Research Stigma Reduction Therapies — 10 September 2018

Photo: Experts say state and territory governments need to focus on improving discharge planning for mental health patients because many people are leaving care without support. (ABC Riverland: Sowaibah Hanifie)

Experts are concerned many mental health patients are leaving hospitals without support and it is putting them at greater risk of suicide.

Shortly after Craig Dixon was discharged from a Darwin mental health ward in 2016 he attempted to end his life.

Mr Dixon felt that his depression was exacerbated by having no support to help him adjust to life at home, and that his time in hospital did not help him address his underlying problems.

He is now recovering, but strongly believes his journey could have been different had there been post-discharge support available to him.

“If you don’t have a good discharge plan, it’s quiet easy to fall back into that state of mind where you’re not thinking clearly,” Mr Dixon said.

Bill Stockman runs a mental health awareness fundraiser, Ski For Life, and through his work has known two people who ended their lives shortly after leaving a facility in South Australia in recent years.

Mr Stockman has been in a mental health facility himself and knows very well the difference that outpatient support can make.

“You’re isolated [in a mental health facility], you’re cut off from the outside world and it’s a safe place to be when you’re in that state of mind,” he said.

“When you get let out into the real world … you’re faced with the feeling of having been in a nut house … that’s when the support stopped.”

A national problem, SA results worst

Research by the Black Dog Institute found that coordinated aftercare for patients with mental health issues decreased suicide attempts by almost 20 per cent.

National guidelines signed by states and territories also recommended hospitals provide outpatients with community care within seven days of discharge.

But according to the latest results from the Australian Institute of Health and Welfare, in South Australia, New South Wales, Western Australia and the Northern Territory around 40 per cent of patients were not receiving timely follow-up, and in other states this figure was close to 30 per cent.

The same research found that 50 per cent of SA hospitals were not meeting all National Mental Health Service Standards.

A survey by Country SA Primary Health Network (PHN) of 300 community mental health representatives and service providers from April this year found more than 50 per cent of respondents believed discharge planning was the greatest gap when it came to suicide prevention.

SANE Australia’s deputy chief executive, Michelle Blanchard, explained that the first three months after a patient is discharged is a high-risk period for suicide.

“It’s really important that people are getting appropriate care and support during that time period. But we know that’s not happening for a vast majority of people,” she said.

Dr Blanchard said there were inconsistent hospital referrals to community support groups, which could be improved if state governments encouraged more referrals.

However she said community groups were also set back by under-resourcing and in some regional areas there were no mental health services at all.

“What we’ve seen is that there tends to be resources allocated at the acute end of the spectrum, so things like hospital-based services,” Dr Blanchard said.

“For people that experience a more complex condition, they often fall through the gaps … so that’s what really needs an increased investment for psychosocial support so people have that ongoing support.”

SA Health Minister Stephen Wade said he was aware of the concern and was aiming to improve the outpatient support in the state over the next year.

“Discharge planning has been an issue raised by accreditation authorities as recent as the Royal Adelaide Hospital problems earlier this year. It’s also a matter that often comes up in coronial inquests,” Mr Wade said.

“The mental health services strategic plan is being developed by the [SA Health] Chief Psychiatrist and the Mental Health Commissioner in the next eight to nine months.”

Program proposed by Beyond Blue

In its budget proposal, the Commonwealth Government agreed to fund a $37 million discharge devised program by Beyond Blue if it wins the next election.

The funding would see the Way Back Support Service program introduced into 25 sites nationally, equipping local service delivery groups with expertise to provide effective discharge support.

Beyond Blue chief executive Georgie Harman said the organisation initially coordinate the program, but would step back once the local organisations were up-skilled to provide aftercare independently of Beyond Blue.

“Of the $37.6 million, $27 million is for service delivery and $27 million will go to primary health networks to help them go out to market and find the right service delivery partners,” Ms Harman said.

She said the aim was to provide clients with three months of support addressing their social, psychosocial and health needs.

“We contact them 24 hours after they’re discharged and make a safety plan. It helps them identify the triggers, who are the people they trust, what are the numbers they can call,” Ms Harman said.

“When they leave the service they leave with a wellness plan.”

Ms Harman is calling for state and territory governments to support Beyond Blue’s program with their own financial contribution.

“The injury or illness which causes someone to consider taking their own life is no different to any life-threatening illness. We need to shift to our thinking,” she said.

This piece by Sowaibah Hanifie was originally published on ‘ABC News‘ 3 September 2018.

 

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