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SA Health seeks private mental health alternative to RAH emergency

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SA Health is seeking a private operator for an urgent mental health care centre to divert patients away from the Royal Adelaide Hospital emergency department.

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In tender documents released this week, the department seeks expressions of interest from private service providers to establish an urgent mental health care centre in “close proximity” to the Royal Adelaide Hospital, as an alternative for mental health patients who would otherwise present to its emergency department.

Last year, InDaily revealed harrowing accounts of the treatment of mental health patients in the Royal Adelaide Hospital’s emergency department, described by legal experts and advocates as “appalling” breaches of those patients’ human rights.

While waiting in the RAH ED – sometimes for several days – some patients suffered malnutrition, extreme sleep deprivation, the administration of “random doses” of medication and long periods of time shackled to a bed without specialist mental health treatment and without access to a toilet or shower, according to hospital staff reports released to InDaily under Freedom of Information laws.

Chief Psychiatrist Dr John Brayley addressed a parliamentary committee in November last year, saying that the restraint of mental health patients was inconsistent with “the human rights focus” of the Mental Health Act and that a new “urgent mental health centre” was planned for Adelaide’s CBD.

This week’s tender documents confirm the contract is open to private providers.

READ MORE: “Appalling … human rights breaches”: How SA’s $2.8 billion hospital failed patients

Clinicians have for years warned that noisy emergency departments, lit 24 hours a day, can often exacerbate mental health conditions rather than improve them, and mental health patients frequently suffer the longest wait times for treatment.

The new urgent mental health care centre will be required to include a “living room” environment with comfortable chairs, and a minimum of four consultation rooms.

The facility would be the first of its kind in South Australia, and will provide assessment and treatment for people requiring urgent, semi-urgent and non-urgent mental health care, with a tentative opening date of July 2020.

People experiencing the most acute mental health conditions will still be treated in the RAH emergency department.

“It is expected the UMHCC (urgent mental health care centre) will reduce mental health presentations to an ED as well as waiting times for people seeking urgent care to enable them to be treated for their illness in a timelier manner,” one of the tender documents reads.

“To achieve this, SA Health is intended (sic.) to establish a centrally located UMHCC being within proximity of the RAH.”

In a statement yesterday afternoon, an SA Health spokesperson said the selected service provider will “need to demonstrate their ability to deliver against a set of outcomes and clinical and medical governance”.

“The co-design of the Urgent Mental Health Care Centre is to be in collaboration with consumers, carers and practitioners, whilst working closely with SAAS, SA Police, Local Health Networks, Primary Health Networks, non-government providers, and other partners.”

The Government’s “rebalanced” health system strategy looks to private providers, with key elements kept secret.

The call out for a private provider is consistent with the Marshall Government’s strategy for a “rebalanced” health system, which was outlined in a consultancy contract, quietly awarded to professional services firm PwC early last year, which InDaily revealed in October.

The strategy centres on a new, out-of-hospital, non-government health services sector, framed as a direct replacement for public hospital beds.

“A rebalanced health system will have a greater focus on health prevention and an ‘industrialised’, out of hospital, sector that adequately services a range of health and mental health conditions,” the contract reads.

“Reliance on beds in hospital facilities will be reduced and current disparate Hospital in the Home, intermediate and community care services will be organised into a recognised service system between hospital and GP care.

“Care will be provided at a lower cost to previous facility-based beds and may increasingly be provided by the non-government sector.”

The Government released a heavily redacted version of the “Roadmap for Rebalancing the Health System in South Australia” document this week.

It describes a “program of work to rebalance the health system with the aim of achieving” four specific aims, one of which is blanked out from the document.

The three visible aims (one of which is partially redacted) include reducing hospital occupancy – from the current typical average of above 95 per cent to 90 per cent or below – investing in illness prevention and capital investment in hospitals.

Each page of the document contains varying degrees of redaction, with three out of its 13 pages blanked out entirely.

You can read the document – the non-redacted parts at least – at the bottom of this article.

InDaily has asked Health Minister Stephen Wade’s office why the document is so heavily redacted.

Thousands of hospital admissions ‘preventable’

The tender documents for the urgent mental health care facility say there were 15,600 mental health presentations to metropolitan emergency departments in 2017-18 and that, of those, 5500 had conditions that could have been treated at an alternative mental health facility, had one been available.

The service will be required to meet a series of KPIs, including that maximum wait times for patients with urgent conditions (30 minutes in at least 75 per cent of cases) semi-urgent conditions (60 minutes in at least 70 per cent of cases) and non-urgent conditions (120 minutes in at least 70 per cent of cases).

Guiding principles for the facility, outlined in the document, include that it should provide “same or improved consumer outcomes and experience of service, and greater consumer-centred care”; and that it should be “fully integrated with the mental health and health system, with clear pathways to care”.

The service provider will be required to maintain an agreed workforce of medical, administrative, allied health, nursing and lived experience staff.

SA Health will offer “up-skilling” opportunities for the service provider’s staff “where requested”, including placements within public emergency departments.

CLARIFICATION: After InDaily published this story on Thursday an SA Health spokesperson clarified that the tender process is open to all providers, not just private, potentially including Local Health Networks and non-government organisations.

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