Evaluating a new model of nurse-led emergency department mental health care in Australia; perspectives of key informants Timothy Wand RN NP MN (Hons) PhD (Associate Professor, Nurse Practitioner, Mental Health Liaison) a, *, Natalie D’Abrew BA Psych (Hons) (Senior Research Manager) b , Louise Acret BN, Grad Cert Crit Care, Grad Cert QHR, MPH (Research Assistant) b , Kathryn White RN, MN, PhD (Professor of Nursing) c a University of Sydney and Sydney Local Health District, Emergency Department, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW 2050, Australia b University of Sydney, Australia c Sydney Nursing School, University of Sydney (MO2), Australia ARTICLE INFO Article history: Received 13 March 2015 Received in revised form 1 May 2015 Accepted 17 May 2015 Keywords: Mental health care Mainstreaming Mental health liaison Nurse practitioner Qualitative Emergency Department A B ST R AC T Background: Mental health nurse services have existed in Emergency Departments (ED) for many years. However, there is considerable variation in the way these services operate, and no standardised model of care has been articulated. Aim: To evaluate an extended hours nurse practitioner-led mental health liaison nurse (MHLN) service based in an ED in Sydney Australia. Methods: As part of a larger mixed-methods study, semi-structured interviews were conducted with a sample of ED patients and nursing, medical and psychiatry staff (N = 46). Newly recruited MHLNs were interviewed at the commencement and conclusion of the study period. This paper presents the quali- tative component from the evaluation. Results: The new service was met with high levels of approval by patients and staff. MHLN team members were challenged by their new role but considered the service reduced waiting times, provided thera- peutic benefits, and enhanced communication and support for emergency staff. Conclusion: A nurse practitioner-led extended hours MHLN service embedded within the ED team struc- ture provides prompt and effective access to specialised mental health care for people with ‘undifferentiated health problems’ and removes a significant workload from nursing and medical staff. © 2015 Elsevier Ltd. All rights reserved. 1. Introduction Effective and timely intervention and follow-up for mental health related presentations to the Emergency Department (ED) is an issue of considerable interest. The Fourth Australian National Mental Health Plan (2009–2014) recognised that EDs are frequently the first point of contact with the mental health system. Services must work in more collaborative ways to support flexible, integrated and re- sponsive models of care rather than operating in rigid silos. Importantly, general hospital staff also need to access expertise to enhance care for people with physical illness complicated by psy- chological and behavioural problems (Commonwealth of Australia, 2009). Health services are required to implement new models of care that streamline transition through the ED for people presenting with mental health related concerns and to support ED staff. The ben- efits associated with mental health nurse service provision in the ED have been recognised from numerous evaluations conducted in- ternationally (Callahan et al., 2001; Clarke et al., 2005; Eales et al., 2006; Morgan and Coleman, 2000; Sinclair et al., 2006; Wand and Happell, 2001). However, there is significant variation in the way such services are designed and operate within the ED, such as team structure and where that sits within the ED, reporting mecha- nisms, patient referral and follow up. A standardised model of mental health nurse service delivery that best meets the needs of the ED and the public is therefore required. This Health Workforce Australia (HWA) funded study consti- tuted part of a broader national evaluation project exploring expanded scope of practice for nurses in ED. The primary aim of this project was to evaluate a nurse practitioner (NP)-led ex- tended hours mental health liaison nurse (MHLN) service based in the ED of the Royal Prince Alfred Hospital (RPAH) in Sydney, Australia * Corresponding author. University of Sydney and Sydney Local Health District, Emergency Department, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW 2050, Australia. Tel.: +61 0417 256 269; fax +61 02 9515 55099. E-mail address: timothy.wand@sswahs.nsw.gov.au (T. Wand). http://dx.doi.org/10.1016/j.ienj.2015.05.003 1755-599X/© 2015 Elsevier Ltd. All rights reserved. International Emergency Nursing ■■ (2015) ■■–■■ ARTICLE IN PRESS Please cite this article in press as: Timothy Wand, Natalie D’Abrew, LouiseAcret, Kathryn White, Evaluating a new model of nurse-led emergency department mental health care in Australia; perspectives of key informants, International Emergency Nursing (2015), doi: 10.1016/j.ienj.2015.05.003 Contents lists available at ScienceDirect International Emergency Nursing journal homepage: www.elsevier.com/locate/aaen