Mental health patients are being chemically restrained in Australian hospitals due to staff pressures

Vulnerable patients are being intubated in Australian emergency departments because of increasing pressure on mental health services, a News Corp investigation can reveal.

A News Corp investigation into health services across Australia found psychiatric patients were intubated to manage violent or complex behaviours everywhere, except in the Australian Capital Territory and Tasmania. Picture: Supplied

Vulnerable patients are being intubated in Australian hospitals and during medical flights because of increasing pressure on mental health services.

An exclusive investigation has uncovered psychiatric patients are being intubated, a process of using general anaesthetic and mechanical ventilation, in emergency departments and “commonly” during patient transport.

In the Northern Territory, a “disturbed” patient was intubated at an ED and left in the Intensive Care Unit for 11 days because there were no specialist mental health beds available.

Top emergency medicine law expert Michael Eburn said the law and philosophy when treating mental health patients was to use the “least restrictive and least coercive practices”.

“You can’t intubate a conscious patient. So what you’re really concerned about is they’re giving them drugs to practically put them in a coma,” Dr Eburn said.

“I’ve been hearing about the sedating of patients not because it’s really clinically indicated … but just because it makes the clinical staff’s life easier.

“That’s not permissible. You’ve got to be thinking about the best interests of the patient.”

Dr Eburn said most state and territory mental health acts didn’t exclude the use of intubation and chemical sedation was rarely legally regulated.

“You can sedate people so they’re a bit groggy … without them actually being unconscious,” he said.

“That’s probably a better option …”

Royal Flying Doctor Service executive director Frank Quinlan said the practice needs to be scrutinised but is used across air-retrieval services. Picture: Jonathan Ng

Royal Flying Doctor Service chief executive Frank Quinlan said most states and territories had a guideline for the intubation of psychiatric patients during air transport and Western Australia was currently reviewing its frequency.

“I am certainly aware of the practice but I do not have any comprehensive data as this will be held by the state governments,” Mr Quinlan said.

“Each RFDS section has their own guideline aligned with their state’s requirements typically set by the office of the chief psychiatrist or equivalent.”

CareFlight and RFDS said under Civil Aviation Service Authority regulations the pilot had final sign-off on the plane’s safety, which often impacted the medical decisions made.

CASA confirmed the pilot had final responsibility but had no regulations regarding the intubation of patients.

There are times when intubation is considered medically necessary and is used to secure the person’s airway.

For example, as a result of an overdose or damage to their windpipe due to self harm.

Victoria will become the first state to legally regulate the use of chemical restraint in September this year.

A Victoria Health spokeswoman said under its revised Mental Health Act chemical restraint could only be used in a designated mental health service or for transport.

“Incidences where a patient is intubated to manage acute behavioural disturbance are extremely rare,” the spokeswoman said.

A News Corp investigation into health services across Australia found psychiatric patients were intubated to manage violent or complex behaviours everywhere, except in the Australian Capital Territory and Tasmania.

In the Northern Territory, NT Health confirmed up to 20 mental health patients were intubated in the past two years.

Staff, who spoke on the condition of anonymity, said psychiatric patients were intubated in the RDH emergency department and transferred to the Intensive Care Unit because the hospital could not find suitable beds for them.

NT Chief Psychiatrist David Mitchell is conducting a review into the use of intubation on psychiatric patients but disputed staff’s claims bed pressures and behavioural disturbances were the reason for intubation.

NT Chief psychiatrist Dr David Mitchell is conducting a cluster review of patient cases where intubation was used. Picture: Floss Adams.

A guideline sighted by this publication confirmed intubation was used during patient transport in South Australia and the Northern Territory by the Royal Flying Doctor Service.

South Australia Ambulance Service said clinical practice guidelines for the transfer of psychiatric patients were introduced in 2013 and regularly reviewed.

“This has almost eliminated the practice of intubating patients for the management of behavioural emergencies,” an SAAS spokesman said.

“Our retrieval teams completed over 100 mental health related transfers in 2022.

“While our teams did not intubate any of these patients for behavioural reasons, 35 required intubation either before or during retrieval, due to medical reasons such as overdose, or injuries sustained.”

The spokesman also said two mental health patients were intubated before their arrival because of behavioural concerns.

A Queensland Health spokeswoman said intubation could be required in “very rare circumstances” but denied it was due to pressure on mental health services.

The spokeswoman said the use of intubation or sedation related to “assessment of clinical need”, including compliance with safe transport requirements.

“Any action we do take to keep our patients and staff safe is performed in accordance with the Mental Health Act 2016 and in the least restrictive way so as to enhance and uphold the rights of people with mental illness,” the spokeswoman said.

“Sedation for mental health patients for transport or in emergency departments for violent and aggressive behaviour management may occur in limited circumstances, and in very rare circumstances, intubation may be required.”

The New South Wales health department declined to confirm if they used the practice.

NSW pointed to policy documents that refer to the intubation of “disturbed” patients.

While in Queensland, medical researchers published studies in 2015 comparing the efficiency of ketamine versus intubation on psychiatric patients travelling on Royal Flying Doctor Service flights.

The study found 44 psychiatric patients were intubated over nine years.

It concluded a ketamine sedation protocol would reduce the need for intubation.

The research showed the practice of intubating psychiatric patients during air retrieval had occurred for almost two decades.

A Western Australia Health spokesman said the decision to intubate took into “account staff and aircraft safety”.

“Patients suffering from an acute psychosis may be a danger to themselves and the health professionals treating them during transfer,” he said.

“The decision to intubate for transfer is primarily made to address the patient’s clinical needs and safety, particularly in clinical situations that require a patient to be sedated.”

An Australasian College for Emergency Medicine spokesman said chemical and physical restraint should only be used as a last resort.

“Escalating resourcing and staffing pressures on hospitals and healthcare systems have resulted in some situations where this practice has been necessary more often than would be required if more psychiatric and general inpatient beds, as well as community-based services, were more readily available,” the spokesman said.

“These distressing situations highlight the importance of ensuring the significant systemic, staffing and resourcing issues which have been compounding within health care systems across the country over many years are addressed.”

The spokesman said major healthcare reform was needed to ensure all patients received access to the medical care they needed, when and where they needed it, and in a dignified fashion.

Originally published as Mental health patients are being chemically restrained in Australian hospitals due to staff pressures