When Charlotte Gonzaga experienced her first panic attack and self-harmed in 2019, she rushed to a Sydney hospital.
But after a long, agonising wait in a busy emergency department (ED), her symptoms worsened.
"It was terrifying … I was waiting for five or six hours, but I felt like I was there the entire day," she said.
"Seeing everyone just walk past you and not check on you made it even scarier."
Ms Gonzaga left the ED without the mental health support she needed.
Several weeks later, the 22-year-old was diagnosed with anxiety and depression.
Every year, over 10,000 young people across Australia attend emergency departments after a self-harm or suicide attempt.
But a report by the peak suicide prevention body, Suicide Prevention Australia (SPA), has found EDs are not set up to address the needs of young people in mental health crisis and alternatives are needed to ensure they receive adequate care.
"It would have made a world of difference if someone [in the ED] was talking me through what to expect and actually checking in on me," Ms Gonzaga said.
Patients in mental health distress who were consulted as part of the report also described their experience in the ED as "overwhelming" and "isolating".
SPA chief executive officer Nieves Murray said negative experiences in the ED could make them less likely to seek help in the future.
"Younger people in particular find [emergency departments] very distressing," she said.
"It exacerbates their crisis situation."
The report recommended a number of alternatives to emergency departments, including Safe Havens — a model being trialled in NSW.
Safe Havens typically operate as a drop-in service, with no bookings or referrals required.
The facilities offer a non-clinical setting for people in suicidal mental health crisis to get free support from a peer worker with lived experience of suicide.
The model is based on one developed in the United Kingdom, which led to a reduction in mental health hospital admissions.
With long wait times impacting the state's hospitals, advocates argue Safe Havens can also help divert people away from emergency departments and in turn, reduce overcrowding.
Emergency psychiatrist Jacqueline Huber said while Safe Havens were a step in the right direction, they had limited hours of operation.
"[Safe Havens] are designed to be warm, welcoming, to give people a sense of community," Dr Huber said.
"The problem is they're not available all the time. They need to be available every day, after hours and on weekends if they're going to give the most appropriate care.
There are currently 19 Safe Havens in operation across NSW.
However, Ms Murray said they are not tailored to meet the needs of young people and more of the facilities are needed to meet demand.
"At the moment, [Safe Havens] are not youth-specific," she said.
"Having Safe Havens that are co-designed with younger people will ensure that we're addressing [their] needs."
The NSW government has allocated $25 million to the Safe Haven initiative.
NSW Mental Health Minister Bronnie Taylor said the state government was looking to "expand the service", including "extending operating hours for existing sites".
A NSW parliamentary inquiry into the impact of ambulance ramping and access block on hospital emergency departments last month recommended the government "improve access to community mental health services, particularly for young people".
The report also suggested the government consider ways of making hospitals "more appropriate spaces for mental health patients", including improving access to mental health specialists in emergency departments.
