As a junior doctor who has moved to psychiatry after previously spending 2 years training in emergency medicine, I read Dr Gordon's article with interest. ^{Reference Gordon1} The survey clearly highlighted a need for mental health training of new doctors working in the emergency department. During one of my training posts in emergency medicine, I completed an audit which showed that 75% of patients presenting to the department with self-harm were being seen by junior medical staff and highlighted the need for increased training and supervision of junior emergency department doctors. In addition, many such patients present out of hours when access to senior support and psychiatric services may be more limited.

I think that it is also important to consider the knowledge, skills and attitudes of senior doctors working in the emergency department. Assessment and treatment of the patient presenting with self-harm and behavioural disturbance does form part of the College of Emergency Medicine curriculum. However, in my experience, many senior doctors working in emergency medicine – with some exceptions – have little interest in assessing and treating patients who present with self-harm or other mental health problems. As my audit showed, many such patients are left to junior doctors to see. When asked for advice about such patients, a common response from senior doctors is to advise that the patient should be referred to ‘psych’, without any meaningful discussion or assessment of the patient; this is in contrast to patients presenting with other problems such as trauma or minor injuries, when a senior doctor may show more interest in seeing the patient and teaching their junior staff.

It would be beneficial for patients if links between emergency departments and psychiatric liaison services were improved and if increasing the amount of mental health training available for all grades of doctors working in emergency departments was considered.