Emergency doctors have undergone psychiatric training as the number of patients seeking urgent help for a range of issues stemming from mental disorders “spiked” throughout the pandemic.

The number of psychiatric cases turning up at Mater Dei Hospital’s Emergency Department increased a year ago, when the pandemic struck, and remained high compared to pre-COVID levels, highlighting the need for this training.

As anxiety levels spiralled throughout the country during the pandemic, emergency doctors faced an increase in the number of patients heading to emergency complaining of chest pains, which turned out to be caused by anxiety, consultant psychiatrist Maria Bezzina Xuereb and Emma Saliba, a higher specialist trainee in psychiatry explained.

Isolation led to depression and loneliness, especially among the elderly. There were cases of self-harm. Some patients relapsed as fear of venturing outside their home meant they did not head to the pharmacy to pick up their medication and lack of contact with friends and loved ones meant there was no one ensuring they did.

Substance abusers faced withdrawal symptoms and, on the other end of the spectrum, some abused more alcohol leading to intoxication and injuries.

Growing number of mental health patients

All these cases presented themselves to Mater Dei Hospital’s Emergency Department where doctors had to assess, treat and refer patients to psychiatrists, Bezzina Xuereb and Saliba said.

“Emergency doctors see a high percentage of patients with mental disorders and, with the onset of the pandemic, we noticed a spike…  There are those who did not have a previous mental illness and, when the pandemic struck, they experienced anxiety, depression or other mental disorders due to psycho-social changes such as loss of employment and the loss or protective factors, such as not being able to meet friends or go for a walk.

“Then there were those who had a previous history and relapsed or did not keep up with medication,” according to Saliba, who, together with Bezzina Xuereb, formed part of a team that led a pilot psychiatric training programme offered to emergency doctors last month. This is the first time that such training is being offered.

A psychiatric emergency is as valid as any other medical emergency

The one-day programme, which is CME-accredited, was originally planned for last year but had to be postponed due to COVID restrictions. It was held in the beginning of August and attended by 13 senior emergency trainees.

The programme was approved by the Association of Emergency Physicians of Malta and the Maltese Association of Psychiatry and was organised with the support of consultant emergency physicians Mary Rose Cassar, Anna Spiteri and Agnes Portelli and higher specialist trainees in emergency Juan Ellul Pirotta and Justine de Gray.

The challenge of dealing with psychiatric patients

Saliba, who first identified the need for the programme, said: “Some psychiatric patients who go to emergency can be very challenging. They can be aggressive and agitated or can refuse to speak to a doctor. The idea of the training is to empower emergency doctors and help them strengthen their skills and be better equipped to assess and manage these patents.”

Bezzina Xuereb stressed on the need for this form of training since psychiatric emergencies were becoming more common.

“We are trying to move away from the old-school mentality that an emergency is only a medical emergency and emphasise the idea that a psychiatric emergency is as valid as any other medical emergency. It can be as significant to someone’s life in the same way that a heart attack can be,” she stressed.

Patrick Farrugia, a consultant emergency physician and the president of the Association of Emergency Physicians of Malta, explained that emergency doctors were specialised in emergency medicine that touched on a range of specialities.

This was because, as front-liners, they had to assess and diagnose a range of conditions, from heart attacks and strokes to trauma and psychiatric cases, and then refer patients to the relevant hospital departments.

In the case of psychiatric patients, emergency doctors would first deal with any medical issue, such as an injury, then liaise with the hospital’s psychiatric team to handle the mental health aspect. 

Farrugia said that emergency doctors faced a chaotic environment and they felt they needed better training to deal with challenging psychiatric cases. The course helped improve communication between the emergency and psychiatric departments.

“It helped to build a better bridge between emergency physicians and psychiatrists and helped us develop skills to connect with patients by listening to their story,” he said.

These skills, he added, were now even more necessary since the hospital had experienced an increase in cases presenting themselves to emergency as people now vaccinated feel safe again to go to hospital.

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