Australian hospitals struggling to treat mental health emergencies

Hospitals across Australia are struggling to cope as Australia’s mental health epidemic continues to spiral dangerously out of control.

Almost 1000 Australians a day suffering a mental health crisis have to rely on hospital emergency departments for help because there is nowhere else to go.

They often spend days waiting for a hospital bed exacerbating their condition, making them aggressive and some have to be forcibly sedated and restrained.

Many get this treatment while coping with suicidal thoughts or self-harm and some walk out of the hospital in frustration to take their own lives.

Others are refused help and every year a handful of people suffering psychotic episodes kill or harm their loved ones after they had contact with the hospital system.

Australian College of Emergency Medicine’s Dr Clare Skinner says staff in emergency departments “often don’t have the skills to work with someone affected by their mental illness”. Picture: Troy Snook

In the past three years nearly one million people attended a hospital emergency department for help with a mental health crisis and attendances have soared by 71 per cent in the last decade.

The devastating revelations from the frontline of Australia’s medical system are contained in a new report by the Australian College of Emergency Medicine which found Australia has only half the mental health hospital beds as comparable countries.

There are 41 acute psychiatric beds per 100,000 population in Australia significantly lower than the OECD average of 71 mental health beds per 100,000.

And the number of public psychiatric beds has plummeted from 2,943 beds in 1998- 9987 to 2,186 beds in 2016-17.

While demand for mental health support in emergency departments peaks after hours most community mental health services are only open from 9am-5pm, Monday to Friday.

Almost half those in mental distress come to emergency departments by ambulance, air ambulance or by helicopter rescue services, and almost 8 per cent were transported by the police underlining the significance of their at risk state.

In 2018-19 nearly 30,000 people were hospitalised for intentional self-harm and numbers were highest in Queensland (8,434) followed by NSW (6,947) and Victoria (6,220).

Women were almost twice as likely than men to be hospitalised for self-harm and the 0-24 year old age group recorded the highest number of self-harm hospitalisations.

News Corp Australia this week launches Mental Health 360, bringing together mental health experts and those touched by it first-hand. Panel experts include former Australian of the Year Professor Patrick McGorry, Sydney University’s Professor Ian Hickie, child psychiatrist Professor Jon Jureidini, Chris Turton who lost his son Dan to suicide, Kids Helpline CEO Tracy Adams, country music star and Rural Adversity Mental Health Program ambassador Melinda Schneider and Federal Health Minister Greg Hunt.

Together with Sky News’ Peter Stefanovic and senior journalists Sue Dunlevy, Ben Pike, Natasha Bita and Kathy McCabe, Mental Health 360 dissects what is arguably the biggest issue impacting Australians.

“People are often traumatised by their experience – brought in by ambulance workers or police, shackled, chemically restrained and left for days until the next place for them to go to,” the Australian College of Emergency Medicine report said.

“The staff in EDs often don’t have the skills to work with someone affected by their mental illness and the culture in EDs is often ‘they are taking up beds” – like the person with mental illness is not justified in being there. The ED is often the last place anyone wants to go.”

“It’s actually a form of moral injury for the care provider,” Australian College of Emergency Medicine’s Dr Clare Skinner said.

St Vincent’s Hospital in Sydney has a six-bed ward close to the emergency department, where patients with a drug or alcohol problem can be admitted for care. Picture: Julian Andrews

“We train in emergency medicine to help people and to be in a situation where we know we can’t provide the care that someone needs and instead we’re sedating or restraining them that’s, that’s a horrible situation to find yourself in,” she said.

Doctors need to have calm, purpose designed environments, and to be able to provide people with the care they need when they need it as opposed to escalating into a crisis and requiring sedation and restraint.

“A lot of people with mental health problems are best treated in the community by people that know them and have a longitudinal relationship with them, but unfortunately many of our community mental health systems have become overloaded and so the backup plan becomes the emergency department,” Dr Skinner said.

Lifeline Australia’s Head of Crisis Services & Quality Rachel Bowes said: “If you are experiencing thoughts of suicide, it is essential that you talk to someone you trust, your GP or a support service like Lifeline. If you are concerned about a person who is in distress or is considering taking their own life, it’s essential that you get them to help. Lifeline’s Crisis Supporters can help to keep you safe and explore what support options are available in your local area. To speak to a Crisis Supporter, call Lifeline on 13 11 14 at any time of the day or night.”

Often those with mental health problems also have physical health problems, are abusing drugs and alcohol, suffer homelessness and present with suicidal thoughts or self-harm.

A lack of specialist services including detoxification, rehabilitation and employment-related programs, out-of-hours services, support groups and resources for families mean they don’t get the help they need.

The psychological and counselling services that are available often charge fees that patients can’t afford.

Homelessness is a large contributing factor and there is evidence that services which integrate responses to mental health and substance abuse and address accompanying, complex social needs may achieve better outcomes, the report found.

The College says the solution has to be building patient centred medical homes that provide wrap around health and social care for the mentally ill.

One example is the Psychiatric Alcohol and Non-prescription Drugs Assessment (PANDA) Unit at St Vincent’s Hospital in Sydney is a six-bed ward close to the emergency department, where patients with a drug or alcohol problem can be admitted for safe observation, management and nursing.

The Royal Perth Hospital has a Homeless Team which ensures people with a mental illness are not discharged form hospital into homelessness, a situation which sees them soon return to hospital.

The Royal Prince Alfred Hospital Sydney has successfully trialled a nurse practitioner-led, extended hours Mental Health Liaison Nurse (MHLN) service based in the emergency department.

The MHLN team see mental health presentations and begin the process for co-ordinating care.

Under a partnership between the Queensland police, health and ambulance services, a mental health intervention project has enabled mental health clinicians to work alongside police to better manage crisis situations involving people with a mental illness. Staff are supported with training in de-escalation strategies and regional co-ordinators work to identify issues, discuss complex cases, develop preventive interventions (such as pre-crisis plans) and identify alternative referral pathways and review procedures

St Vincent’s Hospital in Melbourne has a peer worker employed in the emergency department and a Safe Haven Café physically close to the emergency department. The café offers respite in a warm, caring and respectful environment to people needing mental health support as well as social connection, but not necessarily acute care.

Originally published as Australian hospitals struggling to treat mental health emergencies