Close Search
Open Menu Close Menu Open search

Mental Health and Alcohol and Other Drugs (MHAOD) Care in Emergency Departments

This document summarises information contained in Emergency Department DG-CC4, Provision of Mental Health Care in Western Health Footscray and Sunshine Emergency Departments, and Emergency Department DG-CC4, Provision of Alcohol and Other Drugs (AOD) Care in Western Health Footscray and Sunshine Emergency Departments. The summary has been created to be Emergency Department specific, and has been endorsed by the ED Leadership Team. Staff should review these full documents if they require further information. Alternatively, additional information contained within these PPGs has been summarised in Supporting Documents:

  • QRG – Services Supporting Mental Health Care in Emergency Departments
  • QRG – Services Supporting Alcohol and Other Drugs (AOD) Care in Emergency Departments


This guideline details the care standards that support effective and safe mental health and alcohol and other drugs (MHAOD) patient care across Footscray Hospital and Sunshine Hospital Emergency Departments.


This QRG is applicable to all staff working in SHED.


It is the responsibility of the Nurse Unit Managers and Directors of the Emergency Departments of each site to ensure the relevant staff are familiar with this QRG and associated PPGs.

Guideline/Process Details

Western Health is committed to a recovery-focused, evidence-based approach to providing care to patients presenting with mental health and/or Alcohol and Other Drugs (AOD) care needs, where their dignity and rights are upheld.

Where Mental health and AOD care needs are co-morbid the patient will benefit from integrated, multidisciplinary specialist care.

 Mental health and AOD care needs include but are not limited to the following common presentations:

Common mental health presentations
  • Patients presenting with acute psychotic symptoms (e.g. hallucination and/or delusion)
  • Patients presenting with acute agitation (e.g. agitation due to complex behaviour/psychosis/delirium/intoxication/acute withdrawal, intellectual impairment or acquired brain injury (ABI))
  • Patients presenting post or at risk of an episode of serious self-harm or harm to others, ideation or behaviour
  • Patients presenting post suicide attempt or experiencing acute suicidal ideation
  • Patients presenting with high prevalence mental illness (e.g. anxiety and/or depression), with or without high risk of self-harm
  • Patients presenting with complex psychosocial needs, or in situational crisis
  • Existing community mental health patients
  • Patients under police escort under s351 of the Mental Health Act 2014 (VIC)
  • Patients subject to an order under the Mental Health Act 2014 (VIC) (e.g. an Assessment Order or Temporary Treatment Order)
Common AOD presentations
  • Patients presenting with symptoms of acute intoxication or acute withdrawal
  • Patients with a current or past history of substance use disorder
  • Patients at risk of harm due to their AOD use who may benefit from harm reduction interventions
  • Patients at risk of harm due to their use of prescription drugs of dependence
  • Existing patients of AOD community services

Engaging Family and Support Persons

Engagement and communication with family and support persons of patients is an important part of providing person-centered, recovery-focused care.

Specific consent from the patient is required in order for staff to:

  • engage with family members and carers
  • disclose patient information to family members and carers
  • involve family and carers in care planning and discharge

Provided the patient consents:

  • ED nurses facilitating phone calls can provide a basic overview of how the patient is going (e.g. settled)
  • AOD clinicians can offer families and support persons educational interventions and provide community AOD family support contact information for self-referral
  • Families and support persons should be involved in care planning and discharge

Record all contact in EDIS as well as within nursing progress notes entered on the nursing bedside chart.

Exceptions under the Mental Health Act 2014 (VIC):

  • Under Section 120A family members, guardians or primary carers can be given information without the patient’s consent, where it is needed by them for the ongoing care of a patient with mental illness.
  • For patients subject to an order under the Act, notification to Next of Kin is a compulsory requirement.

Also consider communicating with community mental health or AOD clinicians already involved in the care of presenting patients.

Resources and Tools for Patient Care in the ED

Please refer to Supporting Documents for more information:

Distraction and calming resources are available in Sunshine Hospital and Footscray Hospital EDs.

Long Stay Patients

Best Care Western Health Guidelines add additional care provisions for patients with mental health or AOD care needs who have a length of stay in ED longer than six hours.

Adhering to minimum face-to-face review and observation times for these patients, as specified below, supports safety and protection from harm, and enhances clinical practice and patient care:

Clinical Reviews
  • Face-to-face reviews once every eight hours (at minimum)
  • By a nominated medical officer from ED, AOD or EMH (and a mental health clinician or mental health doctor for mental health patients)
Nursing Observations*
  • Hourly (at minimum)
  • Documents physiological assessment (i.e. conscious state, behaviour, circulation, skin integrity, toileting (2 hourly), hydration provision (hourly), repositioning (2 hourly), vital signs (as clinically indicated)
Hygiene Products
  • Patients are offered a toothpaste and toothbrush (at minimum)
  • Patients are offered a shower every 12 hours if appropriate (based on clinical, safety and risk considerations)

*Note that separate observation requirements apply to a restrained patient – refer to Supporting Documents for more information.

Food Services

All patients in ED should have access to food and beverage service options adapted to their individual needs throughout their ED journey.

Please refer to Supporting Documents for more information:

Behaviours of concern (BOC)

Prediction of Behaviours of Concern and prevention of escalation are critical to reducing the risk of clinical aggression.

  • Clinicians in Western Health EDs use the Behaviours of Concern (BOC) Chart to score patient risk of clinical aggression, which includes a management matrix.
  • Patients with mental health or AOD care needs may additionally receive comprehensive behavioural risk assessment by specialist service (i.e. EMH/ECATT or ED AOD Services) that will further inform what BOC management interventions are best suited.
  • Prevention and intervention strategies will be included in the patient’s plan in EDIS.

Please refer to Supporting Documents for more information:

Mechanical Restraint

Restrictive interventions such as mechanical restraint are a last resort to use with patients and can be a traumatic experience.

  • Alternative strategies must be considered first to mitigate the need for restraint use.
  • Debriefing with the Medical Officer or Registered Nurse is to be offered to patients after restraints are removed.

Please refer to Supporting Documents for more information:

Patients Missing/Away without Leave (AWOL)

Where the patient is voluntary and missing/AWOL, ED and AOD or EMH clinicians (as appropriate) determine if Police must be contacted for a search and welfare check, based upon clinical presentation and risk assessments.

Where the patient is involuntary and missing/AWOL, Police are always contacted for a missing person check.

Discharge Planning

Under the Best Care Western Health Guidelines, an ED medical officer must complete a discharge summary for all patients with mental health and/or AOD care needs.

  • The discharge plan needs to be well-communicated to the patient, as well as their carers and other healthcare providers (where the patient consents).
  • The discharge plan should state specific treatments/interventions, ongoing care arrangements including referrals made and any interim crisis measures.

Discharge planning and referrals consider the best pathway for the patient.

For all patients, consider:

  • Admission to an inpatient unit
  • Admission to a ward
  • Referral to Area MH Community Services
  • Referral to HOPE (Hospital Outreach Post-suicidal Engagement)
  • Referral to AOD Community Services
  • Referral to Primary Health Network
  • Referral to other community support services

For patients with AOD care needs, one or more of the following referrals should be made before the patient leaves ED, provided the patient consents:

  • Addiction Medicine Outpatient referral for appointment
  • WH Community Residential Withdrawal Unit (bed-based)
  • WH youth AOD service (Adolescent Community Program)
  • Primary Health Network
  • Improving and Promoting Community Health (IPC Heath – Dual Diagnosis Counselling)
  • ORT Prescriber referral for Appointment (e.g. GP)
  • Central Intake Service Appointment (if intake screening and comprehensive assessment required in community)
  • Telephone follow-up appointment by ED AOD clinician (where the patient consents) – arranged by email to ED AOD Services

Documenting Patient Care

Under Best Care Western Health Guidelines, all contacts with patients with mental health and/or AOD care needs and their families or support persons, by all clinicians, are to be recorded in EDIS. In addition, nurses record contacts on the nursing bedside chart.

A documented collaborative management plan should be developed for the patient and also entered into EDIS.

Additional requirements apply based on specialist service involvement:

For mental health patients For AOD patients
  • EMH/ECATT clinicians will complete comprehensive mental health assessment, risk assessment, ISBAR and other clinical assessments and documents in accordance with mental health service requirements.
  • Mental Health documentation will be in accordance with the Mental Health Act 2014 (VIC).
  • At minimum, assessment conducted by ED AOD services will include the details listed on the first page of the AOD ED Assessment Form.
  • Where appropriate, assessment will also include completion of a Victorian intake screener assessment +/- comprehensive assessment.
  • For patients who are going to be admitted to community AOD bed-based services, AOD clinicians will copy and paste their notes into the EMR.

Supporting Documents

Policy, Procedure and Guidelines (PPGs)


Document Governance

Title: Mental Health and Alcohol and Other Drugs (MHAOD) Care in Emergency Departments
Version: 1.0
Date Published: January 2022
Date of scheduled review: May 2023
Author: Approver:
SHED Leadership Team SHED Leadership Team


Print this Page