Margaret Perrott
Members of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) will ignore the bed restrictions in NSW hospitals and admit mentally ill patients for "as long as they need".
The ABC Radio National's PM program reported on February 2 that a "crisis in mental health services in NSW" has led to NSW psychiatrists finally taking drastic action on the abysmal provision of services to mental health patients.
Dr Louise Newman, the president of the NSW RANZCP, said: "We have acute bed shortages, with great difficulty in actually admitting all the people who may need to be admitted for appropriate treatment. We also have shortages of longer term and rehabilitation services within the public sector. We have tremendous pressure on beds with pressure being put on clinicians to have a very high turnover and short admissions rates for patients who might otherwise benefit from being in hospital for a longer period of time".
Many mentally ill patients are finding they have to rely on already overburdened general practitioners, who often haven't the skills or the time to properly address the complicated needs of these patients.
Many seriously disturbed patients are being treated by psychiatric registrars in hospital accident and emergency departments and then sent home, or being admitted for only 24 or 48 hours, solely due to the lack of psychiatric beds.
To illustrate the point: a patient of mine who tried to hang herself one Wednesday night was admitted to the local psychiatric ward for 48 hours. She rang me late Friday afternoon saying she had found herself sitting on the edge of a cliff contemplating jumping off, having been discharged from the psychiatric ward that morning. She asked me to tell her what she should do.
Many of the problems facing mentally ill people and those who care for them are social, rather than medical. Problems of housing, finances, access to dental and physical health services, activities of daily living like shopping etc and relationship problems, are often the triggering factor in an episode of acute psychiatric illness.
Since the implementation of the Richmond report of 1983 — which resulted in mentally ill people being kicked out of the established psychiatric hospitals into the general community — the lack of "community services" for the mentally ill has made a mockery of the report. The Richmond report's main point was that "integrating" mentally ill people into local communities and providing them with community-based care would be more beneficial for the patients.
At a public forum on mental illness in Wollongong in 2003, the director of mental health services for the Illawarra Area Health Service acknowledged that "de-institutionalisation" of psychiatric patients meant that services like dental care, housing and even food, which were provided automatically in the institutions, had not been adequately replaced by community-based services.
From the outset, the NSW Coalition government used the Richmond report as a way of saving money, rather than providing services for the mentally ill patients. In 1984 the NSW health department advertised numerous positions for doctors, nurses and psychologists to work in community health care. I was a successful candidate for one of these positions, but was told that I could not start work until the funding was received. That funding never eventuated.
Some of the positions were filled, but were funded out of the general health budget — at the expense of other services.
Since 1984, NSW governments have saved millions of dollars from the closure of long-term psychiatric hospital beds. The NSW Labor government cynically tried to make further profits when it proposed to sell off Callan Park (the historic psychiatric hospital at Rozelle) for development.
The NSW health department recommends at least 1500 beds for mentally ill patients in the public hospital system, while the Labor government will only fund 400.
It is now estimated that at least 20% of the population suffer from some sort of mental illness, but even those who are more seriously affected cannot access adequate services.
The federal government's much publicised "Beyond Blue" program is costing hundreds of thousands of dollars for advertising campaigns, public forums and research into depression and mental illness, while the provision of services remains totally inadequate.
The unprecedented action being taken by the psychiatrists shows how deep the crisis is in NSW. This a desperate move by desperate doctors seeking at least some relief for their patients.
[Margaret Perrott is the Socialist Alliance candidate for the federal electorate of Throsby.]
From Green Left Weekly, February 11, 2004.
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