Mental Health in Acute Care Settings

Dr Kat Riley

Before we dive in, I'd like to start with a trigger warning. We'll be discussing topics like psychological distress, self-harm, and suicidal ideation. If you're not in the right headspace for this, please take care of yourself and listen another time.

RN Tom

Absolutely, and we'll provide links to support services in the show notes if anyone needs help right away. Alright, Kat, kicking off with psychological distress in NSW. What caught your eye from the recent data?

Dr Kat Riley

Well, the numbers tell a sobering story. In 2023, 18% of adults here in NSW experienced high to very high levels of psychological distress. Among young people aged 16 to 24, those numbers jumped dramatically—29% overall, with young women at 36%. It's crucial to note the even greater distress levels reported by Aboriginal adults, sitting at 37%.

RN Tom

Wow. That’s—that’s a huge disparity. And it tells us nurses need to be laser-focused on the unique needs of these groups. What stood out to me is how much distress seems tied to social disadvantages. Like, your postcode or income level shouldn’t determine how much you suffer, but it clearly impacts mental wellbeing.

Dr Kat Riley

Exactly. And that’s where person-centered, holistic care comes in. Psychological distress isn’t just about anxiety or sadness; it’s intertwined with factors like housing instability, cultural disconnection, or past trauma. Nurses need to see the whole person, not just their symptoms.

RN Tom

Right. Like, you could have two patients presenting with agitation, but their backstories totally change how you care for them. One might be grieving a loss, and another could be dealing with long-term trauma. If you don't get to the why, you’re gonna miss... well, you’re gonna miss everything.

Dr Kat Riley

Totally. That reminds me of a patient I worked with in a rural setting. They came in for a suspected rib fracture, but their emotional health was the real crisis. We paused the clinical "tick-boxing" and really talked—turns out they'd been caregiving for their sick parent full-time. Their emotional world was collapsing. What made all the difference was connecting them with local mental health outreach and even respite care. Their recovery wasn’t just physical, it was about restoring their whole sense of self-care.

RN Tom

Love that example. And you know, it brings up the strengths-based approach. Often patients, even when they're at rock bottom, still have these incredible coping mechanisms—friends who check in, a pet they adore, or even just their own grit to keep going.

Dr Kat Riley

Absolutely. And as clinicians, we’ve gotta amplify those strengths, not just focus on what’s "wrong." It’s about finding those spark points of resilience and making them—

RN Tom

—Making them part of the care-plan, yeah. Because when you do, it gives people something real to hold onto. It’s a way of saying, "You’re more than your diagnosis, and you’ve got reasons to hope."

Dr Kat Riley

That’s what recovery-oriented care is all about—partnering with the person where they’re at, emotionally, socially, and culturally, and building them up without judgment or stigma.

Dr Kat Riley

Speaking of building people up, let’s talk about trauma-informed care. Most of us have heard the term, but what does it really mean in practice? At its core, it’s about recognising that trauma—whether it’s abuse, neglect, or sustained stress—often underpins what we see in our patients. It shapes their physical and emotional health and even how they engage with us as caregivers. By acknowledging these ripple effects, we can create a foundation of trust and safety that’s essential for true recovery.

RN Tom

Yeah, and trust is big, isn’t it? I mean, you can’t get anywhere without it. I had this patient once, a young woman with type 1 diabetes. She kept landing in ED because of unmanageable blood sugar spikes. But when we slowed down... like really slowed down... we found out she had a history of food insecurity growing up. So, managing her diabetes wasn’t just about insulin doses—it was about addressing emotional triggers tied to eating.

Dr Kat Riley

That’s a brilliant example. Trauma-informed care is about recognising those deeper connections. It’s looking at the person beyond their diagnosis and learning how their story shapes our approach. And for nurses, that means fostering safety. Simple things like explaining what you're about to do before touching a patient or asking permission can make a massive difference in reducing their anxiety and increasing trust.

RN Tom

So true. I always think about how overwhelming hospitals can be for someone who’s already stressed or worse, suspicious of the system. A calm tone, open body language, just... being kind, you know? It all matters.

Dr Kat Riley

It does. And culturally safe practices are a cornerstone here too. Trauma isn’t experienced the same way across the board. Aboriginal communities, for instance, may carry the weight of intergenerational trauma. Building relationships and including their families in care when they’re comfortable and it’s appropriate is invaluable.

RN Tom

Totally agree. But you know, Kat, it’s also about us as practitioners being aware of our own biases. Like, I remember working with a patient who wouldn’t make eye contact or answer questions. I assumed disinterest. Turns out, culturally, it was their way of showing respect and keeping boundaries. I almost misread the whole situation.

Dr Kat Riley

That’s such a good point. Our assumptions can either bridge or break connection. Taking a moment to learn about someone’s background can transform how we care. Nursing isn’t about rushing patients through a system—it’s about meeting them as individuals and adapting our care to suit their needs.

RN Tom

Exactly. It’s like every patient’s favorite phrase is, "You actually listened." At the end of the day, that’s what sticks with them—not just the treatment, but the care and respect they felt.

RN Tom

All of this makes me think—when we talk about trauma, it’s clear how much trust and understanding matter. But Kat, when a patient is in real crisis—suicidal ideation, agitation, self-harm—how do we even begin to put all of that into practice?

Dr Kat Riley

It always starts with communication. Active listening isn’t just about nodding—it’s using open body language, making eye contact if appropriate, and showing empathy with phrases like, "That must be so hard for you." Patients need to feel heard, not rushed.

RN Tom

Yeah, and it’s amazing how much people will share when they don’t feel judged. I had a patient once who said, "You’re the first person who’s let me finish talking." Like, can you imagine how powerful that was for them?

Dr Kat Riley

It’s huge. And it leads into creating psychological safety—making sure the space feels as calming as possible. Simple things like lowering your tone or asking "Is there someone you’d like us to call for support?" can help de-escalate situations and make patients feel less alone.

RN Tom

Totally. And something I’ve learned is not to shy away from the hard conversations. If someone mentions suicidal thoughts, ask them about it. Be direct. "Are you thinking about taking your own life?" It can feel daunting for us, but honestly, avoiding it won’t help anyone.

Dr Kat Riley

Exactly. But ask in a way that’s respectful and non-alarmist. For example, "Can you share what’s been on your mind lately?" gives them space to open up. And when they do, our role isn’t to judge or solve everything—it’s to co-create a plan that prioritises their safety and wellbeing.

RN Tom

Absolutely. And a safe discharge is key. And if things aren’t lined up—like, if they’re leaving without a proper care plan—hello, red flag. That’s when you involve your team, escalate to senior staff, whatever it takes to make sure no one slips through the cracks.

Dr Kat Riley

Right, nursing isn’t a solo mission. It’s about collective care. And when we collaborate well—whether that’s with family, Aboriginal Liaison Officers, or multidisciplinary teams—it strengthens outcomes for everyone involved.

RN Tom

Couldn’t agree more. At the end of the day, these aren’t just patients—they’re people, each carrying unique stories, strengths, and struggles. Our job isn’t just about stabilising them physically. It’s about seeing them as whole individuals and setting them up for sustainable recovery.

Dr Kat Riley

Well said, Tom. Remember, listeners: care isn’t just about treating symptoms. It’s about showing up with kindness, curiosity, and a commitment to leaving people better than how we found them.

RN Tom

And on that note, thank you for tuning in to this episode. Hopefully, we’ve left you with some tools and a little extra confidence to handle these tough but crucial moments in acute care.

Dr Kat Riley

And if today’s conversation resonated with you—or raised more questions—we’d love to hear them. Till next time, stay curious, stay compassionate. Take care.