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Hospital patients under guard as govt misses key mental health target

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Up to 10 patients a day who may have “committed violent crimes” are being turned away from the state’s specialist forensic psychiatric facility due to a lack of beds – and are being kept under guard in emergency departments and hospital wards.

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They are often handcuffed to beds that should be available for other patients and monitored by multiple security guards, putting further strain on the state’s overcrowded hospital system.

Leading South Australian forensic psychiatrist Dr Paul Furst has told InDaily there is a “well recognised shortage” of forensic mental health beds – a problem the doctors’ union says is having an “enormous” impact on hospitals.

It’s also the first concern highlighted in outgoing mental health chief John Mendoza’s 10-point plan for urgent action, released yesterday.

Figures provided by SA Health show there are 60 inpatient forensic mental health beds in South Australia – 20 short of what is recommended in the state’s Mental Health Services Plan.

James Nash House – SA’s high security forensic psychiatric facility – has 50 inpatient beds, while Glenside has 10.

There are also 10 “step down” beds at Ashton House at Oakden.

Furst, who is the SA branch chair of the Royal Australian and New Zealand College of Psychiatrists, said the number of forensic mental health patients in South Australia had grown from about 12 in 1995 to 250 today.

“We’ve had significant growth in prisoner numbers but also significant growth in the number of patients who are what we call ‘forensic patients’ – those who are either found not guilty (of a crime) by reason of mental impairment or mentally unfit to stand trial,” he told InDaily.

“Not all are of them are in inpatient care, many of them are in the community on supervised release.”

Furst said there were “anywhere from five to 10 patients per day” unable to access James Nash House and instead kept in hospitals.

“It’s probably closer to 10 most of the time,” he said.

“So there are a significant number of patients who are outliers as such.”

Furst said they were kept primarily in locked wards at the Royal Adelaide Hospital and Lyell McEwin Hospital and sometimes at Flinders Medical Centre and Glenside.

“Obviously if you have a forensic patient in a psychiatric intensive care unit (in a hospital) you’ve got one less bed for people who are very acutely unwell,” he said.

“So it places significant pressure down the line and that trickles down throughout the system.

“We are significantly under at the moment.”

SA Salaried Medical Officers Association president Dr David Pope, an emergency doctor at the Lyell McEwin Hospital, said forensic patients were also commonly kept in emergency departments.

“It’s extremely serious because we essentially have to have emergency cubicles occupied for many days, essentially for people who are under continuous guard,” he said.

“It’s a very difficult environment for that person as well so it’s completely counter-therapeutic, it usually makes people worse.

“Imagine being confined to a small cubicle space that’s lit all the time, that’s noisy, no access to any sort of exercise or even food.

“You don’t get much food in that sort of environment for days on end.”

Pope said it was an “extremely common” occurrence at the Royal Adelaide Hospital while at the Lyell McEwin “it probably happens on average every week or so, either one or two patients”.

“That’s just in the ED,” he said.

“Across the hospital, it would be more than that.

“Across the hospital, you’ve probably got two or three most of the time.”

Pope said the union often received phone calls from “distressed doctors about the numbers of forensic mental health patients stuck in the ED for long periods of time”.

“They usually have two guards, and they’re essentially tied to the bed, handcuffed to the bed,” he said.

Pope said they were “kept like that for days until they go to James Nash or sometimes if they are lucky enough to get to one of the locked wards”.

He said it put “enormous” pressure on hospital staff.

Adjunct Professor John Mendoza, who has resigned as Adelaide’s mental health chief in protest at a lack of government action, yesterday released a 10-point plan for urgent action to reform the system.

At the top of his list, he wants all forensic patients transferred out of general hospitals and into forensic mental health services by the end of April.

He’s calling on SA Health and the Correctional Services Department to set up additional capacity “now” – “not in two or three years”.

You’ve got people who have committed violent crimes in general mental health wards

Mendoza told InDaily that “virtually every day of the year” there were up to seven forensic mental health patients in non-forensic mental health beds across the Central Adelaide Local Health Network.

He said there was currently one patient who has been at Glenside for more than 110 days, who should have had a bed at James Nash House.

Mendoza said he had written to SA Health chief executive Dr Chris McGowan about the “forensic overflow” problem.

“I said, ‘you cannot, under any ethical basis or duty of care to staff, allow the forensic mental health patients to be treated by non-forensic mental health staff in non-forensic mental health facilities’,” he said.

“I said, ‘you allow this to happen knowingly’. I said ‘I will not allow it to happen’.

“It’s damaging to staff, it’s damaging to other patients because you have security guards everywhere to ensure that they are safe.

“You’ve got people who have committed violent crimes in general mental health wards.

“This is unacceptable. You would not do this to any other group of patients.”

Mendoza blamed successive governments for failing to establish enough forensic beds.

In a statement, a spokesperson for the Northern Adelaide Local Health Network said “we acknowledge there can be high demand for forensic mental health beds – particularly for high-risk offenders who may only be suitable to be treated at a particular facility”.

“While the majority of forensic mental health patients are managed in the community, a number of measures are being put in place to stem the flow from prison and the courts, and also to facilitate more rapid admission to James Nash House including a court diversion program,” the spokesperson said.

In a statement sent to InDaily recently, Chief Psychiatrist Dr John Brayley said that in response to the COVID pandemic, “an additional $15 million was provided to fund a temporary surge in mental health services, with some of this funding being used to increase mental health in-reach services to young people in youth justice facilities and to adults in prison”.

“Discharge decisions for forensic patients are mostly made by courts,” he said.

“It is possible that a change of legislation that came into effect in late 2017, which altered the principles to be followed by the courts, has slowed discharges.”

Health Minister Stephen Wade said the government had “brought ten extra forensic beds online at Glenside” and would continue to expand a program linking specialist mental health staff with paramedics.

“Mental health services will continue to be a focus of this government,” he said.

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