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Snelling moves to curb mental health crisis

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Health Minister Jack Snelling is conducting an urgent internal review into the mental health crisis in South Australia’s emergency departments.

Last week, Snelling met with around 50 clinicians, psychiatrists and other health professionals to discuss how to reduce the numbers of mental health patients being held in windowless cubicles, for days on end, in the state’s hospital emergency departments.

In August, InDaily revealed mental health patients were being routinely confined in cubicles at the Lyell McEwin Emergency department for between four and five days, because beds were not available in its mental health ward.

Doctors’ union inspections of other state hospitals during the intervening months uncovered evidence that the problem was widespread across the hospital system.

The inspections also found that, increasingly, mental health patients suffering psychosis were being chemically sedated because of the added agitation of confinement in emergency department cubicles, made necessary by a lack of available acute psychiatric beds.

Snelling told InDaily he was urgently seeking solutions to the problem.

“I’m setting up a parallel process to (the omnibus hospital reform program) Transforming Health to work out how we’re going to sort out this problem of people having to wait for significant periods of time for admission into acute mental health beds,” Snelling said.

“It’s not really part of the Transforming Health process, I guess, because it’s more urgent.

“I’ve had a series of meetings, including with clinicians and leaders in the field, about what we can do to reduce the time some mental health patients are spending in our EDs.

“It is a priority for me and an ongoing concern that I want to resolve and I hope to have something more to say about how we plan to resolve it soon.”

South Australian Salaried Medical Officers’ Association spokesperson Bernadette Mulholland – who was one of the hospital inspectors – said she was heartened by the minister’s efforts.

However, she warned that the problem was inexorably linked to underfunded and understaffed services in the community mental health sector – which helps to prevent mental health consumers becoming very ill and needing hospital admissions.

She said that a focus on hospitals would not solve the problem.

“I think the minister undertaking these discussions with a broad range of mental health clinicians can only benefit the patients,” she said.

“We’ve got an ever-increasing demand – that demand then flows onto the community mental health services; what we then see is that demand is not being met, then the (seriousness of the patient’s illness) rises and they present to the emergency department looking for a mental health bed.”

Improving the treatment of people with mental illness would require adequate “funding and resourcing of community mental health and funding and resourcing of acute mental health beds”.

“We’ve got neither of them at this stage.”

She said, however, that newly opened short-stay unit mental health beds in some hospitals were likely reducing lengths of stay.

SA Branch Chair of the Royal Australiasian College of Psychiatrists Dr Michelle Atchison said the need for mental health patients to stay for several days in emergency departments was damaging to patients and staff.

“You can’t do any decent psychiatric treatment while people are in an emergency department beds (so) it puts off their actual treatment,” she said.

“It is very distressing for patients and their families.”

She said one of the important factors in acute psychosis was a lack of sleep, and patients’ conditions can be made worse “if you’re psychotic and you’re in a high-stress environment with lights on 24 hours a day”.

She said it was also unfair to expect emergency department nurses to manage a patient suffering acute psychosis for more than six or eight hours – “not for six or eight days, as they are”.

“We need to look at the mental health system overall,” she said.

“We need to not close any more acute beds.

“That’s where we got ourselves into trouble.

“We need more supported accommodation so people can move somewhere in the long run (and) we need to take forensic patients out of the acute mental health services.”

Mental Health Coalition of South Australia (MHCSA) Executive Director Geoff Harris agreed all aspects of the mental health system needed review.

“The review would be more welcome if it can look beyond the immediate emergency and unplanned acute care settings to look at effective ways to reduce the flows into and out of these settings,” he said.

“Research shows that if we can support people earlier and more effectively the life-long impact of even the most severe illnesses can be reduced.

“The problem in mental health is that investment in community services has always been underweight…

“We need work hard to increase the balance of investment in mental health so that there are more options for people to get well and stay well in the community.

“The costs of not doing this are borne by the individuals, families, friends and the community.”

Photo: Nat Rogers/InDaily

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