SA mental health advocates call for services to keep patients out of ED
For 23 years, Jacki Brune has been in and out of hospitals just to stay alive.
- SA is ranked worst in the nation for seeing mental health patients within “clinically recommended waiting times”
- Often there are no mental health beds for those who need them
- One charity is calling for more respite services
With no intensive community-based mental health programs in her hometown of Port Pirie in South Australia, she had no choice but to go to hospital when she was at risk of suicide.
“I was having really bad panic attacks, really bad panic attacks all day, everyday for six months and it just got to the point where I [tried to take my life] because no one was helping me,” Ms Brune said.
“I’d go to the doctor, I’d go to the emergency, I’d lost so much weight and I was a mess.
“I suppose they didn’t know what to do with me until I broke, and I broke in a big way.”
Advocates have said Ms Brune’s experience is not unique, with mental health patients increasingly forced to present to South Australian emergency departments when they are in crisis because of a lack of community-based support programs.
They say beds for mental health patients in the state’s hospitals are often in short supply with patients forced to spend hours, sometimes days, waiting in emergency departments.
According to the Australian Institute of Health and Welfare (AIHW), South Australia has the highest mental health related ED presentations in the nation, placing greater pressure on hospitals.
This contrasts with community support, which mental health experts allege is being wound back and defunded.
Mental health treatment ‘too medicalised’
The AIHW also found South Australian hospitals had some of the longest wait times in Australia for mental health patients in emergency departments, and psychiatrists have been put under enormous pressure to discharge patients.
Geoff Harris said the health system was missing things to help people avoid hospitalisation. (ABC News)
At the end of last month, the South Australian Government opened the 10-bed psychiatric intensive care unit at the Royal Adelaide Hospital (RAH) which it said would ease pressure on the emergency department.
It followed issues with duress alarms which delayed the opening of the unit.
However, executive director of The Mental Health Coalition of South Australia Geoff Harris said the state’s approach to mental health treatment was far too medicalised.
“For a lot of people who have mental illness, they talk about the experience of hospitalisation and of crisis services as traumatising so there’s a real imperative for us to avoid that where we can,” he said.
“If we’re talking about emergency departments, they’re jangly [noisy] environments and so people who are in a distressed state find them very difficult to stay in and they do have to wait for quite a while.
He said crisis respite was important “in terms of being able to provide support when people are in distress”.
“If you’re … starting to experience becoming unwell, it’s difficult to get support until you’re in a crisis, and then you need to access the public mental health system to get the services you need,” he said.
“It can help people avoid weeks or months of becoming unwell if they can just get the support early.”
According to the Report on Government Services 2019, South Australia ranked worst in the nation for seeing mental health patients within “clinically recommended waiting times”, with just over half of patients presenting to emergency departments being seen within the recommended timeframe.
Health Minister Stephen Wade said emergency departments were the gateway to other services.
“It’s not that people with mental health issues shouldn’t be going to an ED, we need to make sure that whatever the next step is out of an ED that that opportunity is available,” he said.
“We will certainly be continuing to work to make sure that we provide support in the community so that as people are becoming unwell they might be able to manage their needs in the community.”
Jacqui Brune said often after receiving treatment she returned home with no support. (ABC News: Carl Saville)
Each time Ms Brune was hospitalised, she would be admitted to a ward for about five nights.
She said the hospital environment and staff could not provide the emotional support she so desperately needed.
“You get put in there and that’s it — the nurses won’t come and talk to you, they don’t know what to do with you, you feel as though you shouldn’t be there because you’re not really sick so you’re taking up a hospital bed,” she said.
“You’re in a pretty bad place when you’re there and you just want the pain to stop.
“And then usually you’re just discharged, and you go and see a mental health nurse in two or three weeks and that’s it, like you go home and you’re still left with your head.”
Calls for crisis service to be reinstated
Skylight Mental Health — a charity that delivers mental health services — chief executive Paul Creedon called on the State Government to bring back the crisis respite service, which he said could again reduce emergency department presentations and hospital admissions and improve patient outcome.
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The 24/7 live-in service was established in 2014, with Federal Government funding, to assist people in acute states of mental crisis, including housing, a relationship breakdown or grief.
A 99-page independent evaluation of that program, undertaken by the University of New South Wales in 2016, found the success of the service had significantly reduced hospital admissions, emergency department visits, the time spent in hospital and the psychological distress in clients.
It found that a large proportion of the service’s cost was offset by the reduction in hospitalisation and emergency department presentations, yet two months after the report the program was defunded.
“We don’t have the crisis respite stuff which is designed to stop people getting to that point of needing a hospital,” Mr Creedon said.
“The costs of community-based services is significantly cheaper than medicalised hospital-based services and the more we take away that option for community-based systems, the more we run the risk of increasing the number of high cost, high-labour intensive services.
“I think that’s an indictment of our system that the system doesn’t work well to make people [better] it only works to keep people out of immediate harm’s way.”
Skylight’s Paul Creedon is calling for the Crisis Respite Service to be reinstated. (ABC News)
Mr Creedon and other mental health advocates have lobbied for the crisis respite service to be reinstated for years.
In June last year, the former Labor state government approved funding to reinstate the intensive home-based support service — and Ms Brune became one of the first clients.
On her most recent discharge from hospital, she joined the new community mental health program which provides psychosocial recovery support for people who are leaving acute care.
Over the next 12 weeks, she met with a support worker three times a week in her home.
“This is the best I’ve been in years, no word of a lie,” she said.
“Towards the end of the program you are really positive.”
At the completion of that program, she was placed on a longer-term program which has helped her find and maintain a job for the first time in years.
However, the future of that program is still at risk with funding only secured until June.
“If it wasn’t for [the program], I would be back to just sitting at home, not getting out of the house and would have had another episode,” she said.
“If you know you’ve got someone coming to see you, coming to check on you, you’re more likely not to go down that path again.
“You feel as though you’re not all alone, there is someone out there who does care.”