Psychologist Nivedita Malik, who advises her patients to access help immediately during an emergency, says the skills needed to deal with mental health patients at a hospital emergency department are quite specific.

"Untrained staff lack education and understanding of what mental health patients are actually going through, and insensitive comments and neglect can be quite detrimental to the patient's condition," Ms Malik said.

Such was the case with University of Wollongong student Mary.*

When she told triage nurses of her pre-existing mental condition, she believes their attitude changed to the extent they even questioned the validity of her symptoms.

While Illawarra Shoalhaven Local Health District mental health director Julie Carter could not speak to individual cases, she said in a statement: "The Mental Health Service provides education and support to ED staff around management and care of mental health consumers.

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The health district says the "care, treatment and safety of people with a mental health condition very seriously". It acknowledged the recent busy times and said waiting times may have been delayed for those "with less urgent conditions".

After waiting more than eight hours Mary approached the nurses to ask for a time frame of when she would see a doctor, and was told: "Should I help someone who isn't breathing or someone who is making things up?"

Mary presented at the ED for abdominal pain but ended up also suffering from a mental health crisis.

"With the support of my general practitioner and psychiatrist, I have learnt to manage my borderline personality disorder extremely well, but the waiting room triggered it."

Mary was told if she left to retrieve her medication she would lose her position in the queue. Even when her symptoms worsened, her request for a quiet corner was dismissed.

Although there is a private, safe assessment room for mental health patients at Wollongong Hospital, Mary was not provided access to one even after her persistent requests.

"It got too much for me so I lay on the ground to help myself regulate my breathing and the next thing I know, I was being dragged out of the hospital by two security guards."

She was asked to leave for being "disruptive". While she tried to reason with the staff, a doctor approached her and privately revealed her potentially fatal diagnosis: acute pancreatitis and gallstones.

She needed immediate surgery, but, the admission process could not begin until a bed was available. She waited another eight hours in distress.

Mary was critical of the staff's insensitivity: "It took me about six weeks post-surgery to stabilise myself and get on with my life."

She has vowed never to return to the hospital of her own volition.

Another Wollongong patient, Jessica*, visited the ED when she was suicidal.

She said, at the time last year, she was experiencing the worst phase of her bipolar disorder and borderline personality disorder.

"The doctor told me to not be suicidal because I had a bright future ahead of me. He ignored me when I said that I had zero reasons to live and would probably die if I left the hospital."

Jessica waited to be seen more than 12 hours on each of three consecutive days. And when the doctor finally did see her, it was to tell her to "not be depressed".

Hospital staff, she says, did not understand the severity of her situation.

Ms Carter said admission to hospital and treatment and care of consumers is based on each individual's clinical assessment and needs.

"The district operates a networked Mental Health Service across all of its facilities, which includes a number of acute inpatient mental health units. Consumers are allocated to the most appropriate facility based on their individual needs," Ms Carter said.

*Patient names have been changed

The health district has a number of initiatives aimed at reducing the need for mental health patients presenting to ED. They include:

Mental Health, Ambulance, and Police Project (MHAPP)

The health district has a number of projects supporting consumers in hospital, the community and in their homes as well as specific initiatives focused on reducing the need for presenting to ED, including:

Mental Health, Ambulance, and Police Project (MHAPP)

ISLHD has worked with its partner organisations to prevent the need for presentation to the emergency department with innovations like the MHAPP. NSW Police, Ambulance and mental health clinicians work hand-in-hand to help people during a mental health crisis in the community by providing emergency access to mental health advice and assessment. One of the key aims of the program is to prevent presentations to the ED and link consumers with more appropriate care in the community. MHAPP has been expanded into Shellharbour and the Shoalhaven after successfully being launched in Wollongong and Lake Illawarra in 2020.

Safe Haven

Opened in 2021, the Wollongong Safe Haven provides a free 'walk-in' service for people experiencing suicidal distress and situational crisis. Safe Haven is a welcoming environment where people can talk openly about how they're feeling and what they're going through. People can talk to a Peer Support Worker or a mental health professional or, if they don't feel like chatting, can spend time in a quiet space and listen to music.

Wollongong Safe Haven is located at 55 Urunga Parade, Wollongong and is open Wednesday to Saturday from 2pm to 10pm. The walk-in service is free and no appointment or Medicare is required. Safe Haven is one of four key initiatives the Local Health District is currently implementing as part of the NSW Government's $87 million Towards Zero Suicides prevention project.

Community support

Consumers who present to the ED experiencing at risk behaviours are offered a referral to a local Community Mental Health Team for 48 hour follow-up care and support. In addition, Grand Pacific Health, in partnership with ISLHD, offers the Next Step Program aimed at supporting consumers who have presented to the ED and are at risk of suicide. The program is delivered by clinicians and Peer Workers with lived experience who can assist with strategies and goal setting.

The program is consumer led, flexible, and is for a maximum of 12 weeks and may work parallel with the Community Mental Health Team and other support services. The program aims to facilitate the consumer connecting with both natural and formal supports, always working towards independence and self-determination as is appropriate.

If you, or someone you know, is thinking about suicide or experiencing a personal crisis or distress, please seek help immediately by calling 000 (Triple Zero) or one of these services: