Summary on Perceived quality of Emergency Mental Health Care

Socio-demographic characteristics of study participants

Most of the respondents 83% (n=110) were nurses, and majority 79% (n=125) of them being

female. Most 41% (n-63) of the respondents were 40-49 years, followed by age 50-59 years

30% (n-48). Education level of respondents was higher diploma 42% (n=67), with nurses

being majority 50% (n=66), diploma 28% (n=45), majority being nurses 33% (n=44), all the

registrars were at degree level. Most 21 (n=34))of the respondents had worked in the hospital

for 6-10 years, followed by 18% those who had worked for 10-15 years, and 17%)1-3 years.

Association between socio-demographic characteristics and perceived quality of psychiatric

emergency care indicated the proportion of perceived good quality emergency care was more

From this study, most of the respondents rated the quality of emergency care as average.

There was significantly low proportion of perceived good quality emergency care among

respondents aged 30 to 39 years (30.6%) [OR=0.09; 95%CI=0.02-0.47; P=0.004] and 40 to

49 years (44.4%) [OR=0.16; 95%CI=0.03-0.79; P=0.025] than those aged 20 to 29 years

(83.3%). A study in Australian and New Zealand indicated there is a significant relationship

between structure and process, and quality of care (Smart et al. 1999)

Majority of the respondents described that there was average adequacy of facilities and

medical equipment (55.3%) required to support provision of emergency mental health care [p

= 0.013]. Staff skills and respect of patients was perceived as good .Monitoring of secluded

psychiatric patients was reported as fair, however, (39.6%) indicated poor budget allocated

Majority of the participants 66.9%, (n = 105) were of the opinion that the hospital is not

structurally adequate to handle quality mental health emergency care. The following are

structural factors which participants perceived to be affecting quality of mental health

emergency care: inadequate medical equipment [81 %, n = 129P=.013], adequate skilled staff

[83%, n= 132, p= .011], use of referral protocols [p=.016], motivation [p=.029], support from

hospital management [p=.03], communication [p=.03].

The above components were looked at in the study as structural factors influencing the

quality of mental health emergency care. These were analyzed and scored to obtain an overall

score which measured quality index. Findings also indicate that majority of respondents, 47%

(n=45) reported that the structure for mental health emergency care was poor. Structural

that budgetary allocation for mental health emergency care was not sufficient as indicated by

the key informants. “Budgetary allocation is not sufficient” (KII 1).

A similar study conducted in Kilifi indicated that there was no budget allocated for mental

health care (Bitta et al, 2017).

Accreditation of health facilities has been reported to impact positively in the structural and

process-related factors leading to better care outcome (Alkhenizan A. Shaw C. 2011)

lack, which hinders the provision of care (Moyimane M.B. et al, 2017). This study found that

majority 81% (n=129) reported inadequate medical equipment. Most 93% (n=148) reported

that the existing seclusion rooms in the wards were not adequate for psychiatric emergency

care. This may be due to lack of, or non-exiting records of client identified health needs

(WHO, 2012)

Privacy ranges from storage of patient information, who is allowed to access the information,

with mental health emergencies (Marciano et al, 2012). (Turner et al. 2015). This study

indicated the majority felt there was inadequately skilled staff to handle psychiatric

emergencies. About 61% (n=98)of healthcare providers in Mathari hospital have specialized

training in mental health care, however, the study demonstrated that majority 76% (n=121)

had not had any refresher course on mental health emergency care within the previous six

month.

According to Betz et al, (2013) revealed care providers felt staffing was adequate. However,

this study 61% indicated that the available staffs were adequately skilled in providing

emergency psychiatric services [p=.011] Adequate skilled staffing may positively impact on

the therapeutic environment have the expertise to handle mental health emergencies. Well

2013)

Safety measures within the hospital were perceived to be inadequate 82% (n=130) to

ensure safety for both staff and others. (d”Ettorre, Pellicani (2017), in their study

indicated that risk assessment should be given priority when assessing a patient in an

acute state of mental illness in order to reduce the risk of violence meted on care

providers.

A referral protocol for referring psychiatric emergency patients is in use as reported by

65% (n=103). This is inconsistent with another study which indicated that the presence

of policy frameworks that are not up to standard pose a challenge to the delivery of

care (Marangu E. et al, 2014). Consistent use of SOPs guides in harmonizing procedures

experienced between the hospital administration and the staff should be perceived as

mutual so that it may positively impact on the staff performance (Bird., et al 2011).

Administrative support may be perceived as not sufficient because there other areas

that need their attention, such as day to day running of the hospital.

The study indicated that there was effective communication 55% (n=88%) within and

across departments to facilitate proper management of psychiatric emergencies. This is

attributed to the fact that communication has been made easier through the use of

common format and terms. A toolkit targeting teamwork and communication among

care providers which was found to significantly improve communication and feedback.

Coordination amongst care providers during management of mental health emergency is