Examining models of mental health service delivery in the emergency department Timothy Wand, Kathryn White The purpose of the present paper was to review the current models of mental health service delivery used in the emergency department (ED) setting. A search was conducted of the nursing and medical literature from 1990 to 2007 for relevant articles and reports. Consideration was also given to the global and local context influencing contemporary mental health services. Wider sociopolitical and socioeconomic influences and systemic changes in health-care delivery have dictated a considerable shift in attention for mental health services worldwide. The ED is a topical location that has attracted interest and necessitated a response. The mental health liaison nurse (MHLN) role embedded within the ED structure has demonstrated the most positive outcomes to date. This model aims to raise mental health awareness and address concerns over patient-focused outcomes such as reduced waiting times, therapeutic intervention and more efficient coordination of care and follow up for individuals presenting to the ED in psychological distress. Further research is required into all methods of mental health service delivery to the ED. The MHLN role is a cost-effective approach that has gained widespread approval from ED staff and mental health patients and is consistent with national and international expectations for mental health services to become fully integrated within general health care. The mental health nurse practitioner role situated within the ED represents a potentially promising alternative for enhanced public access to specialized mental health care. Key words: emergency departments, mental health services, patient-centered outcomes. Australian and New Zealand Journal of Psychiatry 2007; 41:784 Á 791 Fundamental changes in health-care policy in Australia over the past 20years have substantially alteredthemannerinwhichindividualsaccesspublic mentalhealthcare.Thesechangesoccurredunderthe directionofthefirstNationalMentalHealthPlan[1], which championed the concept of mainstreaming. Thisprocessincludestheprinciplesofserviceintegra- tion, equity of access, early intervention and mental health promotion. Implementing this approach has had many benefits for people with mental illnesses, although it appears to have resulted in increasing numbers of mental health presentations to general hospital emergency departments (EDs) in Australia and overseas [2 Á 5]. Local reports have found that mental health presentations to the ED account for only 2.3 Á 3.5% of total presentations [4,6], although Heslop etal .estimatedtheratetobeashighas6.5% [7].Presentationratesnodoubt varybetweendiffer- ent settings as does data collection and coding methods. However, it is clear that mental health services are required to respond with initiativesthat supportEDstaffandimproveoutcomesforpatients. This paper reviews the literature on approaches currently used by health services to address these challenges while endeavouring to meet the expecta- tions and key principles of mainstreaming. This all Timothy Wand, Nurse Practitioner, Mental Health Liaison (Corre- spondence) Emergency Department, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia. Email: twand@email.cs.nsw.gov.au Kathryn White, Professor Faculty of Nursing and Midwifery, University of Sydney, Sydney, New South Wales, Australia Received 26 February 2007; accepted 22 June 2007. # 2007TheRoyalAustralianandNewZealandCollegeofPsychiatrists