When news of Erin Berg’s suicide in Mexico hit the headlines earlier this year, fingers were pointed at euthanasia advocate Dr Philip Nitschke and the Western Australian mental health system. Many shared Berg’s sisters’ shock and anger at the fact that an involuntary patient at King Edward Memorial Hospital could be released into the community despite evidence she intended to take her own life. Berg’s family have been vocal in their condemnation of the mental health system, saying medical staff negligence led to her death.

Every year in Australia 2000 people take their lives, but ten times as many are admitted to hospital for intentional self injury. In the case of mental health patients, admission to hospital may be their first encounter with medical professionals. Most Australians would not be aware that when someone is admitted to the emergency ward of a hospital after self harming, they will not necessarily see a psychiatrist before they are discharged, their family may not be contacted and they may be discharged alone.

Privacy laws restrict medical staff from informing family members unless specifically requested to do so by patients, which can have interesting repercussions if a patient is paranoid or delusional. The Mental Health Council’s Simon Tatz told Crikey that family and carers of mentally ill Australians repeatedly name privacy laws as their biggest issue.

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“They feel excluded from the process of care, they feel there is no opportunity for them to give input,” says Tatz.  “What is missing is the involvement of carers, which is not in the best interests of the carers, patients or treatment.”

National Mental Health Charity Sane executive director Barbara Hocking agreed, “Informing carers doesn’t breach human rights — in fact it can enhance them.”

Hocking told Crikey that although each state has a different Mental Health Act that can override privacy laws, these eight pieces of state legislation are continually in flux, with one under review at any given time. Hocking says the issue is how the Mental Health Act is interpreted by hospital staff. She argues that medical staff who would happily contact family members of car accident victims behave differently with mental health patients:

“With mental illness they (hospital staff) make an assumption the person doesn’t want their family to know, which comes back to the stigma and the distinction of mental illness.”

Tatz told Crikey our country is experiencing a crisis in mental health care and that restructure on a federal level is necessary. “There is no pathway, no clear plan at hospitals upon discharge for mentally ill patients who have self harmed. The nurses and doctors are done with the physical health bit, but not the mental health bit – which is critically needed at a state and national level,” says Tatz.

Add that to the fact that there are simply not enough psychiatrists and nurses trained in mental health care to deal with the influx of mentally ill patients.

Sydney psychiatrist Alan Rosen said the folding of community based mental health services into hospitals was causing overcrowding. Dr Rosen said of the Commonwealth, “I think they are losing their way under the states, and the National Mental Health Strategy — while it started really well in 1992 — has been spread thinner and thinner.”

St Vincent’s Hospital in Melbourne have used DHS funding over the last two years to specifically improve upon their capacity to deal with psychiatric patients. Mental Health Operations Manager Jenny Smith told Crikey they found extra space in emergency for private interviewing space and now have trained staff available 24 hours a day, three during working hours.

“St Vincent’s has a tradition of being inclusive in our responses to psychiatric help, but now we have a specialized team of people in emergency it makes responses faster and better,” says Smith.

But only last week COAG stalled on a national revamp of mental health services with Health Minister Nicola Roxon saying reforms would be the subject of further negotiation. This effectively placed the issue of inconsistent standards in hospital mental health care on the backburner for the foreseeable future.

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Peter Fray
Peter Fray
Editor-in-chief of Crikey
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