Crisis Point: Australia’s Mental Health Patients Wait Over 23 Hours for Hospital Beds
A new report from the Australasian College for Emergency Medicine (ACEM) has laid bare the inadequacy of Australia’s mental health care system, revealing that public hospital emergency departments (EDs) remain the “only option” for many people needing acute care. The crisis has deepened, with data showing that 10 per cent of mental health patients waited more than 23 hours for an inpatient bed in 2023–24.
The ACEM report, Still Waiting, analyzed data from 2016 to 2024 and found that despite years of calls for reform, ED time-based performance has declined. ACEM President Dr. Stephen Gourley emphasized the urgency of the situation, stating, “The data is clear. The solutions are known. The time for reform is now,”.
Rising Acuity and Declining Capacity
Mental health-related presentations to EDs increased by 11 per cent, rising from approximately 277,000 in 2016-17 to over 310,000 in 2023-24. Worse than the rising volume is the increasing complexity and urgency of cases.
Key findings highlighting the severity of presentations include:
- Urgent Care Delays: Nearly 75 per cent of mental health patients were triaged as needing to be seen within 30 minutes (Australasian Triage Scale 1–3) in 2023-24, compared to more than 63 per cent in 2016-17. Despite this urgent need, the proportion of mental health presentations seen on time nationally decreased from 68 per cent to just 60 per cent over the same period.
- Mode of Arrival: In 2023-24, 53.4 per cent of mental health-related presentations arrived by ambulance, double the proportion for non-mental health patients. The increase in ambulance arrivals suggests a greater number of people in the community have higher acuity mental health conditions requiring treatment.
- State Hotspots: Wait times for admission are particularly high in South Australia, Tasmania, and Western Australia. These jurisdictions also consistently reported lower proportions of mental health-related presentations seen on time. South Australia (35 hours 46 minutes) and Tasmania (34 hours 7 minutes) reported the longest 90th percentile ED length of stay for admitted mental health presentations in 2023-24.
The core issue driving the excessive delays is a system failing to keep pace with demand. While the number of mental health-related presentations requiring admission increased by 3.2 per cent between 2016-17 and 2023-24, the number of public specialist mental health hospital beds decreased by 1.3 per cent between 2016-17 and 2022-23.
Disproportionate Impact on Vulnerable Groups
The data also reveals that the strain is felt most heavily by specific demographics:
- First Nations Peoples: Aboriginal and Torres Strait Islander peoples accounted for 14 per cent of mental health-related presentations in 2023-24, a significant increase of 3.7 per cent since 2016-17. The College noted that cultural safety must be embedded in EDs, as Aboriginal and Torres Strait Islander peoples are more likely to be impacted by the social determinants of health and are more likely to leave the ED before care is completed.
- Older Australians: Presentations among people aged 65 and over rose by 3.6 per cent. Long ED waits for older patients can contribute to delirium and worsen dementia symptoms.
ACEM’s analysis also highlights that system failures extend “beyond hospital bed access block,” as excessive waiting times are affecting not only admitted patients but also those discharged without
admission. The longest 90th percentile ED length of stay for non-admitted mental health patients exceeded the national average in Western Australia, Victoria, Tasmania, and South Australia.
Calls for Immediate Whole-of-System Reform
Dr. Gourley stressed that EDs are not designed or resourced for long-term recovery support; they are merely the “default entry point for crisis care”. He urged policymakers to recognize that “people are not a burden” but rather individuals seeking help in vulnerable moments, noting that the problem is a health system that has failed to meet community need.
The Australian Medical Association President, Dr. Danielle McMullen, supported the ACEM findings, noting that the report underscores the “devastating impact of a lack of investment” in community services and general practice, which could otherwise keep people out of busy EDs.
ACEM outlined several critical steps needed for decisive action, including:
- Increased Inpatient Capacity: Increasing the number of inpatient beds to reduce access block and unnecessary delays to admission.
- Expanding Community Services: Committing to funding the expansion of community-based mental health services and affordable psychology services to match community needs.
- Crisis Alternatives: Investing in ED alternatives, such as Safe Haven Cafés, which provide more therapeutic spaces for people experiencing a mental health crisis.
- Scaling Up Models: Continuing to invest in the Police, Ambulance and Clinician Early Response (PACER) model, which has demonstrated an ability to reduce unnecessary ED transfers and provide community intervention.
- Cultural Safety: Resourcing EDs with Aboriginal and Torres Strait Islander Liaison Officers to provide culturally safe care.
Dr. Gourley concluded that without decisive action, Australia risks perpetuating a reactive model that fails its most vulnerable populations.
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