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SA ED wait times for mental health patients branded 'worst in world'

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South Australia is “the worst jurisdiction in the world” when it comes to leaving people experiencing mental health crises in emergency departments for more than 24 hours, a former Adelaide mental health chief turned whistle-blower has told a parliamentary committee.

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As revealed in InDaily in April, Adjunct Professor John Mendoza quit one year into his three-year post as mental health executive director for the Central Adelaide Local Health Network, citing significant concerns within the system and criticising authorities for a lack of commitment to reform.

He has since continued to publicly blast state health authorities, with psychiatric and emergency doctors saying he was voicing concerns “many people thought privately”.

Mendoza fronted this morning’s select committee on health services in South Australia, telling members it was his “last throw of the dice” to convince health leaders to enact change.

He gave a blistering 30-minute opening address, during which warned South Australia was “sleep-walking into an intergenerational disaster” and “laying-down the foundations for intergenerational trauma”.

“My concerns and those of others, including the Australian New Zealand Royal College of Psychiatrists… all of our concerns – every one including the lived experience network – have been dismissed,” he said.

“I say the state is sleep-walking because these concerns have largely been dismissed and the position articulated by the Minister and the chief executive of SA Health, Dr McGowan, and indeed the Premier, is that we have this ‘nothing to see here folks’ (response).”

Mendoza asked committee members to “put on the record” his view that South Australia “is the worst jurisdiction in the world in terms of people stuck in emergency departments for mental health crises for more than 24 hours”.

“I’ve asked many colleagues around the world, ‘show me the worst data you’ve got in terms of delays of transfer from ED to where care is going to be provided – whether that’s in-patient (wards) or community supported places’,” he said.

“Nowhere reaches the state of South Australia.”

The adjunct professor said on a daily average, five South Australians experience delays being transferred from emergency departments to in-patient wards when they present with mental health concerns and the situation was “worsening”.

He said while they wait in emergency departments, patients can experience “trauma” from being subjected to shackling, medical restraints and seclusion to control their behaviour.

Mendoza touched on his family’s own experience of suicide to express concerns about the impact of ED transfer delays.

“My own nephew hated the idea of going into in-patient mental health units,” he said.

“He died because he refused to go into a unit and there were no grounds to hold him.

“He was dead within 36 hours of discharge from the Gold Coast University Hospital.

“This is what happens when you have a traumatic experience in that pursuit of care – you don’t want to go there again.”

Mendoza also criticised SA Health chief executive Chris McGowan, saying he had “no confidence in his capacity to lead an agency of the complexity of SA Health and all of its components”.

“He has not demonstrated to me what leadership at that level requires,” he said.

“What leadership at that level requires is the capacity to form alliances, to form partnerships with those people that you don’t necessarily like, but you know you’ve got to work with – be that the Ambulance Union, be that the nurses, be that SASMOA.

“I don’t think there’s a group of professionals in South Australia working in the health system that has that view at the moment.

“You have to say, that is a failure of leadership on a gross level.”

Mendoza said SA Health had access to numerous reports that outlined how it could better manage its mental health services, but action was not taken.

“It has bundles of reports from Deloitte, from KPMG – you name it – nothing is implemented.

“The capacity of that department to implement is the worst I’ve encountered in any job.”

He said he had only met with McGowan on one occasion while he was working as mental health executive director for CALHN and never met with Health Minister Stephen Wade.

“There will be a loss of talent if there is not a change in the direction of the department.”

The former health boss said his attendance at the parliamentary committee was a “last throw of the dice… in terms of getting you to wake up as a parliament to what is actually happening in your community and that serious action – not more sideshow alley stuff – has to be taken in order to address these deep, systemic problems that you have”.

The committee’s chair, SA Best MLC Connie Bonaros, described Mendoza’s evidence as “an extraordinarily frightening, bleak picture”.

InDaily asked SA Health to respond to Mendoza’s evidence.

A spokesperson said $15 million had been allocated this year across a range of mental health initiatives and drug and alcohol services in response to the COVID-19 pandemic.

The spokesperson said a new $14 million Urgent Mental Health Care Centre also provided a range of mental health support services and out-of-hospital care.

They also cited government spending on the new Mallee Ward at the Women’s and Children’s Hospital, which they said provided “the highest level of care to children and young people experiencing mental distress and crisis”.

“A number of services to improve care in the community have been implemented, including Mental Health CORE, which embeds mental health specialists within SA Ambulance response teams,” the spokesperson said.

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