Now is the time to fix mental health
The growing focus on mental health and suicide highlights a societal problem that affects us all in one way or another. While it raises awareness and encourages more people to seek professional help, it also starkly demonstrates that our health services and the nongovernment sector are struggling to deal with those who have already sought help.
Feedback from patients, families and clinicians is consistent — the current system is not working. Our most vulnerable patients are frequently re-traumatised by a chaotic, underfunded and poorly co-ordinated health service that repeats the cycle of rejection and abandonment.
The “care” patients receive is further affected by a demoralised workforce increasingly suffering burnout, with resultant absenteeism and high staff turnovers.
The responsibility for mental health does not lie solely with public services. We all have a need to address the social aspects of suicide, the tip of the iceberg of mental suffering.
Numerous reviews have been done to identify problems in the system but the ad hoc solutions to date have failed to translate into meaningful progress.
The facts speak for themselves: recent ABS suicide data underlines the importance of mental health services in providing timely and appropriate interventions and treatments in response to a growing number of patients and their carers. These have to be accompanied by appropriate resources and funding.
To achieve this, there is an urgent need for a system of governance for mental health where the consultation, policy, planning and resourcing dovetail.
Emergency departments are increasingly bearing the brunt of demand, with ED physicians describing the situation as shambolic. Those in need of emergency and lifesaving care should be transferred promptly to calm mental health units more suitable to their needs. This is not happening.
The lack of co-ordination and integration between services is limiting patient flow. Making matters worse, exclusion criteria commonly bar our most vulnerable patients from accessing vital services.
Once in ED, forget any idea of a “four-hour rule”. After triage, if patients are not discharged back to their family or GP, they may endure up to four days or more in the tumultuous emergency environment, awaiting allocation of a bed in an acute mental health unit. There would be a public outcry if patients with orthopaedic injuries or a diabetic coma faced such delays.
The existing system, with its innumerable rules, is inordinately complex and almost impossible to navigate.
Those of us working in the health sector struggle to understand it, so what hope is there for so-called consumers. Patients and their families try endlessly to find the right section, organisation or department to will help them — only to learn they do not meet strict admission criteria.
Despite the bad news, there are some signs of moves in the right direction. The State Government has recognised the problems in system integration, co-ordination and governance. Premier Mark McGowan and Health Minister Roger Cook, in particular, have resolved to take action.
We hope that service culture and vision will be addressed. It is critical that patients and their supporters are the focus of future service development — everything planned must be aimed at helping patients and reducing their suffering.
The AMA recognises the need for mental health services to be resourced to the same level as physical health services. It is enthusiastic about novel projects with strong potential to benefit patients, including mental health observation areas attached to EDs, which facilitate overnight acute care.
There are great examples of innovative community services and diversion programs for alcohol and drug patients, such as the five-bed unit at Royal Perth Hospital.
Unfortunately, most such projects are limited in scope rather than implemented on a whole-of-system basis. All the concerns relate to funding.
While mindful of the ethical obligation to spend taxpayers’ dollars judiciously, we advocate for cost-effective investment in staff and infrastructure to provide the comprehensive care that patients deserve. A simplified corporate and clinical structure is critical if this is to succeed.
A properly organised system would allow a system-wide response to problems. Suicide prevention strategies could be implemented across the whole sector in an organised and collaborative way. Mindful of the importance of primary and secondary prevention, there would also be links to social and education services.
The AMA is cautiously optimistic that change can and will occur. With the emergence of new technologies, the community’s willingness to embrace change and the current emphasis on mental health, the time is ripe for action.
This time, we can hopefully develop the right plans and provide the money to find solutions to one of our community’s biggest and most important issues. The time has come for real and meaningful change. The alternative is a continuation of crowded EDs, alarming statistics and more broken families.