Emergency departments are failing people with psychosocial disability, new research finds

People with psychosocial disability who present to emergency departments are often leaving worse off than when they arrived. New research from Adelaide University, published in Emergency Medicine Australasia, found that EDs are retraumatising vulnerable people in crisis rather than helping them.

A psychosocial disability is when a mental health condition — such as depression, bipolar disorder, schizophrenia, or PTSD — limits a person’s ability to take part in everyday life. That might mean difficulty maintaining work, managing relationships, or living independently. It’s distinct from a mental health diagnosis alone: the disability is defined by the impact on daily functioning, not the diagnosis itself. Around 62,000 Australians currently receive NDIS support for psychosocial disability.

84% of presentations in the study happened after hours, when community-based supports weren’t available and emergency departments were the only option.

The experience inside those departments was consistently difficult. Patients reported overwhelming noise and bright lights, long waits, and crisis-driven protocols that increased their distress. Many said they were disbelieved or stereotyped. Physical health concerns were overlooked. They were excluded from decisions about their own care, despite having NDIS plans designed to support their recovery.

The numbers on NDIS coordination are stark. Only 34% of patients were asked whether they had an NDIS plan. Only 25% were asked what information could be shared with their support networks.

“When a person with PSD is in distress after hours, emergency departments are usually the only place they can go for help,” said lead researcher Dr Heather McIntyre. “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.”

Clinicians described their own set of problems. Many said 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. That gap is producing moral distress and burnout across clinical staff.

Separately, research published in a related study shows the risk of suicide is significantly higher for people discharged from inpatient mental health care than for the general population, making continuity of support after an ED visit a serious concern.

Senior researcher Professor Nicholas Procter, Chair in Mental Health Nursing at Adelaide University, pointed to a structural problem: when the NDIS was established, psychosocial disability wasn’t fully considered. That left a gap in crisis care that nobody has clearly owned.

“Some clinicians assume the NDIS provides clinical care rather than disability support,” Prof Procter said. “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.”

The study calls for more integrated, recovery-focused care models, better after-hours alternatives to emergency departments, and stronger coordination between health and disability services.

For NDIS participants and their families, this research confirms what many already know from experience. The system wasn’t designed with psychosocial disability in mind, and the gaps show up most clearly at 2am when someone is in crisis and there’s nowhere else to go.