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‘Completely broke me’: Three days of mental health crisis in an emergency department

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One woman’s recent experience inside the Royal Adelaide Hospital reveals the disturbing reality of an overstretched, underprepared public health system trying to cope with patients in the grip of mental health crisis. Warning: this story may be distressing for some readers.

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Mental health crisis

The woman, whom InDaily has chosen not to name, was first brought to the RAH in an ambulance on Wednesday last week after attempting to take her own life.

Already struggling with anxiety, depression and post-traumatic stress disorder, the 40-year-old mother-of-three was detained under the Mental Health Act and placed in a room with a guard outside the door.

The next morning, she says she was discharged – despite telling staff she was still a risk to herself.

“I said ‘I’m feeling suicidal and I don’t feel safe’,” she told InDaily.

“A nurse said ‘the doctor said you’re being discharged either way’. They actually let me walk out by myself. They said ‘there’s the exit’.”

Shortly after leaving hospital and contacting her psychologist, she was brought back to the hospital by police.

She spent another two nights in the ED in what she describes as a “seclusion” room, empty except for a bed – no TV, no books, nothing to do for days while waiting to be admitted for treatment.

Left alone with her thoughts and the sounds of distressed patients in nearby rooms, some watched over by guards, she was checked occasionally by busy nurses but says she was at times made to feel like an “inconvenience”.

“I didn’t have anything. I didn’t even get told there was a buzzer for a nurse until the second day,” she said.

“The room next door to me, there was a guy that was going off. With my stress and depression and anxiety and stuff I didn’t want to go out of the room.

“By that stage one of the nurses said there is actually a call bell on the wall behind the bed. No-one had told me about it.”

She said she pressed the call button and “after 45 minutes of no nurse coming I finally got the guts up to walk up to the nurses’ station”.

“I couldn’t get anyone to talk to me because they were doctors, not nurses,” she said.

“I went back to my room and, at that stage, I completely broke down.”

She said a nurse eventually came to her room and agreed to get some medication.

“It took him 45 minutes to find a nurse that could co-sign the medication out,” she said.

“So from the time I pressed the bell to the time I got my medication was two hours almost.”

While she doesn’t blame busy hospital staff, “I was in a really bad way and just to sit in a room like that for days… was horrible”.

“At one stage one of the mental health people came down and I said, ‘Is there any chance I can get some pencils and paper or something just to do something?’ and they’re like ‘Oh yeah we’ll bring you something down’,” she said.

“I didn’t get anything. I literally sat in a room with nothing for that whole time.”

She described her wait as “terrible”, adding to her distress.

“I know it made me worse,” she said.

I don’t want people to go through what I went through – that was really, really bad.

“I think it would be bad enough if you were in with a physical problem, let alone a mental health problem. You’re already bad and they put you in an environment where there’s so much going on. There’s people yelling and screaming, going off next door.

“I felt really vulnerable.”

She said at one point in the ED there were “people sitting in the corridor, vomit bags and bandages and stuff”.

“I assume at that stage they’d run out of beds and they had people sitting in the corridors of the ED. I couldn’t believe how bad the health system was.”

Even getting some basic comforts wasn’t easy.

“It took about eight hours to get a pillow because apparently, pillows are in short supply,” she said.

As well as a bed, there was a rubber mattress on the floor. A nurse explained that it was for patients who became violent or destructive and needed to have the bed removed from their room.

“The person next to me who I said was going off, he had the rubber mattress and a blanket,” she said.

“He had a guard but I still felt very vulnerable.

“I wasn’t kept up to date with what was happening.

“I got told there was a bed at ‘rural and remote’ and that was on Friday.

“I got told, ‘We’re just waiting for an ambulance to do a transfer for you’. That never happened.”

On Saturday, she was transferred to the private psychiatric facility The Adelaide Clinic, as a public patient, where she remains and feels “safer” and “calmer”.

“I’ve still got lots of issues going on,” she said. “I feel like I’m being treated appropriately.”

The experience made her determined to speak up about how mental health is dealt with in a public hospital system not designed for such treatment, and why it was time for the State Government to make it a priority.

“It’s going to end up benefiting everybody in the long run if we make priorities now and spend the money where it’s needed now to provide the appropriate facilities and treatment,” she said.

“We can’t keep going this way. We can’t keep having people in the ED for days on end.”

“I need to get this out there. I can’t change what’s happening if I don’t say something. People need to know how bad it actually is.

“I don’t want people to go through what I went through. I thought I was a pretty resilient person even with all my mental health stuff but that just completely broke me.

I honestly feel like I would have been treated better if I was in prison.

She said if she hadn’t been brought back in to hospital after being initially discharged “it would have been a coroner’s matter they would have been looking at, not a mental health matter”.

“I want people to know that this is what happens and it shouldn’t happen,” she said.

“I don’t want to scare people off of trying to get help, though. They need more mental health beds and they need better services available to people who are in distress.”

Opposition health spokesman Chris Picton said “we often hear of the crisis in mental health described in statistics and rhetoric, but it really hits home when we hear directly from patients about how they are being personally impacted”.

“It’s one thing to hear that in the past year, more than 1,400 mental health patients were subjected to over 24 hours in emergency departments waiting for a bed – and it is another to hear in detail the awful impact this has,” he said.

“The Government should imagine if this was their loved one, how they would feel about them being stranded for days-upon-days in an emergency department bay waiting for a bed, with 24-7 lights, sounds and interruptions.

“Being stuck for most of a week in an emergency bay would be bad enough for anyone, let alone someone who is already suffering from a mental health condition.”

He said the example highlighted the widespread impacts of ramping and overcrowding – “having dozens of emergency bays taken up by people stuck waiting for beds means there’s no where for the next ambulance patient to go”.

“This matches exactly the warnings we have heard on why it is a human rights abuse the outrageously long delays that patients are subjected to,” he said.

Picton also said it showed the need for more high acuity mental health beds, called for by Professor John Mendoza, the Adelaide mental health boss who recently quit in protest at a lack of government action, backed by the peak body for psychiatrists.

“This is yet another wake-up call to Minister Wade – he can’t keep ignoring this crisis that is having a huge impact on South Australians each and every day,” he said.

InDaily has asked Wade for a response on the woman’s treatment and the broader issue of mental health patients languishing in emergency departments.

In a statement, a spokesperson from the Central Adelaide Local Health Network said “we sincerely apologise to patients who experience an extended wait in our Emergency Department, we know that this can be distressing”.

“When consumers who require admission present to our ED, we allocate them to the most appropriate bed and our clinicians continue to provide ongoing personalised care until a suitable bed becomes available,” the spokesperson said.

“Patients may be discharged with a plan for support and follow up care in the community on the understanding that they can return to hospital for further support at any point in time.

“We have established initiatives to help improve the interface between mental health and emergency staff and our mental health taskforce is looking at other ways we can provide better care. However, we know there is much to be done and we are always looking at ways to improve the care we provide to patients.

“We are working closely with the Office of the Chief Psychiatrist and SA Health to address pressures impacting our emergency departments while continuing to identify, implement and monitor new ways we can improve the system for our patients.”

If this story raised issues for you, call LifeLine on 13 11 14. Beyond Blue and headspace are other national organisations that offer comprehensive mental health support.

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