President’s Blog: Heavy wait on mental health patients | AMA (WA)


Mental health patient

President’s Blog: Heavy wait on mental health patients

Friday November 18, 2022

Dr Mark Duncan-Smith, AMA (WA) President

Bedlam is a word shortened from ‘Bethlehem’, as in the London hospital Saint Mary of Bethlehem that started treating mentally ill patients centuries ago and now refers to any chaotic scenario. Unfortunately, the long and the short of it is that a kind of bedlam still prevails in the treatment of such illnesses.

In my previous blog I registered support for aspects of the independent review of WA health system governance that indicated a consolidation of mental health with a single point of responsibility for its execution and operational delivery.

Based on a new AMA report card that has found Australia’s health system and its public hospitals are failing people with poor mental health, better governance is the bare minimum for addressing shortcomings in the treatment of this vulnerable group of patients.

“The AMA’s Public Hospital Report Card – Mental Health Edition found that due to the hospital logjam, patients with poor mental health often have to wait longer compared to any other patient group presenting to Australia’s emergency departments,” the AMA said.

“The report showed a big drop in the number of available public hospital beds for mental health patients, as increasing numbers of more severely ill patients present to emergency departments after exhausting all avenues for help.”

Findings from the report showed:

  • The number of patients presenting with poor mental health has almost doubled to 121 per 10,000 Australians, up from 69 in 2004.
  • There has also been an almost 40 per cent decrease in the number of mental health beds in public hospitals per capita — from 45.5 to 27.5 beds per 100,000 population between 1992 and 2020.
  • The data show a rising reliance on ambulances to reach emergency departments, with every second mental health patient (52.2 per cent) arriving by ambulance in 2020–21 compared with all other conditions, where one in three people arrive by ambulance.

Key findings for Western Australia for mental health presentations included:

  • Measured by 100,000 population the number of beds decreased from 43.6 to 29.5 since 1993-94. However, the number of public hospital beds increased in real numbers since the low point of 639 in 2001-02 to 782 in 2019-20.
  • The rate of emergency department presentations per 10,000 population almost tripled: from 50.7 in 2004-05 to 144.5 in 2020-21.
  • The triaging data for emergency department mental health presentations has been steady over the six years, since 2015-16. The biggest increase has been in presentations triaged as emergency (to be seen within 15 minutes) of 2.1 per cent.
  • In 2020-21 ED median length of stay for all mental health presentations was 4 hours and 9 minutes. For presentations ending in admissions, median length of stay was 5 hours and 21 minutes. 90th percentile length of stay for mental health presentations ending in admissions was 18 hours and 53 minutes.
  • While the overall number of patients who arrived at emergency departments with ambulance as the mode of arrival stayed relatively the same in the five-year period since 2016, the number of mental health ED presentations where ambulance was the mode of arrival grew by 4 per cent. It appears that the annual biggest increase happened between 2019-20 and 2020-21, which were COVID-19 pandemic years.
  • In 2019-20 the average length of stay in public hospitals for mental health patients was 13.8 days, slightly above the national average.

It corresponds to a system-wide malaise in public hospital bed numbers, as outlined in the Australasian College for Emergency Medicine’s (ACEM) recently released State of Emergency 2022 (SOE22), an inaugural annual report that presents the numbers behind the healthcare crisis.

As I told the media in response:

“The report released today shows that WA suffers with a lack of beds and a lack of capacity. The AMA (WA) yet again calls on the McGowan Government to have an active policy to increase our bed numbers to the national average. WA started the pandemic with the lowest number of beds per head of population and the lowest number of ICU beds per head of population of any state or territory in Australia.

“Doctors and nurses are sick and tired of trying to deliver safe and quality healthcare with one hand tied behind their back. The primary cause of ramping and bed block and lack of access to emergency care is a lack of beds in the system. We can chip away at the edges, trying to reduce demand and to increase efficiencies and outflow. But the primary problem is we quite simply do not have enough beds.

“The standout figures from the report for me are that demand for the system and beds has gone up by 9 per cent over the last five years, but the supply of beds has only gone up by 2 per cent. That differential represents high occupancy of the hospitals, bed block, ramping and poor outcomes.”

It’s the end of 2022 in Australia, not 1400s London. Less bedlam. More beds.

You can find the AMA’s Public Hospital Report Card – Mental Health Edition at: