Mental health system’s cracks and failures


An inadequate mental health system has failed the mentally ill, says a major mental health report.

Mental health nurses have been long voicing concerns about the inadequacies of the mental health system but a damning report has sparked media and public outrage over a system that has seriously failed the mentally ill.

The Not for Service report paints a shocking picture of neglect, preventable deaths, the inappropriate incarceration of people with a mental illness, the grief and despair of the families left to cope when services are unavailable or fall short.

The Not for Service Report – appropriately subtitled ‘Experiences of injustice and despair in mental health care in Australia’ – was compiled by the Mental Health Council of Australia and the University of Sydney’s Brain and Mind Research Institute, in association with the Human Rights and Equal Opportunity Commission

The hefty tome describes thousands of cases of service delivery failures, accounts of lives devastated by institutional neglect, suicides and the grief of families left behind – and calls for an overhaul of the mental health system for the 20% of Australians who will suffer mental illness at some time in their lives.

There’s the case of a young man who had been admitted to hospital hallucinating and in a psychotic state, but the doctor discharged him, diagnosing ‘homesickness’ despite his mother’s desperate pleas that her son was very sick. After being discharged, he killed his friend. He was placed in Long Bay gaol. No psychiatric assessment was conducted nor any mental health care delivered, even though he appeared to be in a psychotic state. He hung himself in his cell. ‘I would like to know why he was failed by three government departments. How did this happen?’ asks his mother.

NSWNA Assistant General Secretary Judith Kiejda said, ‘This is an important report that documents issues with the mental health system that nurses have consistently raised over a number of years.

‘Governments have applied a cut-price approach to mental health care and this report describes the impact of this.’

The Not for Service report identifies a lack of respect for people with mental illness, poor resources and inadequate facilities – underpinned by numerous reports of reduced safety within mental health care services – as the core failings of mental health system.

It calls for urgent action by all governments to work together and commit to a process of genuine and adequately resourced reform, with recognition that mental health reform is a national priority

Real and sustained increases in over-all funding for mental health services are needed over the next five years so that expenditure on mental health will be equivalent to 12% of total health care funding.

It recommends that funding to NGO service providers should be significantly increased from a national average of 6% to around 15% of mental health funding. It argues NGOs are the most effective at delivering many crucial mental health services.

It also called for governments to recognise the need for urgent action to address the declining morale and chronic skills shortages in the mental health workforce.

‘The greatest nursing shortage is in the area of mental health,’ said Judith.

‘It is a demoralising, stressful and distressing situation to be working with patients who are suffering and receiving inadequate or inappropriate care due to inadequate funding.’

Co-author of the report, Ian Hickie, Professor of Psychiatry and Executive Director of the Brain and Mind Research Institute, University of Sydney, said: ‘What we do not need is continued blaming of those who use the services, those professionals who provide the services of those independent bodies who report on them.

‘A continuation of this culture of blame will only worsen the workforce crisis in public sector mental health services,’ he said.

Damning report no surprise to mental health nurses

Suzi Neufeld, CNS at Camperdown Community Health Centre, said the report is no surprise to nurses working in the mental health sector.

‘We’re working in ridiculously understaffed circumstances.

‘Actually, it’s a relief that the situation has been made public. Nurses working in mental heath sector are always under pressure, working above and beyond the roles they are employed to do.

‘They are up against angry relatives who want more done for their sick relatives.

‘We are the meat in the sandwich between patients and their families and services with no funds.

‘It’s difficult and frustrating work. More funding is needed at the acute and community care ends,’ she said.

Suzi explained that the waiting lists for case managers at her service are getting longer.

‘The service is unable to fill vacancies for case managers so existing staff suffer heavy workloads and are under constant pressure. The crisis team is taking on the role of case managers because of the nurse shortages.

‘In the meantime, while people are waiting for services or receiving inadequate care, they are getting sicker.

Suzi said the nurses at the Camperdown Community Health Centre are fantastic at managing pressure, juggling workloads, and doing overtime ‘because there’s no one else to do the job’.

‘We do it for the patients. Just because we do it, doesn’t mean we should be working like this, nor is it right.’

Abbott ‘welcome to mental health system’

The Not for Service report and the systemic failures it describes received widespread media coverage at the time of the launch in October – especially the threat of a federal takeover of the mental health sector touted by federal Minister for Health Tony Abbott.

You’re welcome to it, said NSW Health Minister John Hatzistergos. ‘If Mr Abbott is serious about this proposal he should put his money where his month is. If he can guarantee that the federal government will provide more resources and better services, then NSW will not stand in his way.

Premier Morris Iemma backed the NSW Health Minister and
called for a national summit on mental health.

‘If Mr Abbott is serious about this proposal he should put his money where his mouth is.’
NSW Health Minister John Hatzistergos