Our EDs are overflowing with patients with mental health issues. They are hardly suitable places for distressed patients who need to be in calm mental health units or properly supported in the community.
In our system, patients can be stuck in ED for up to four days. This unacceptable situation sounds the alarm that the WA mental health system is not working.
Clinicians working in hospitals and community services can’t understand the system. They describe inordinate levels of bureaucracy, endless rules, paperwork and delays. Committed staff are trying their best, but are left demoralised and burnt out.
Staff are exposed to high levels of violence with one mental health worker paying the ultimate price for trying to give care.
Increasingly, the system is getting in the way of patient care.
Recent ABS suicide data shows that WA suicide rates are the worst they have been for 20 years. We also lag behind other states in our suicide rates. The issue is not new, with problems for many years and over successive governments.
To be fair, this is not just about mental health services. Social factors such as financial strain, social disadvantage and substance abuse play a major role in community mental health issues.
Health spending is rising and unsustainable. The inconvenient reality is that funding will be stretched further if we continue with the system as it is. Complex systems waste taxpayers’ money through delay, duplication and readmissions.
Funds must go to frontline services and unnecessary administrative waste addressed. The system is not only failing but also expensive.
The normal service response is to cut patient services to save money. Funds must be quarantined for vital front line services and unnecessary administrative waste addressed.
A first step is to accept there is a real problem.
Premier Mark McGowan and Health Minister Roger Cook do appear to grasp the issues and have resolved to take action. The Mental Health Commissioner, Tim Marney, appears passionate and has a vision that is generally supported by the AMA.
Reviews indicate that the main issue is the complexity of the system. Mental Health Services are giant bureaucracies that have grown over decades and taken on a life of their own. A top-to bottom-revamp of the whole system is desperately needed.
The guiding focus must be on delivering quality care to patients and their supporters. We need to deliver the right care to those who need it, when they need it. Most service decisions are being made by managers with no frontline experience. We need to get patients, supporters and clinicians back into every level of planning.
The recently announced review of clinical governance is a first step in this process. The hope is for a system that is streamlined, simplified and coordinated.
Clinicians must be freed up from endless forms and administrative tasks to focus on patient care.
Innovative services should be applauded and their ideas used by all other services — rather than being shelved.
New technologies need to be used. Patients should be able access online directories that guide them to services in their areas. Online patient bookings, results and follow-up reminders have been available for years. The multitude of hospital, community, NGO and GP services should be coordinated and be working together for patients. Software to coordinate multiple providers together is at hand, with an example being the My Health Record.
Patients from regional areas should have access to telehealth specialist services and if they need to come to the city, should have appointments coordinated to avoid multiple trips. We live in an age where the solutions are already available.
Reform is desperately needed in areas such as disability payments, accommodation services and prevention services for the most socially disadvantaged. All of these issues impact on the mental health of the community.
In Mental Health Week 2038, I hope we will be celebrating a community where people can speak about mental health without fear of stigma. And when they do, I hope they will be greeted by a responsive, supportive mental health system that will care for them and their supporters.
Dr Omar Khorshid is the Australian Medical Association (WA) president.