Deterioration in mental state: A National Standards conundrum

Abstract

Expedited interventions are integral to reducing mental health related morbidity and mortality in general hospital settings. The early recognition of a worsening mental state is essential for optimizing care and treatment of patients in need of specialist assessment, escalation and response. However, a lack of mental health training provides a challenge for generalist clinicians in recognizing clinical cues of variance consistent with a change in mental state, and subsequently acting upon them.

In April 2010, Australian Health Ministers endorsed the National Consensus Statement ‘essential elements for recognising and responding to clinical deterioration’ as the standard national framework for recognition and response to patient clinical deterioration in acute care facilities. In 2012, this consensus statement informed the first National Safety and Quality Health Service Standard for recognizing and responding to acute deterioration, which became part of the inaugural Australian Commission on Safety and Quality in Healthcare (ACSQH) National Standards (hereafter National Standards).

Generalist healthcare facilities were thus required to develop systems, processes, education and training to address the criteria contained within this National Standard, which initially focussed on physiological deterioration only. However, the 2012 National Standards have since been rescinded and superseded in 2017, where recognizing and responding to acute deterioration also encompasses acute changes in mental state. Consequently, significant attention within healthcare organizations now focusses on screening, monitoring, escalation and referral for, and of, acute deterioration in a person's mental state. However, screening and assessment of a deteriorating mental state has unique nuances and complexities not found in its physiological counterpart, which provide a significant challenge for Australian healthcare organizations, and perhaps consultation liaison nurses in particular, in meeting accreditation mandates and requirements.

This commentary explores the concept of a deterioration in mental state, the challenges for healthcare practitioners in addressing this if efforts are misguided, and finally outlines suggestions for healthcare organizations in meeting the requirements set out in the National Standards, which may confound some organizational attempts and thinking to date.