Emergency departments are failing Australians with psychosocial disability, as new research from Adelaide University reveals that the very system designed to help, is instead retraumatising vulnerable patients in crisis.
Published in Emergency Medicine Australasia, the national study reports the experiences of people with psychosocial disability presenting to emergency departments, alongside the views of clinicians involved in their care.
Both patients and clinicians reported frustrations that the care provided often did not meet people’s needs.
Specifically, researchers found that emergency environments can be overwhelming, unsafe and traumatic for people with psychosocial distress, with clinicians feeling under-skilled, under-resourced and under-prepared to respond therapeutically.
The study highlights a fundamental mismatch between emergency care, disability support and mental health systems, leaving people with psychosocial disability falling between services and at risk of further harm.
“A psychosocial disability (or PSD) is more than a mental health diagnosis,” said Dr Heather McIntyre.
“It’s when a mental health condition limits a person’s ability to engage in everyday life – from going to work, to living safely and independently – and it’s shaped by the world around them.
“When a person with PSD is in distress after hours, emergency departments are usually the only place they can go to for help. This study found that 84% of presentations occurred after hours, when community-based supports were unavailable.
“People with PSD said that emergency departments were extremely challenging, with noise and bright lights, a lack of privacy, long waits and crisis-driven protocols contributing to their distress.
“They also reported being disbelieved or stereotyped, having their physical health concerns overlooked, and being excluded from decisions about their care – despite having NDIS plans designed to support their recovery.”
The study revealed critical communication gaps, with just 34% of patients asked if they had an NDIS plan, and only 25% asked what information could be shared with their support networks.
While these experiences highlight the impact on patients, clinicians described parallel challenges within the system that limit their ability to provide appropriate care.
“Clinicians consistently told us they feel underprepared to manage complex mental health presentations, with limited training in trauma-informed care and little access to specialist support or clear pathways,” Dr McIntyre said.
“That creates moral distress and burnout for clinical staff and can lead to approaches that patients experience as dismissive or even harmful.
“It points to a broader systems issue, particularly in how emergency care intersects with the NDIS, where gaps in understanding and coordination are leaving people without the support they need.”
Research shows the risk of suicide is significantly higher for people who have been discharged from inpatient mental health care than for the general population – highlighting the critical importance of continuity of care and support.
Senior researcher and Chair in Mental Health Nursing at Adelaide University, Professor Nicholas Procter, said the study exposes a growing disconnect between the health system and the NDIS.
“When the NDIS was established, psychosocial disability was not fully considered, leaving confusion about who is responsible for care, particularly in crisis situations,” Prof Procter said.
“Without funded service integration, support between systems is often uncoordinated. Clinicians are left managing complex needs without clear pathways, while people can leave hospital without the right supports in place.
“There is also widespread misunderstanding of the NDIS, with some clinicians assuming it provides clinical care rather than disability support. This can lead to people being seen as ‘double dipping’, a withdrawal of services, and discharge back into the very situations that led them to seek help.
“Even when clinicians did understand the role of the NDIS, confidence in the system was low, with participants reporting challenges navigating plans and gaps in support.
“This is not about individual failure, it’s a system that was not designed with these patients in mind.
“We need more integrated, recovery-focused models of care, better after-hours support including alternatives to emergency departments, and stronger connections between health and disability services, so people receive the right care, in the right place, at the right time.”
