#79 We must provide better care for mental health patients
28 May 2019
I am a pretty optimistic person. I think the job that I have is incredibly rewarding, but can also be incredibly draining. What keeps me going is the people I work with; the team in my emergency department, but also the enormous team of dedicated doctors, nurses, PSAs and clerical staff who rock up to work every day, 24 hours a day, to keep our emergency departments, the coalface of public health, accessible to all people who need care, when they need it.
Being part of a team keeps us all going. We look forward to working together, combining our strengths and skills; tackling anything that comes our way. Determination. Tick. Compassion. Tick. Support. Tick. It is in our DNA.
Drawing strength from this optimism, I want to make a difference in patients’ lives. We all do. So, when I arrive at work, before every shift I make it a habit to tell myself, “I can make a difference today. Whether it’s one patient, a family, a staff member, I have an opportunity to help people when they most need it”. What can be more rewarding than that?
Every patient who comes through the emergency department is looked after with the skill, care, professionalism and compassion you would expect from specialist doctors, trainees and nurses. But having spent more than 20 years in public hospitals across Melbourne and regional Victoria, I recognise one particular group of people who desperately need our help in providing better access to appropriate healthcare; those with mental health needs.
The care for these patients is being compromised because of the dysfunctional state of our mental health system. Patients come to emergency departments for help that they often can’t find elsewhere. We do our bit; triage, assess, address acute needs and involve specialist colleagues when needed. Many need admission, but that is often when things grind to a halt; patients wait in emergency departments for an inpatient bed often for hours and, in increasing numbers, for days.
They are in the wrong place. Staff are heartbroken in having to look after them in a sub-optimal environment. An environment that is unable to respond and cater for their needs in a timely way, unable to provide any semblance of a therapeutic environment to meet patients’ needs.
Every emergency department doctor in Victoria – across Australia, for that matter – can tell you a distressing story about how the health system is failing. The plight of Indigenous Australians and those living in rural and regional areas are particularly confronting. Each year, more than a quarter of a million Australians present to emergency departments seeking help for acute mental and behavioural conditions.
I have previously told my story about Nathan*. A kid who had an unimaginable, but all too common, history: abused by an uncle, his father had died when he was very young and his mother was drug addicted and on the streets. With a provisional diagnosis of borderline personality disorder, he would regularly come to the emergency department, but the care and attention we tried to provide was completely inadequate, though through no fault of any one individual. Anyway, this kept on happening over many visits until the visits stopped. News came through he had killed himself.
Colleagues tell of starting a shift and coming across a dishevelled patient, who has been in a trolley for days with no privacy, no dignity, and feeling guilty about not giving them the care and respect they deserve. Again, not because of a lack of compassion from staff, but because they are not supported by an adequately resourced system. Instead, it’s a system which is in a state of functional failure.
There are good days and bad days, as with any job. What I have described above is the bad; the despair. This is what drives many staff to the point of burnout; of questioning their choice of career. To ask people to provide acute, emergency care andhave to constantly fight against a system which isn’t providing the resources they need to carry out their job drives the best of us to the lowest point.
But the good, the hope, the cause for optimism is the will and actions of emergency department teams in fighting for what is right.
The College of which I am President, the Australasian College for Emergency Medicine (ACEM), has a commitment to maintain the highest standards of medical care for patients in emergency departments across Australia and New Zealand. We have been outspoken in calling for better patient care for the community’s most vulnerable people.
We have seen and heard from individuals and groups; those who have confronted poor patient outcomes, spoken up and been voices of change.
And the College, following a successful summit in Melbourne late last year that saw more than 170 emergency doctors, psychiatrists, consumers, clinicians and key decision-makers discuss and agree on key principles to tackle this mental health crisis, is working on a range of measures to address in a mental health consensus statement that we will use as a driver for change when we discuss these issues with state and territory health ministers.
I love the work that we do. The variety of patients, the amazing people you meet and the team I work with. But the team I want to build now, the team we all need to build so we can change the way we deliver care, goes way beyond the walls of any emergency department in the country. It needs all of us to understand our roles and have a common sense of purpose. That our job is to work together to make our system as good as it can be for the sake of our communities.
I’m seeing that happen, slowly but surely. That’s why I am optimistic that we will do better.
* Nathan is not his real name.
Dr Simon Judkins
Dr Simon Judkins has been a doctor for close to 30 years and has worked as an emergency physician for 22 of those. He has worked in emergency departments across Melbourne and regional Victoria. He is the President of the Australasian College for Emergency Medicine and a member of AMA Victoria.
This article appears in the April 2019 edition of Vicdoc magazine.