our story - health.nsw.gov.au · our story bankstown ed sees approximately 47,000 ... in 2011 34.5%...
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Our story
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Bankstown ED sees approximately 47,000 patients annually
Approximately 8% of these patients present with a primary psychiatric disorder
Source: First Net.
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Bankstown ED is a ‘Declared Mental Health Facility’
Bankstown hospital has an on-site 30 bedded adult psychiatric unit ‘Banks House’
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The city of Bankstown is a multicultural area. In 2011 34.5% of our population
were Non English Speaking, with 37% of the Bankstown City population being born
overseas. 7.1% (12993 people) were born in Lebanon, followed by 6.8%
(12394) born in Vietnam; 2.9% (5222) were born in China and 1.3% (2363)
were born in the UK.
Census 2011.
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Specific to Bankstown
Psycho-Stimulant Intoxication/delirium
+/- psychosis/mania
PTSD/Psychosis from Villawood Immigration Detention Centre
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People affected by serious mental illness face critical challenges to achieving and maintaining the same physical health as other people in the community.
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‘The medical clearance’ added benefit
For some mental health patients who are not admitted it is a rare opportunity to offer primary healthcare.
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Schizophrenia
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Challenges
Medical assessment of mental health presentations offers a huge spectrum of acuity from life threatening conditions like serious suicide attempt to people with no mental health history in crisis following an acute stressor such as a relationship break up.
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Challenges
First Episode Psychosis
How far to go?
CT head now or later?
UDS in house
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why can it sometimes be so hard?
the patient may not clearly have a delirium nor a
psychosis but is acutely disturbed the thought disorganisation and agitation of some patients with
acute psychosis can make it hard to distinguish from a delirium delirium patients may have auditory hallucinations instead of the
more common visual hallucinations psychosis patients may have visual hallucinations instead of the
more common auditory hallucinations up to 40% of patients with dementia have psychotic symptoms
(delusions and hallucinations) most of the causes of delirium can also cause an acute “toxic”
psychosis
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delirium is commonly caused by anti-psychotic medications or drug overdoses
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patients are often uncooperative if not aggressive compromising history-taking and careful examination
many patients with mental health issues also abuse substances which add to the complexity of the assessment (Dual diagnosis)
a history of a drug overdose may not be forthcoming have they been taking too much lithium and developed acute
on chronic lithium toxicity?
have they taken a potentially lethal paracetamol overdose and not disclosed it?
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Linguistically Diverse population/ NESB
‘Frequent Flyers’ risk of complacency?