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'Dysfunctional', 'unsafe': Review damns SA's community mental health services

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South Australia’s adult community mental health services are “extremely dysfunctional”, to the point of being “unsafe” for patients and staff, SA Health clinicians have told a formal review.

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A damning report on the services, obtained by InDaily, describes them as “in crisis” and providing “fragmented” care, with managers bullying stressed clinicians who are forced to treat patients “blind” due to information-sharing restrictions.

Co-commissioned by SA Health and the state’s nursing federation, the report says management staffing decisions are “greatly increasing… risk” to patients, while clinicians see care being sacrificed to cost-cutting and are quitting in high numbers.

The services, intended to replace or reduce the need for hospital-based care, are used mainly by those with severe illnesses such as schizophrenia and bipolar disorder.

“The most common theme reported … was that the current community mental health system is extremely dysfunctional,” wrote reviewer Jocelyn Douglass, a senior SA Health mental health nurse seconded for the project to the SA branch of the Australian Nursing and Midwifery Federation.

“The system is ‘in crisis’, with fragmented care leading to perceived poor services for consumers [patients] and a highly unsatisfactory workplace for clinicians.

“This has led to increased sick leave and staff absences, high levels of burnout and an exodus of more experienced staff particularly in some teams/LHNs [local health networks].”

Mental health nurses were poised to launch industrial action last month over what they say has been SA Health’s failure to address their longstanding concerns, but the campaign was called off after the department committed to a number of steps “this calendar year”.

These included the release of a separate review, sparked by Douglass’s report, into bullying allegations, as reported by InDaily last month.

You are talking about those who, if you fail to take care, will be homeless; they will be in jails; they will be dying prematurely.

News of a crisis in community mental health services represents a new problem for SA Health, already beset by controversies that include abusive treatment of elderly mental health patients at the Oakden Older Persons Mental Health Service and chemotherapy and rostering bungles at flagship hospitals.

InDaily can reveal SA Health has known about most of the issues identified in Douglass’s report since at least 2015, when the department commissioned a review by Deloitte which identified a similar litany of basic failures affecting the $80 million a year services.

In coronial findings of recent years South Australian State coroner Mark Johns has also sharply criticised community mental health services for organisational and care failures in relation to patients who subsequently died by suicide.

Douglass’s report, written last year, says staff in “several of the teams” have reported “severe and sustained” bullying by managers and “toxic team cultures in some teams”.

It says patient caseloads are “perceived as unmanageable”, and in some local health networks a practice of not replacing frontline staff who have taken leave is “greatly increasing the potential for missed care and … risk” to patients.

There is a “lack of clarity of ‘core business’”, and clinicians report there are “no clear pathways of care for consumers”, with no consistency around approved therapies.

“It was widely reported by staff that they were ‘flying blind’ with limited opportunities to share current clinical information about consumers…

“Clinicians commonly reported they felt the current work practices were unsafe for consumers and themselves…

“There is a perception that the delivery of good clinical care is compromised due to a focus on ‘efficiencies’ in the context of budget deficits in a highly ‘top down’ bureaucratic, managerialist system.”

A spokeswoman for SA Health said the wellbeing of patients and staff were “priorities” for the department.

“As part of its commitment to continuous improvement, SA Health commissions reports where appropriate and implements their recommendations where feasible.

“SA Health is working with staff and their unions to address concerns that have been raised.”

National Mental Health Commissioner Ian Hickie called the findings “very distressing” and said despite political efforts, successive South Australian governments and health professional groups had failed to work together to implement recommendations of “continuous inquiries”.

“Neither has sufficiently prioritised the needs of those who use the service,” he said.

“You are talking about those who, if you fail to take care, will be homeless; they will be in jails; they will be dying prematurely.”

In an earlier department-commissioned review produced in 2015, Deloitte had already found services suffered from 24 “key issues”, including “lack of effective communication with consumers and carers”,  “ineffective and passive care planning and interventions” and  “mismatch of clinical skills … to consumer needs”.

It is understood SA Health has committed to conduct a series of workshops on clinical and industrial issues, to investigate bullying allegations and to pilot a change to the structure of service teams.

An estimated 12,000 patients of Australian state mental health services die early per year, most from preventable physical illnesses, and research has suggested effective integrated community care can reduce this excess death rate.

For help talk to a medical practitioner or call the SANE Australia Helpline on 1800 187 263 or Lifeline on 13 11 14 (24 Hrs).

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