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Shared rooms continue in mental health wards despite warning

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Psychiatric patients continue to be detained together in shared rooms in South Australian public hospital mental health wards, despite a warning from the Deputy Coroner 18 months ago that it was dangerous and should not occur.

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SA Health has told InDaily it is “working towards” single-use rooms for all psychiatric patients and that in the meantime “risk mitigation strategies” were in place to minimise potential harm.

In December 2020, Deputy State Coroner Anthony Schapel put SA Health and then Health Minister Stephen Wade “on notice”, recommending room-sharing “no longer be permitted” in psychiatric wards.

Schapel warned authorities that detaining mental health patients together was “a highly undesirable practice” and said there was “a certain inevitability” someone would be killed.

His recommendation followed an inquest into the death of a patient in the psychiatric ward of Noarlunga Hospital – the Morier Ward – in August 2014.

Stephen John Barton, 43, was strangled during the night as he slept by his 23-year-old roommate Lindon Sekrst, who was suffering from an ice-induced psychosis.

Nearly eight years after his death, and 18 months after the Deputy Coroner’s call for change, SA Health told InDaily psychiatric patients were still sharing rooms in four mental health units – in the Morier Ward at Noarlunga Health Service, Cramond Ward at the Queen Elizabeth Hospital, Clare Ward at James Nash House and Ward 4GP at Flinders Medical Centre.

“We are working towards the use of single use rooms for all psychiatric patients and the need to provide single rooms at each site is considered in planning for each site,” a spokesperson said in a statement.

“In addition, planning has commenced to increase mental health bed numbers to meet this standard.

“In the interim, while these facilities continue to be operated, hospitals use a range of risk mitigation strategies related to the allocation of rooms, and levels of observation with fixed duress alarms being trialled.”

A response from SA Health to the Deputy Coroner’s recommendations, tabled in State Parliament a year ago, said there were requests in with the State Government to “move to single occupancy rooms through capital works projects”.

“These projects will require approval from the Minister for Health and Wellbeing prior to submission to the Department of Treasury and Finance,” the response stated.

It said there were a “variety of mitigation strategies” across Local Health Networks, including “nursing management” of patients in shared rooms.

“Nurses regularly discuss room arrangements with patients and frequently move or swap patients to minimise any conflict and/or disagreement,” the report said.

It said “patients of high concern are placed in single rooms and/or moved closer to the nurses’ station to allow for closer observation”.

“In addition to this, doctors routinely ask patients about their perception of safety on the ward,” it stated.

The report said the Southern Adelaide Local Health Service – responsible for the Morier Ward where Stephen Barton was killed – was obtaining quotes for swipe cards for individual room access as well as fixed emergency buttons in dual occupancy rooms.

“Swipe cards will ensure that only patients residing in a room, or those they invite, will be able to enter,” the report said.

“This will reduce the risks not only of violence, but of conflict, theft, and assault in general.”

The report said fixed emergency buttons in dual rooms “would be separate to the duress alarm that would trigger a local alarm on the ward”.

“The Office of the Chief Psychiatrist welcomes the use of fixed emergency buttons in dual occupancy rooms as a temporary strategy and has had previous discussions with SALHN on the use of mobile alarms for consumers,” the report said.

“Those discussions will continue as fixed alarms have some limitations.”

SA Health told InDaily this week that fixed emergency buttons specifically for patients separate to duress alarms had been trialled in the Morier Ward at Noarlunga Hospital.

“Due to a design issue the buttons have been temporarily removed and will be replaced,” a spokesperson said.

“The Southern Adelaide Local Health Network (SALHN) is (also) in the process of obtaining swipe cards.”

A year ago, Chief Psychiatrist Dr John Brayley expressed his concern about the use of shared rooms for psychiatric patients, telling InDaily “the risk remains a concern, and my office will continue to monitor how this is managed”.

Asked for his views that room-sharing still hadn’t stopped a year later, he said “the risk still has to be managed, but as long as a move to single rooms is occurring it is reasonable to rely on temporary measures in the interim”.

“Such measures includes allocating rooms based on clinical and risk assessments, as well as duress systems,” Brayley said in a statement.

“I am reassured that single room designs are being incorporated in existing hospital redevelopment plans, and that the latest strategy to build extra mental health beds (all single room) will also create building opportunities to fix this problem in the design of some older units.”

SA Health said: “It is expected that a progress report on the implementation of temporary risk mitigation strategies for dual occupancy rooms, and the move towards single rooms will be completed by late June, based on inspection reports and capital plans.”

InDaily has asked Health Minister Chris Picton for a response.

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