Table 3 Factors perceived by participants to influence confidence in the assessment and management of mental health related presentations

Theme

Environment

Lack of resources

When I work in the private system I have less confidence because I just don’t have the resources… (M7)

…everyone is time poor and the aim is to use whatever length of time in the most effective way. I think if opportunities are made available people will embrace them for sure. (N17)

Safety and security

Certainly what increases my confidence is knowing that the environment is safe and secure. (M13)

Also there are times when I haven’t felt safe in a room where there’s only one exit and not many people around, it’s very closed off, the patient is aggressive, anxious and that affects me… (N24)

Staff

Most of my experience has been in city placements where there is a large frequent flow of psychiatric attendances. This regular contact helps to build confidence. (M33)

I guess I’ve had a lot of exposure in managing them, particularly when they are spectacularly off their tree. (N18)

Case complexity

…the other day we had a developmentally delayed patient, they’d had a brain injury 25-years ago, so they were actually quite difficult …. Ringing and talking it through with the psychiatrist made it pretty clear that he probably did have a mental illness… (M39)

…the dual diagnosis still does throw me. ...especially if they come in an they’re under the influence of the drugs or intoxicated… (N2)

Behaviour

People where you’re seeing an acute behavioural disturbance, and at the moment it doesn’t seem to belong clearly to either drug or alcohol or to psychiatry. I think in ED we get very caught around those issues. (M1)

…if they’re aggressive, I’m not going to ask them a lot of questions only because I’m worried about if I ask them something they don’t like, are they going to lunge at me, are they going to get crankier, so I don’t have a lot of confidence with psych patients at all… (N16)