a change in
national hospital service standards, dependent
on:
1. Consumer identification of a valid issue
Discussion
Consumer input can lead to a change in
national hospital service standards, dependent
on:
1. Consumer identification of a valid issue
2. A "win-win" relationship with the hospitals
Discussion
Consumer input can lead to a change in
national hospital service standards, dependent
on:
1. Consumer identification of a valid issue
2. A "win-win" relationship with the hospitals
3. Early collaboration with our national
accreditation body
Discussion
Consumer input can lead to a change in
national hospital service standards, dependent
on:
1. Consumer identification of a valid issue
2. A "win-win" relationship with the hospitals
3. Early collaboration with our national
accreditation body
4. Luck!
ACKNOWLEDGEMENTS
Judith McLeay
ER Manager
Foothills Hospital
Donna Kelly
ER Manager
Peter Lougheed Centre
Lois Reister
ER Manager
Rockyview Gen. Hospital
Beth Dorsey
Regional Pt
Care Mgr
Psych Emerg
Calgary Regional Health
Authority
Paula Greco
Canadian Council on Health Services
Accreditation
www.cchsa.ca
FIN
World Psychiatric Association Anti-Stigma Campaign
EMERGENCY ROOM QUESTIONNAIRE
The World Psychiatric Association is leading an international health campaign to reduce the stigma associated with
schizophrenia. Calgary and Drumheller were chosen by an international committee to be a pilot site for the implementation of
this campaign, which includes the development of materials for use in other jurisdictions worldwide.
One of the areas identified was emergency room services. The goal for this part of the campaign is that persons with
schizophrenia and other mental illnesses will be viewed as being as important as those with physical illness.
We would appreciate your help in reviewing Emergency Room service in your region by providing the following information
for your Emergency Department.
•.Is adequate, safe, secure space, ensuring reasonable privacy, available for the examination and interview of psychiatric
patients and their families?
•.Is security staff available?
•.Is there a written statement of patient rights in your hospital? If so, how and when is it provided to psychiatric patients who
present at the ER?
•.If restraints are used, is there a policy in place? (Please provide copies, if available).
•.Do you provide on-site staff who are trained in managing mental health emergencies? If yes (circle one):
 At all times
 At specified hours only
 On call only
 A combination of the above (please provide details)
•.Are your Emergency Room medical staff trained in managing mental health crises?
 Are they required to participate in CME in this area?
 How does this compare with requirements, training, and qualification in other areas of medicine?
•.Are your other staff (e.g. nurses) trained in managing mental health emergencies?
 If trained, how did they receive the training?
 Is there any in-service requirement in this field?
•.If you have data on whether wait times differ in any way from those with other illnesses or conditions, please provide the
most recent results.
•.If you have data on patient (mental health) and family satisfaction with your Emergency Room services, please provide a
copy of the most recent results. Please include data, if possible, drawn from patients with other illnesses. Is such data
collected on a regular basis?
•.Do you have plans for any changes in the above areas?
•.Do you have any comments pertaining to the care of the mentally ill in Emergency Departments?
PROPOSED ER GUIDELINES FOR
PATIENTS WITH A MENTAL ILLNESS
Detailed Recommendations
ER GUIDELINES: PATIENTS WITH A MENTAL ILLNESS
P1.0 The examination and interview process and
space are adequate for the safety, security, and
privacy of patients and staff
P1.1 There are enough private interview rooms
available to ensure privacy during interviews in most
situations
P1.2 Interview rooms are secure
P1.3 Security staff are available on a timely, as
needed, basis
P1.4 There is a policy in place governing the use of
restraints
ER GUIDELINES: PATIENTS WITH A MENTAL ILLNESS
P2.0 There is a client/pt. /family rights policy that
defines its application to mentally ill individuals
P2.1 Information on rights is provided to the patient
P2.2 These rights are provided in a timely manner
P2.3 There is a policy whereby an interested second
party is consulted when the patient’s mental illness
interferes with the understanding of these rights
P2.4 There is a process for obtaining consent on
behalf of a patient when mental illness interferes
with understanding of the intervention being offered
P2.5 There is a process for deferring the above
provisions in emergent cases
P2.6 There is a process for patients & families to voice
concerns about rights violations
ER GUIDELINES: PATIENTS WITH A MENTAL ILLNESS
P3.0 Staff will be available who have competence in
the management of mental health emergencies
P3.1 Staff will be available who are qualified to
manage mental health emergencies
P3.2 In-service training is provided to fill any gaps in
staff skills
P3.3 Staff will have acquired a “sensitivity” to mental
illness
ER GUIDELINES: PATIENTS WITH A MENTAL ILLNESS
P4.0 The quality of services to psychiatric patients
will be evaluated
P4.1 There is information on whether wait times for
psychiatric patients differ from those with other
illnesses or conditions
P4.2 Information on patient and family service
satisfaction is gathered
P4.3 Information is gathered on the quality of
treatment provided to ER psychiatric patients