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AUSTRALIAN MEDICAL ASSOCIATION (WA)
Earlier this year, the State Government released an ambitious plan to halve the number of suicides and suicide attempts in Western Australia over the next decade.
The Suicide Prevention 2020 Strategy (Together We Can Save Lives: One Life) has been developed by the Ministerial Council for Suicide Prevention, which is chaired by Dr Neale Fong. The Strategy has been funded in the current State Budget with $26 million earmarked to implement initiatives and programs over four years. The funding represents a doubling of investment from previous levels. Whilst this is clearly welcomed, it is critical that, in the implementation of the new strategy, the serious failings of its predecessor are recognised.
The previous five year strategy, established by the Liberal – National Government in 2009 was resoundingly criticised by WA’s Auditor General for poor implementation after a comprehensive review was undertaken. Initial planning was found to be inadequate and arrangements were unclear and costly in terms of time, effort and money.
Despite this, in her foreword to the 2020 Strategy, the Minister for Mental Health, the Hon. Helen Morton, celebrates the achievements of the 2009-2013 Strategy. The 2009 strategy came in at a cost of $18 million. Many parts of the strategy were not completed and it limped into 2014 with no replacement in sight.
WA’s suicide rate had increased over the past decade to 36 per cent above the national rate in 2012 and the annual number of suicides rose from 194 in 2004 to 366 in 2012. In 2011, suicide was the leading cause of death for women aged 35 to 44 years.
The most recent figures show in 2012, suicide was the leading cause of death for both men and women between the ages of 15 and 44. More people completed suicide in 2012 than were killed by skin cancer or road trauma. The suicide rate is higher in rural and remote areas with the Kimberley region at highest risk.
Kimberley Aboriginal communities inBalgo, Fitzroy Crossing, Mowanjum and Derby have suicide rates up to 20 times the state average. Minister Morton has acknowledged that in WA on average, one person loses their life to suicide every day. She has set a high achievement target for the 2020 Suicide Strategy – to halve the number of suicides in WA by 2020. The Mental Health Commission has been tasked with developing the 2020 Strategy implementation plan (including separate Aboriginal and Youth strategies) and these are expected to be complete by mid-August.
The AMA (WA) will await the details of the implementation plan as this is expected to provide important specifics that are missing from the glossy booklet released by the State Government. The 2020 Strategy has six action areas, including public awareness, community support and prevention programs, workplace prevention programs, increased suicide prevention training, data and information improvement. Dr Fong said the 2009-2013 strategy was heavily focused on raising awareness and reducing stigma. He claims that awareness is now better, and it is time to do more about the suicide “epidemic”. The 2020 Strategy targets high-risk groups — the mentally ill, people who have previously attempted suicide, young people, Aboriginal people and drug and alcohol users.
The AMA (WA) sincerely hopes that lessons have been learned from the failure of the 2009 Strategy – particularly in terms of improved governance, procurement and planning for implementation. Had these processes been appropriately managed, considerably more time, effort and money could have been spent on suicide prevention activities. It is hoped that that the suicide prevention activities in the 2020 Strategy will be co-ordinated with existing activities and hence will avoid duplication, increase efficiencies and be sustainable.
AMA (WA) members in Psychiatry, Emergency Medicine and General Practice are at the forefront of a WA mental health system that is in crisis. The AMA (WA) has consistently communicated members’ concerns to the Minister for Mental Health, only to be told that the dedicated ministerial portfolio for mental health in WA is a “real story of success”.
Minister – the dedicated and skilled doctors working at the frontline of mental health and many of their patients would strongly disagree!
Just days ago, the WA Coroner found that systemic problems within the State’s mental health system contributed to the suicide of a young Perth man. The Coroner reiterated what the AMA (WA) has been regularly and strongly communicating to the Minister – that continuing to have acute mental health patients waiting for days in Emergency Departments for acute care places is shameful.
The Coroner could not have been clearer in his findings in the case of 31-year-old James Anthony Stanczyk. The Coroner said that “while this situation continues, it is likely that more at-risk patients will abscond from emergency departments, with the potential for similar tragic results”.
Our doctors are doing the very best they can within this chaotic and dysfunctional system. In the case of Mr Stanczyk, the treating doctor rightly identified the patient to be at high risk and attempted to have him admitted to a locked section of the mental health unit – only to be confronted with no availability of suitable beds.
The Coroner found that “a longer-term solution to this unsatisfactory situation from a medical/mental health management perspective would be the provision of a sufficient number of places in mental health facilities where mental health patients can be managed and treated appropriately”.
This will not be news to the Minister – it echoes what the AMA (WA) has been calling for over many years. The State’s mental health system declared a “code yellow” in late July due to the acute beds crisis. In the course of one week, approximately 20 mental health patients were kept in the EDs of Royal Perth and Sir Charles Gairdner Hospitals.
With a flawed Mental Health Act due to be proclaimed in November this year and a 10 Year Mental Health Plan, which appears to be unfunded at both State and Commonwealth levels, the present and the future for patients needing acute mental health care is bleak.
However, the AMA (WA) will continue to advocate vigorously for the required number of specialised emergency care facilities for acutely ill mental health