Experiences providing care to patients with mental health conditions in a tertiary care hospital emergency department in Jerusalem

The emergency department (ED) often serves as the first point of care for those with mental health conditions. Mental health-related visits to the ED tend to increase during and after public health crises. In Israel, the war that started in 2023 has had substantial adverse effects on the population's mental health, increasing the need for emergency services for people with mental health conditions. This article examines the perceptions and experiences of Israeli staff providing care to patients with mental health conditions in an ED of a tertiary-care hospital in Jerusalem. Based on an inductive thematic analysis of 24 semi-structured interviews with staff members, this study sheds new light on the staff's challenges in treating these patients. The study found that providers navigated a high level of stigma towards people with mental illness. Many providers were aware that negative perceptions of these patients were potentially harmful and may lead to diagnostic overshadowing, and in some cases, they tried to mitigate the effects of stigma. Staff often viewed patients with mental illness as inappropriate users of the ED, assuming limited responsibility for these patients. The findings also illuminate the providers' inadequate training and skills for treating and managing mental health, as well as organizational and structural constraints. The article recommends ways to improve the treatment of mental health in EDs, such as educational workshops, more support of mental health specialists in EDs, providing calm environments, working alongside experts by experience, and conducting person-centered risk assessments. EDs should strengthen collaboration and referral pathways to community-based mental health services. Moreover, the healthcare system must provide patients with alternative sources of care, such as community crisis centers. These steps can mitigate the expected post-war mental health crisis in Israeli EDs and are relevant to many other countries.