MARK COLVIN: South Australia’s Government calls it the biggest reform of the health sector in its history, but already some say it’s forgotten about mental health. Overcrowding in Adelaide’s emergency departments has left mental health patients sedated for days waiting for a bed. The government says it’s dealing with mental health separately, but some doctors say it should have been included. In Adelaide, Natalie Whiting reports.
NATALIE WHITING: Doctor David Pope works in an emergency department in Adelaide. He says overcrowding means mental health patients are regularly left in poor conditions.
DAVID POPE: Oh they’re absolutely horrendous and inhumane. You’ve got people spending many days in emergency departments that are lit all the time, that are very noisy, they can’t sleep, they can’t get proper access to food. And their mental health conditions get worse. So leaving mental health patients in emergency departments for days is simply inhumane.
NATALIE WHITING: Doctor Pope is past president of a group called the South Australian Salaried Medical Officers Association. It audited Adelaide’s main hospitals and found patients being physically or chemically restrained, while they waited for a specific mental health bed. The State Government has released proposals for a massive shake-up of the health sector called Transforming Health, but it doesn’t include plans for mental health. Were you surprised that mental health wasn’t part of the Transforming Health paper?
DAVID POPE: Absolutely, it’s part of our health system which is failing to deliver to very unwell mental health patients. They’re not getting the services that they need to return to health and become well again and it’s creating enormous pressures on emergency departments which flow onto the rest of the system.
NATALIE WHITING: The Health Minister Jack Snelling acknowledges the significant problems with treating mental health patients. He says that’s why it wasn’t included.
JACK SNELLING: Basically it’s a body of work that needs to be done by this winter. Transforming Health is something that’s going to take two to four years to roll out completely. I can’t wait for four years for the mental health issue to be fixed. It needs to be significantly fixed and I’ve set targets for the health system that I expect mental health patients, to us to have no mental health patients waiting in emergency department longer than a day by the first of January next year.
NATALIE WHITING: In a bid to overcome the delays, a new psychiatric short stay ward has been opened at Flinders Medical Centre. Minister Snelling says another one will be set up at the Royal Adelaide Hospital.
JACK SNELLING: Ideally what we’d like to see is for the majority of mental health patients being able to go straight to that ward rather than having to go through the emergency department. We need to do a bit more work before we can get there.
NATALIE WHITING: And in terms of the beds in these wards, are they new beds or are they beds just being moved to a specific area?
JACK SNELLING: To a large extent they’re being drawn from our existing bed stock, but what we’re making sure we do is use the beds – the mental health beds we’ve got – more effectively.
There is an issue there about a legitimate question about how many acute mental health beds we have compared to the rest of the nation. We’re having a good look at that.
NATALIE WHITING: How do we compare with other sates quickly?
JACK SNELLING: Mental health beds we have a little less but we have a lot more sub-acute beds. Ah so…
NATALIE WHITING: I know there’s been calls for more of the actual acute beds, if you’re not putting more beds into these specific wards, is there a thought that you should?
JACK SNELLING: We’re having a clinical audit done of the way our mental health beds presently are being used and if it comes back to me and says well it’s actually not really working, then we’re going to have to have a serious look at that mix sub-acute and acute beds
NATALIE WHITING: Alan O’Connor is the director of Flinders Medical Centre’s Emergency-Department, where the short stay ward has opened. He says it’s working well.
ALAN O’CONNOR: Here at Flinders it has much reduced. The amount of time spent by mental health consumers in the Flinders ED has reduced by over 65 to 70 per cent over the last number of months and that’s usually implementation of the changes down here at Flinders.
NATALIE WHITING: But David Pope says while it’s a good step, more work is needed.
DAVID POPE: Well it’s certainly one step but it’s not a big enough step to address the issue, so the main problem with mental health are the very unwell patients who need to be in hospital for a number of weeks because that’s how long it takes for the medications to work and for them to return to health. So short stays may help a very tiny amount but it’s nowhere near going to be enough to address the problem.
NATALIE WHITING: He’s also concerned some of the proposed reforms could increase the pressure. Under Transforming Health, Adelaide’s Repatriation General Hospital will close and its services will be run out of other hospitals. The State Government is also planning to build a specialised Post Traumatic Stress Disorder centre to replace one of the Repat wards. But Doctor Pope is concerned not all of the mental health beds will be retained.
DAVID POPE: We’re seeing enormous pressures on the existing mental health beds and now we’re concerned with closure of Repat that there will be a significant number of mental health beds that simply disappear from the system.
NATALIE WHITING: He says opening more acute mental health beds is the only answer.
DAVID POPE: Until that happens we’re going to continue to see patients dealt with inhumanely by being left in emergency departments for days on end.
MARK COLVIN: Doctor David Pope ending that report from Natalie Whiting.
This transcript first appeared ABC, 4 February 2015.