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'Missed opportunity' as mental health reform hopes dashed

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UPDATED: A key SA Health whistleblower who quit in protest at a lack of action has had his recent hopes of mental health reform dashed, following a day-long forum on the issue – from which the paramedics’ union was shut out.

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The forum was organised by Health Minister Stephen Wade, in response to escalating concerns about the mental health system.

Those concerns came to a head three weeks ago after InDaily revealed the executive director of mental health and prison health services at the Central Adelaide Local Health Network (CALHN), Adjunct Professor John Mendoza, had quit his post a year into his three-year contract, unleashing on SA Health and the State Government over a lack of action.

At the time, he said he wasn’t going to waste his time pretending to be part of a reform effort that wasn’t there, and lamented a “Praetorian Guard” limiting access to the Health Minister.

Mendoza has since had a key hearing with Wade ahead of today’s forum, which left him hopeful that important action would occur, after initially fearing the workshop would be no more than a talkfest.

He spoke with the Minister for an hour on Monday evening.

“Without breaching confidences, I would simply say that the conversation was encouraging and I think on the basis of that I’m optimistic about some positive and tangible outcomes,” he told InDaily at the time.

“Certainly that’s my expectation and I’m more hopeful of that now given the conversation with the Minister.”

Mendoza said while a workshop wouldn’t have been his method for addressing the significant urgent issues, “whatever forum has been offered we need to go into that with a view that this is going to be constructive, it needs to be action-orientated and it’s going to be delivering some immediate results for consumers and clinicians working in the system”.

However, those newfound hopes were dashed at the end of the day-long session.

“I can confidently say that the situation for frontline clinicians come 1 July, nothing will be different – what a missed opportunity,” Mendoza tweeted late today.

“Having listened to over 90 minutes of ‘workshop feedback’ there was almost nothing about the COVID mental health surge in demand.

“Lives will be lost. Careers ended through unrelenting stress.”

Asked by InDaily if that meant his previous hopes had evaporated, he replied: “Gone. Totally.”

“It was a classic play from bureaucrats handbook on applying the dead hand of government,” he said.

“Nothing will be different come 1 July. Patients will still be stranded in EDs for more than 24hrs every day, some will be there 2-5 days; there will still be people air transferred from around the state waiting for psychiatric intensive care beds being subject to violence and trauma; there will still be staff dreading going to work everyday.”

His comments came after the paramedics’ union told InDaily it had been snubbed from the major mental health workshop, which had a guest list of about 60 including other key unions such as the doctors’ and nurses’ peak lobby groups.

The closed forum ran from 10am to 6pm, although the Minister was only scheduled to attend for the last two hours, while SA Health chief executive Chris McGowan attended for the start.

A spokesman for the Health Minister said their presence was intentionally limited so it could be a “frank and fearless” discussion.

Reports from inside the forum indicated it was certainly that.

InDaily has been told that Mendoza began the roundtable by “blasting” McGowan for “waltzing in and opening the meeting by saying that everything was fine and the mental health services plan was a good plan, then waltzing out of the room”.

It was a sudden shift after he described his earlier one-on-one lengthy conversation with Wade as “a great show of good faith from the Minister to take the time but also it demonstrated to me that he’d had significant discussions leading up to that and he had also thought deeply about a number of issues”.

“His questions indicated to me that he was looking for more detail,” he said.

“My expectation is that we will get some immediate, meaningful improvements to the situation immediately but also some commitment to longer-term reform coming out of it.”

Mendoza, who has released his own ten-point plan for action, earlier told InDaily the most urgent matters to address were:

MOVING forensic mental health and NDIS-ready patients out of hospital beds

INCREASING the number of psychiatric intensive care beds

BRINGING IN an immediate auxiliary workforce to work alongside mental health clinicians.

The paramedics’ union – which is locked in a dispute with the government over ramping and staffing levels – was similarly lacking optimistic any meaningful action will occur.

It reported that overnight two mental health patients were ramped at the Royal Adelaide Hospital for more than four hours.

Ambulance Employees Association state secretary Phil Palmer said it was “a slap in the face to ambos” that their union had been left out in the cold from today’s forum.

“We’ve not been invited, even though our members are frontline with mental health patients as well,” Palmer told InDaily.

“The AEA is persona non grata in this government’s eyes.

“Our members have got a big role to play. They’re a big player in the mental health system.

“We are conveying mental health patients from their home. Our members are getting ramped with mental health patients. We are right in the frontline.

“We are not surprised by the exclusion from the Minister. He’s excluding us from everything.”

Palmer said the government had held two roundtables a few years ago on the ramping problem but had failed to fix the problem.

“There was a lot of talk and a lot of suggestions but no change and ramping has got worse ever since,” he said.

“The cynic in me – and I’ve got good reason to be cynical – is that this will be another roundtable, the Minister will do a lot of talking, and then the situation will stay in the same bad state that it is.”

Dr Paul Furst, the SA branch chairperson of The Royal Australian and New Zealand College of Psychiatrists, said it was “odd” that the paramedics’ union hadn’t been invited.

“The fact that one of the key issues we have in the state is ambulance ramping, and mental health demand and ED blockages is a significant contributor to that, for that union to not be included… is concerning,” he said.

“There should be somebody representing ambulance services because they are a significant part of the mental health system.”

Furst said this was particularly so given one of the key reforms needed was a new “non-ambulance” system of transporting mental health patients to and between hospitals and services.

Furst said two things needed to come out of today’s forum – a commitment to address urgent issues as well as a longer term plan to fix the system.

“The failure to announce anything I think would be a huge mistake and I don’t think the Minister is that silly,” he said.

“He’s a pretty sensible, reasonable person who’s quite across his brief.

“I’m optimistic we’ll get something, it’s just a matter of what it is and whether it’s something that’s going to be more skewed towards solving a political problem or whether it’s something that will actually improve the overall performance of the mental health system.”

The nurses’ union also said it was “critical” today’s proceedings generated urgent actions.

Australian Nursing and Midwifery Federation SA secretary Elizabeth Dabars said “if nothing is done then we as a community all suffer”.

“There will be increased hospital wait times, missed and delayed care, and a very real threat to people’s lives,” she said.

“The lack of appropriate care for people in need of mental health services also poses serious social problems as vulnerable people who need support are instead returned far too soon back into the community without the necessary follow-up.”

When asked why the paramedics’ union wasn’t invited, a spokesman for the Health Minister said SA Ambulance Service chief executive David Place would be in attendance.

Wade has not responded to interview requests by InDaily but this morning he told ABC Radio that “it was great to have a one-on-one conversation” with Mendoza and that he “learned a lot” from him.

“I completely agree with John that we need to be operating at two levels here – there’s the long-term strategic reform of mental health services which is very complex and a long-term project but, as John and I were talking about on the weekend, there are opportunities to better coordinate and deliver mental health services,” he said.

“He and I discussed some of them in detail so I think it’s important we go into this workshop with two lenses.”

During the lunch break at the conference, a group of union, doctor and community representatives spoke to the media, urging the Minister to show “political will” and “do something”.

“We need the Minister of Health to actually step up (and) provide leadership in this area,” Dabars said.

“That is what we are still yet to see.

“Chris McGowan arrived at the start, made some very simple statements, we are expecting to see the minister at the end, but we’re still concerned that this could be another talkfest and that is not what we need.

“There are at least 20 mental health patients waiting as we speak in the emergency department of the Royal Adelaide Hospital and what we’re not gaining is a sense of urgency to address the issues of bed availability and also the staffing and workforce that is urgently required to fix these issues.

“We’re still very concerned there is no level of urgency.

“There is an absolute desperate need for more nurses and other health professionals in the system just to fill existing vacancies let alone address the urgent need for additional beds in the system.”

South Australian Salaried Medical Officers Association president Dr David Pope said “the system’s in crisis right now”.

“We need resourcing that’s put into our hospitals to create the beds to recruit and employ the staff so that we can deliver the care that’s needed,” he said.

“The government needs to lead, it needs to decide where the priorities are right this moment and put the necessary resourcing in to fix the problems.”

Pope also said it was “remarkable” that the paramedics’ union wasn’t invited, considering ambulance officers play a “key role in responding to acute mental health crises”.

“I think that shows that the department hasn’t thought this through properly,” he said.

“We’re seeing very little people (here) from SA Health in general and it’s largely people working in the sector and many NGOs.”

Ellie Hodges, director of Lived Experience Leadership and Advocacy Network, said “what the lived experience community is really interested in is action that is supportive of us when we try to get help”.

“We want options where we have good quality care at all points of the system and services,” she said.

“We also need it earlier in the community and we need people with lived experience helping us as well.

“True alternatives to emergency departments are one of the quickest wins we can have to shift the urgency and the load on our emergency departments.”

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