Navigating 'deterioration in mental state' - from recognition to response in general hospitals to satisfy 'National Standards': a discussion paper

Background: The Australian Commission on Safety and Quality in Health Care 'National Standards' require general hospitals to have systems for clinicians to recognise and respond to patients' deteriorating mental state. The lack of an evidence-based operational definition and clear guidance challenges this requirement.

Objective: To review governance mechanisms and assessment processes for deteriorating mental state in a metropolitan general hospital and propose an organisational framework.

Methods: A qualitative document analysis using the READ approach systematically reviewed hospital committee reports, health district policies, and training programs to identify and synthesise key assessment points and processes.

Findings: The study mapped assessment points for recognising and responding to deteriorating mental state across patient journey stages. An organisational systems infographic provides a blueprint for meeting National Standards accreditation criteria.

Conclusions: Hospitals should establish comprehensive systems to observe, monitor, assess, and refer individuals with deteriorating mental state, involving multiple governance processes and frameworks.

Impact statement: Our paper maps governance and assessment processes to enhance deteriorating mental state recognition in general hospitals, aligning with National Standards.

Plain english summary: General Hospital staff often need to recognise and respond to patients whose mental health is getting worse. This problem is serious because a worsening mental state can lead to harmful behaviours, such as self-harm or violence, and can result in poor healthcare experiences for patients. Our paper aimed to find ways to help hospital staff better identify and manage these situations. We looked at the systems and processes currently in place in hospitals to see how they could be used to meet national healthcare standards for mental health care. We created a detailed plan that hospitals can follow to improve their mental health responses. This plan includes steps for governance, assessment, and clinical pathways, ensuring that all parts of the hospital system work together to support patients with deteriorating mental states. Our findings suggest that using existing hospital processes, rather than creating new tools, can help staff more effectively recognise and respond to mental health issues. This approach not only meets accreditation requirements but also enhances patient safety and care quality. This paper provides valuable insights for healthcare practitioners and policymakers, showing that with the right systems in place, general hospitals can better manage mental health care, ultimately leading to better outcomes for patients.