While we wait…

While we wait…


Dr David Mountain
AMA (WA) Emergency Medicine Spokesperson

Monday 2 December 2019

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The issues raised in Dr Anne O’Sullivan’s timely article (And so it goes; Medicus October 2019) are important and systemic. Although it clearly gives the perspective from one hospital’s service, these are the same issues faced by patients, staff and carers throughout Western Australia.

 

Indeed, some sites will suffer greater deprivations and delays where their system has less access to beds, capacity and resources (e.g. rural and remote) or specialist beds. What Anne’s article amplifies and makes clear are the severe consequences for patients and their carers, from prolonged waits, poor access to light, sleep, and sometimes food, with excessive need for restraints and sedation.

 

It also puts an extraordinary strain on staff, working in a system without answers, where substandard care and outcomes are routine, and where there seems to be no light at the end of the tunnel.

 

This is not a new phenomenon, but a slow-rolling train wreck perpetuated by a lack of will (do politicians or bureaucrats really care about mental health patients?), poor co-ordination, ineffectual leadership and dysfunctional bureaucracies, attached to a mantra that we never need additional resources. Yet routinely running our acute mental health system at over 100 per cent capacity, requiring 5-25 ED cubicles to act as the sponge to mop up the acute mental health system’s overspill, shows that there is a major problem with acute capacity.

 

In the last month alone, patients with over 24-hour ED stays spent 8,000 hours in our cubicles or 12-14 cubicles just used as overflow for unplaced patients. The real number is probably almost double this as many more patients take 8-24 hours to find a bed in our chaotic system.

 

Change is slow, as seen with this system failure having carried on for over 15 years with few successes. We will hopefully start to put in place long term changes and find out what works in the community and intermediate care.

 

The focus driven by the recent Productivity Commission Report, and hopefully the soon-to-be-released Chapman/Stokes report in WA will put a much-needed focus on redesigning and resourcing our mental health systems. 

 

However, while we and our patients continue to wait, it is crucial that we open enough acute care capacity to stop torturing our patients with prolonged ED stays. An essential first step is to provide behavioural assessment areas for all larger EDs so patients are assessed in purpose-built, calming environments with security, toxicology and psychiatric services able to start assessment and treatment early and de-escalate behavioural disturbances. 

 

Other potential diversionary environments (mental health cafes/ drop-in centres) or early treatment/ diversion programs looking at vulnerable populations e.g. the homeless with mental health issues, as trialled at Royal Perth Hospital should be assessed and rapidly expanded if successful.

 

Anne’s article seems to have touched a nerve, and along with the other reports and focus in national and local media, maybe governments finally want to take these issues seriously. Health Minister Roger Cook has said he wants to know about 24-hour ED stays and has been receiving data for the last four months. Mr Cook has suggested as well that 92 additional beds will be found although it is unclear when and where they will be opened.

 

Our very low numbers of acute psychiatric beds have been well below OECD averages, and below the national average for over a decade, whilst demand has increased dramatically.  Routinely confining people in the worst possible environment for their condition (torturous is a realistic description) is unacceptable. This must be dealt with as a health emergency and we look forward to the Minister and health leadership’s urgent engagement to find solutions and resources to fix this blight on WA’s health system.

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