In an exclusive interview with InDaily, speaking for the first time since his appointment as the state’s top mental health bureaucrat, former Public Advocate John Brayley says he will implement a rigorous new inspections regime, designed to prevent sub-standard care and patient abuse in public psychiatric facilities.
Meanwhile, his office is leading a landmark review of mental health services and their funding across the state and overseeing a redefinition of staff roles within each of Adelaide’s local health networks to guarantee accountability.
“All mental health facilities will receive unannounced visits,” said Brayley.
“That could be on any day of the week, on any time of the day, to check on the delivery of care.
“I expect to have psychiatrists assisting me with delegated powers to do that.
“I would be hopeful (it would be) the best inspection system in Australia.”
However, he said that inspections alone wouldn’t be enough.
“While inspections are important, my experience is it’s generally reports from consumers and carers, or staff whistleblowers that raise some of the most significant issues.
“If you can’t respond to those concerns effectively when they arise there is a problem … even in places with very intense inspection processes.”
Brayley said Independent Commissioner Against Corruption Bruce Lander’s report into maladministration of the Oakden facility had created a new mandate that demanded a stronger role for the Office of the Chief Psychiatrist and its operations.
Brayley said his office would routinely exercise powers that, before the release of that report, had been considered optional – as part of his effort to improve quality across the board and to identify those who abuse their responsibilities and duty of care.
“I am commencing this position soon after the ICAC report into Oakden, about those tragic and shameful events that occurred in South Australia.
“That report has made very clear the obligations (and) accountabilities of all people in the mental health system, and will lead to a strengthening of the role of Chief Psychiatrist and this office.”
He said his office would be involved in signing off all new mental health facilities before they open, and that it was overseeing a broad review to clarify lines of accountability for staff in mental health services across the state.
“We’re boosting our functions in terms of inspecting units, gazetting units (approving them to operate) and responding to issues of concern that are raised with our office,” he said.
“That also improves the accountability and the level of information that can go back to the chief executives of the local health networks.”
At the same time, he said, his office was working on a landmark review of how mental health services are funded, and how they operate across South Australia.
Brayley said he would consider whether mental health services in the Northern Adelaide Local Health Network – which managed both the Oakden facility and the Lyell McEwin short stay unit – had been chronically underfunded over more than a decade.
“I am aware of that long-term issue (underfunding of Adelaide’s northern mental health services) and I believe that a population-based plan offers a sound way of identifying that and making sure there is equity across the regions of Adelaide and the state,” he said.
Brayley said that failures to adequately address complaints about safety and quality, such as those that occurred at Oakden and the Lyell McEwin short stay unit, would become an “intolerable” feature of the past.
The Lyell McEwin facility was closed in December after staff warned it was “only a matter of time” before a patient dies because of unmitigated safety risks there.
As InDaily has exclusively revealed over the past month, SA Health received repeated warnings from staff, unions and independent inspectors about key safety risks that were apparently ignored between 2015 and 2017.
Brayley said he was also in the process of reviewing how that was allowed to occur, speaking to those involved and assessing a proposal for a new, temporary mental health short stay unit to be established at the Elizabeth Vale hospital until a permanent unit can be built, late in 2019.
He said he was unsure whether there would be any formal investigation into the old short stay unit, but that he wanted to make sure that he understood what went wrong so that he could prevent the past mistakes at the new unit.
“I have been given some explanations about what has happened in the past, but I haven’t spoken to all parties about the events leading to the closure of the unit,” said Brayley.
“I absolutely agree … that if there’s been a quality issue, and a major one that’s led to the closure of a unit, all lessons need to be learnt from that.
“The people who operate the (new temporary) unit will need to be engaged and involved in the planning … so that they are satisfied that their patients are going to be safe, and that the steps taken to provide a safe physical environment and the model of care are sound.”
He said he would make sure that safety risks from any ligature points – features of a room that can facilitate suicide – are mitigated, that the unit is adequately staffed and that mental health patients and medical patients are treated in separate areas “for the benefit of all patient groups”.
Staff, unions and the Community Visitor Scheme had repeatedly warned that the Lyell McEwin facility featured ligature points, posing grave risks to patients.
InDaily revealed last month that, according to staff safety reports, at least two patients had attempted to take their own lives using ligature points.
Brayley suggested a key function of his office was to ensure that the public has can rely on an independent arbiter to tell the truth about public mental health facilities – including in situations when SA Health’s official account differs from the testimony of staff and other stakeholders.
SA Health has claimed that the Lyell McEwin facility maintained “an appropriate patient-to-staff ratio that included a social worker, psychologist and nurses at all times” while it was functioning between 2015 and 2017.
However, reports from staff and others between 2015 and 2017 repeatedly claim the unit was often understaffed.
“I think parliament envisaged these challenges when it created the statutory Chief Psychiatrist role,” said Brayley.
“(It) is a statutory role within a department that gives the minister and the community advice about the standards of mental health services – how they’re being delivered.
“The ICAC has recognised the importance of those functions, and for them to be intensified and bolstered.”
He said the health system was responsible for ensuring “open disclosure” when it failed to deliver adequate care.
He added that the system currently failed to adequately fund forensic mental health services – those that cater for people with mental illness who have committed crimes.
Brayley was most recently Chief Medical Officer of the Australian Border Force before his resignation last year.
If this article has raised issues for you, you can call LifeLine on 13 11 14 – or you can call the Mental Health Triage Service / Assessment and Crisis Intervention Service on 13 14 65.
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