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Dec 12, 2008

Privacy laws keep psych patients’ families out of the loop

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, reports Eleri Harris.

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.

“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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5 thoughts on “Privacy laws keep psych patients’ families out of the loop

  1. Scott

    So many things to comment on.

    As someone else pointed out, I thought KEMH was a maternity hospital.

    Privacy is a complex and difficult subject. I know of one patient with a serious physical condition who was discriminated against, to the detriment of her health, on the basis of stigmatisation. After a failed suicide attempt she was viewed as a “mental patient”, not someone with serious physical injuries. Pain clinic specialists refused her appropriate treatment on a mistaken belief that she was an “addict”. Had her mental diagnoses been kept aside from her medical record, they would have treated her physical condition without the bigotry.

    As to the mental health system, there is not enough space to express my disgust. To take one example, a year or two before her suicide attempt, she had sought help, saying she was feeling suicidal. She was admitted for three days. She received no treatment. On the day of her discharge the psychiatric registrar handed her a yellow pages phone book with instructions to “find a therapist”!!! She did. The therapist turned out to be incompetent and her (the therapist’s) maltreatment lead directly to the suicide attempt.

    By the way, in Britain there is an organisation called POPAN, funded by the NHS, whose aim is to support patients who have been subjected to therapeutic abuse. To the best of my knowledge there is no similar organisation in Australia.

  2. bev

    I think mental health is good in some ways, but some times you have to look further a field and build up some knowledge that gives you confidence to be a whole person again, and learn to have confidence in getting out in the, community,
    Some people in our community who do suffer from mental health, do not have enough positive friends, to help them I know it is a difficult job helping some one who lacks confidence in themselves, but having a strong belief in God helps, and it gives you consolation, and strength to go on with life.

  3. Dr Harvey M Tarvydas

    If medical staff (doctors & nurses) see themselves as agents of information transfer then they may well concern themselves with the to who and what laws but if they act as the obliged deliverer of a beneficial health outcome communication of information may be considered to be part of the method as if the knife sticking out of the abdomen has to be dealt with without any over-precious babble communication of information about the/to who and what laws of privacy.

  4. Jenny Haines

    I am not sure of the legalities here. Most Mental Health Acts require incoming mental health patients to be seen within 24 hours of admission by psychiatrists. Not contacting the family is not just a civil liberties question. People who are admitted on a voluntary basis to mental health facilties are often very fragile and in need of care and protection. If the family are able to contribute to that care and protection they should be contacted. If the family are going to make the patients mental health status worse it can become a difficult professional and ethical question, balancing the patient’s rights against treatment options. There is a mistaken belief that relatives care about the patient. Often they don’t, and even if contacted, don’t visit. There is no standard answer here as the situation can often be complex but the overriding consideration for staff is their duty of care.

  5. Sam

    While I empathised with the Erin Berg family I did not agree with their rage at the system. Firstly King Edward Memorial Hospital is a maternity hospital not a hospital for the mentally ill. Also, based upon my experience at Alma Street, Fremantle which is a mental health facility if you turn up as a carer with a mentally ill person you are expected to be part of the consultation and your input is valued. Also most mentally ill people, if they seem capable are not restrained or held by a hospital and if a person wishes to discharge themselves or leave the facility then they will not be stopped. The carer, as far as I’m aware is not contacted, as the patient is not considered a prisoner and the carer is not usually seen as an enemy of the patient. The privacy laws only hindered us when we originally started in the private system, going public opened up communication and respect for the carer tenfold. Is there room for improvement? probably. Is the solution simple? History says no.