Two words on hospital admission form highlight broken system

A Sydney woman has revealed how two words written on an emergency room admission form exposes a huge problem facing Australia.

It was two words written on an emergency room admission form that highlighted for Sydney woman Courtney that she was stuck in a broken system.

“I was in the emergency room at 3am because I was having intense suicidal ideation,” Courtney told news.com.au. “I’d been having panic attacks for months by that point and was in immense psychological pain. I’d never found existence more excruciating. But on my admission form they’d ticked a box next to ‘appears comfortable’.”

That detail cemented for Courtney what she calls the “cognitive dissonance” between how mental health problems are perceived in the medical system, and how they are experienced by the person living with them.

The 36-year-old, who has been navigating anxiety and panic attacks for half her life, said she understands the reason that box was ticked, and acknowledges that she appears outwardly quiet and withdrawn when she is at her most unwell.

“I have friends who work in hospitals, and I understand the need to triage based on risk to life, and I do understand the purpose of emergency departments. I hold no blame towards the staff who wrote that. But the fact remains that at that time I most definitely was not comfortable,” she said.

“I don’t think it really matched what was happening, because I don’t really think I was asked if I was comfortable or not.”

Australia is in the grips of a mental health crisis, and people are struggling to know who to turn to, especially our younger generations. Can We Talk? is a News Corp awareness campaign, in partnership with Medibank, equipping Aussies with the skills needed to have the most important conversation of their life.

A 2020 Victoria University report to the Australasian College of Emergency Medicine (ACEM) found Australians with mental health issues were getting “stuck” in emergency rooms with nowhere else to go because of a lack of appropriate training and care in these settings.

Sydney local Courtney said two words on a hospital admission form exposed a big problem Australia is facing. Picture: Supplied

The report found that people presenting with mental health issues wait longer than other patients with a similar severity of physical illness before they can be assessed and have their treatment commenced. They are also 18 per cent less likely to be seen within the appropriate Australasian Triage Scale time frame.

In the report’s foreword, Dr John Bonning and Dr Simon Judkins (the then-president and immediate past president of ACEM respectively), wrote: “Emergency departments are often considered the ‘canary in the coal mine’ in identifying failures in the health system and hospitals, and mental health patients presenting to emergency departments in crisis could be described as ‘the ambulance at the bottom of the cliff’.”

The first time Courtney had a panic attack, it was 2007 and she was in a university tutorial. It was so severe, paramedics had to be called.

“I started feeling nauseous, and like food poisoning, it came on then intensified very, very quickly,” she recalled.

“But unlike food poisoning, it was accompanied by such intense emotional distress and terror, which quickly overwhelmed me. I felt a white-hot burning sensation all over my skin, so I left the class, texted my boyfriend at the time to tell him that I needed some help, and it kind of all fell apart.

On her admission form they’d ticked a box next to ‘appears comfortable’. Picture: Supplied

“From there, it all accelerated to the point where I was lying on a lounge, and the adrenaline coursing through my body had locked up my ankles, my wrists and my kneecaps. It was very physically painful as well. I ended up looking like this distorted, contorted kind of creature.”

When paramedics arrived and checked Courtney over, it didn’t take long for them to assure her that she had “just” had a panic attack.

“You hear it all the time when people talk about panic attacks, that you feel like you’re dying. But there’s no other available explanation to you at the time. It’s such an extreme event, physically and mentally. I didn’t actually know humans were capable of feeling like that, let alone that there was nothing fundamentally wrong with me, which is what paramedics then told me.”

In the years that followed, Courtney – with the help of a supportive network of family, her partner, and friends – sought help via multiple avenues, including GPs, counsellors and psychologists.

One by-product of panic attacks, she explains, is that once you’ve had one, you can develop anticipatory anxiety about having one again.

“It took me many, many years and the insight from a therapist to accept that severe panic attacks are deeply traumatising experiences for the brain and body, and so like any highly traumatising experience, the brain and the body are geared to ensure we don’t encounter that again,” she said.

Courtney – with the help of a supportive network of family, her partner, and friends – sought help via multiple avenues. Picture: Supplied

“After that first attack, I was just terrified of that happening again. The way I described it for many years was like waiting to have the rug pulled out from under you and knowing it will be pulled out at some point.”

Over the course of the past 18 years, the anxiety and panic attacks has at times become so acute that, although rare for her, she has required emergency care, usually following a long period of trying to get help elsewhere.

“I joke that I have a breakdown every decade or so,” she quipped. “Although I’m hoping to change that pattern for the next decade.”

It’s in these acute phases, however, that Courtney said she’s been able to see big gaps in understanding in the mental health system.

In 2021, after requiring emergency care once more for treatment, Courtney began medication, which she described as “life-changing”.

Medication has been life-changing for Courtney. Picture: Supplied

“It doesn’t work for everyone, but medication has been life-changing for me, to the point where I went through a period of feeling quite angry that it hadn’t been offered to me as an option before now,” she said. “And I think a big part of why I hadn’t is that I’ve at times felt quite dismissed by medical professionals in those settings.”

Black Dog Institute executive director Sam Harvey describes Australia’s mental healthcare system as “overwhelmed”.

“It’s quite a confronting situation,” the psychiatrist said.

Prof Harvey said while there were more tools at professionals’ disposal, far too many people with “very treatable” symptoms didn’t get to sit in front of a clinician that could provide them.

He said this was due to Australia’s “very confusing” system, where many people felt they could not afford care, and a “real shortage” of mental health professionals.

“We still struggle to recruit people to work in the mental healthcare system … they see that it’s a system that’s not funded with parity compared to physical healthcare systems,” he said.

“So it’s harder to recruit really good staff, and it becomes a bit of a self-fulfilling prophecy that because it’s an overwhelmed system that’s really difficult to work in, then it becomes less well-staffed and even more overwhelmed.”

Courtney has felt quite dismissed by some medical professionals. Picture: Supplied

Speaking from nearly two decades of experience navigating the system, Courtney said the way a patient is responded to when they do open up can have ongoing impacts on the success of their treatment.

“It really starts with that first touchpoint, because we always talk a lot about people needing to share and talk about their mental health. However, it’s really important to remember a lot of people do talk about it,” she detailed.

“I’m a case in point. I’ve never not spoken about it. A tremendous amount of people do talk about it and seek help, and it is really that first touchpoint that really shapes their treatment journey from then, particularly around how the person responds to what they’re saying.

“One thing I would say to medical professionals is just because we are presenting as severely unwell, we nonetheless can be extremely reliable narrators about our lived experience.

“If I’m talking to a new person tomorrow about panic attacks, I can give you an accurate 18-year history, which will contextualise why I’m in the emergency room right at that moment. And I’ve found a lot of times that’s been dismissed because you’re unwell, and it’s also considered that you can’t speak articulately about your mind and body. When in fact there’s no bigger expert on what it’s like to be inside my mind and body than me.”

Bek Day is a freelance writer

Originally published as Two words on hospital admission form highlight broken system