Now is the time to fix men­tal health

The West Australian - - AGENDA - Caro­line Crabb Opin­ion Dr Caro­line Crabb is the AMA (WA) psy­chi­a­try rep­re­sen­ta­tive

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.

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