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Disability Rights: Not for Service - Report: Part 6_8

Not for Service: Experiences of injustice and despair in mental health care in Australia

PART SIX: ANALYSIS OF SUBMISSIONS AND FORUMS AGAINST THE NATIONAL STANDARDS FOR MENTAL HEALTH SERVICES

6.8 TASMANIA

ANALYSIS OF SUBMISSIONS AND CONSULTATIONS FROM TASMANIA AGAINST THE NATIONAL STANDARDS FOR MENTAL HEALTH SERVICES

In summary, information presented in this section was gathered from 14 submissions (see Appendix 8.3.8) and presentations made at a community forum attended by approximately 80 people (see Appendix 8.1). A draft copy of this report was sent to the Premier and Minister for Health for comment. An analysis of the response from the Tasmanian Government (reproduced in Appendix 8.4.8) and an overall review of mental health service delivery in Tasmania is contained in Part 2.7.8.

6.8.1 STANDARD 1: RIGHTS

The rights of people affected by mental disorders and/or mental health problems are upheld by the MHS.

Under this Standard, submissions and presentations indicate concerns about:

  • lack of access to advocates;
  • lack of access to interpreters;
  • lack of respect for patient dignity and right to least restrictive form of treatment; and
  • information not being provided to carers and families about mental illness, treatment and support services.

6.8.1.1 Lack of access to advocates

Advocacy Tasmania reported that until recently, access to advocates for consumers when they appeared before Mental Health Tribunals was rare despite the fact that the Mental Health Act grants such representation:

[T]he Tasmanian Mental Health Act 1996, s57, grants representation for people appearing before the Mental Health Tribunal in keeping with the United Nations Principles for the Protection of Persons with Mental Illness. Principle 18 states: "The patient shall be entitled to choose and appoint counsel to represent the patient, as such, including representation in any complaint or appeal". Until the Representation Project was commenced this had not happened ... Of 102 hearings held in 1999 / 2000 only 2 clients were represented.

(Advocacy Tasmania Inc - Mental Health Tribunal Representation Scheme, Tasmania, Submission #189)

This report also suggests that consumers are not being made aware that they have a right to have an independent advocate or support person with them at any time during their involvement with the MHS. Standard 1.6 states: 'Independent advocacy services and support persons are actively promoted by the MHS and consumers are made aware of their right to have an independent advocate or support person with them at any time during their involvement with the MHS'.

As stated by Advocacy Tasmania, lack of representation of people with mental illness has meant that some of the most disadvantaged people in our communities have not had a voice during hearings or may not have understood what was happening and hence been powerless to promote or protect their rights. The recent commencement of Mental Health Tribunal Representation Scheme has allowed consumers access to trained volunteer advocates when appearing before the Mental Health Review Tribunal, although it is suggested that continued funding and operation of the Scheme is not assured:

...a program that has commenced in Tasmania, which focuses on the rights of those with mental illnesses, and which has been very successful. This program is known as the Mental Health Tribunal Representation Scheme. The Scheme is where volunteers have offered to represent those people appearing before the Mental Health Tribunal in relation to the automatic review of the person's Continuing Care Orders. This relates to people who have been detained in a hospital against their will, during the past 28 days. Previously, these people, who we acknowledge as some of our most disadvantaged community members, have not been represented; they have not had a voice with which to be heard at their hearings. By this, it is meant that often such people have felt disadvantaged, misunderstood and not listened to. They also have often not understood what has been happening, or been said, to them at the Mental Health Tribunal hearing. They have been powerless. This demonstrates the potential for abuse, not only of these people's rights, but also of the legislation governing the rights of the mentally ill.

(Advocacy Tasmania Inc - Mental Health Tribunal Representation Scheme, Tasmania, Submission #189)

The Scheme is funded for the 2004/2005 year, but has not been guaranteed funding after that time. Advocacy Tasmania is currently seeking a commitment from the Tasmanian Government to continue to fund the Scheme in the future.

(Advocacy Tasmania Inc. - Mental Health Tribunal Representation Scheme, Tasmania, Submission #189)

6.8.1.2 Lack of access to interpreters

For people who speak a language other than English, access to mental health care can be complicated by language and cultural barriers. These barriers compound understandings of mental health services, mental disorders, mental health problems and available treatment and support services, and how to navigate the system. In many cases a person may be socially isolated or reluctant to have family or friends involved as carers or act as an interpreter for reasons of confidentiality or stigma. Concern was expressed that many consumers, the elderly in particular, from a non-English speaking background (NESB) are isolated in their homes and are not accessing services due to language and service delivery barriers. This could also indicate health promotion and prevention campaigns are not reaching people who do not speak English as they are not aware of their illness or services available, including the 'right of the consumer and their carers to have access to accredited interpreters' (Standard 1.7). This was highlighted by a service provider attending the Hobart Forum:

People are isolated in their houses and no one is coming to their homes. They can't express themselves and everyone is in a hurry.

(NESB and Ageing Worker, Tasmania, Hobart Forum #5)

This report could also indicate that staff who come into contact with these consumers are not spending sufficient time to discuss these issues or arrange an interpreter or are not aware of the consumers' right to have access to an interpreter.

6.8.1.3 Lack of respect for patient dignity and the right to the least restrictive form of treatment

One consumer at the Hobart forum raised concerns about practices involving seclusion and degrading treatment during their involvement with the MHS. The practices referred to in the following quote indicate that relevant legislation, regulations and instruments protecting the rights of people with mental illness or mental health problems are not being complied with in all cases (Standard 1.1).

I stayed in the Psychiatric Intensive Care Unit at the Royal Derwent Hospital ...There was no access to a toilet so I had to urinate in the corner of the room.

(Consumer, Tasmania, Hobart Forum #3)

6.8.1.4 Information not being provided to carers and families about mental illness, treatment and support services

Concern was expressed that carers and families were not receiving sufficient support and information about the illness or treatments available (Standard 1.8). For carers, information about the course of the illness and how they can best support their family member and access support for themselves is vital in achieving the best possible outcome for the consumer and minimising the impact of the illness on the family. The following quote indicates that this information is not always being provided:

There is a lack of education and support for families of people with a mental illness.

(Anonymous, Tasmania, Submission #254)

6.8.2 STANDARD 2: SAFETY

The activities and environment of the MHS are safe for consumers, carers, families, staff and the community.

Under this Standard, submissions and presentations indicate concerns about:

  • lack of policies and procedures in hospitals to ensure the safety of consumers, carers and the community upon discharge; and
  • lack of policies, procedures, resources and training to enable staff to respond safely to aggressive and difficult behaviours.

6.8.2.1 Lack of policies and procedures in hospitals to ensure the safety of consumers, carers and the community upon discharge

SANE Australia's Sane Mental Health Report 2004 noted under its "Bad News" section claims of abuse and neglect in the inpatient unit at Launceston Hospital:

When a system is under pressure, things start to go wrong ...a review of the Psychiatric Ward at Launceston Hospital is being undertaken by the Health Complaints Commissioner and the Nursing Board of Tasmania following claims of abuse and neglect.

(SANE Australia, National, Submission #302)

One consumer at the Hobart Forum also described the tragic consequences of her early discharge without an adequate risk assessment being undertaken or treatment and support services being organised prior to her exiting inpatient care and returning home:

They said it wasn't a positive thing for me to be there and I wasn't interviewed about my own safety so I went home and poured metho over myself and that's a much greater cost to the health system.

(Consumer, Tasmania, Hobart Forum #3)

The result for this consumer was complete disfigurement (extensive burns and scarring). This report suggests that policies, procedures and resources were not available to promote the safety of consumers (Standard 2.3) prior to discharge from the MHS to the community and was consistent with other evidence presented in submissions and at the community forum.

6.8.2.2 Lack of policies, procedures, resources and training to enable staff to respond safely to aggressive and difficult behaviour

Standard 2.4 states: 'Staff are regularly trained to understand and appropriately and safely respond to aggressive and other difficult behaviours'. Concern was expressed that staff may not be sufficiently trained to understand and safely respond to aggressive and other difficult behaviours. This could result in the unnecessary use of force to control situations and jeopardises the safety of the consumer, staff and other consumers in treatment settings.

Concern was also raised that staff are sometimes placed in potentially violent situations with no back-up systems in place (Standard 2.5). These concerns also suggest that policies (including occupational health and safety policy), procedures and resources are not available to promote the safety of consumers, carers, staff and the community (Standard 2.3):

There is a crisis in attracting all disciplines to work in Mental Health due to lack of support / training and poor working conditions and a lack of attractive career paths. This impacts on comprehensive care and there are recurrent safety issues due to Staff dealing with potentially violent and dangerous situations, sometimes without any back up.

(Anonymous, Tasmania, Submission #254)

6.8.3 STANDARD 3: CONSUMER AND CARER PARTICIPATION

Consumers and carers are involved in the planning, implementation and evaluation of the MHS.

Under this Standard, submissions and presentations indicate concerns about:

  • barriers to effective participation by consumers and carers; and
  • lack of meaningful consultation with consumers and carers.

6.8.3.1 Barriers to effective participation by consumers and carers

Concern was expressed that many staff lack the necessary knowledge and skills to allow consumers and carers to participate effectively. One consumer at the Hobart Forum stated that consumers are willing to contribute and have valuable information to offer, but that some staff need training in cooperation and consultation skills to enable consumers to contribute to service reform:

Let's celebrate us - we must stop apologising, use us, we are valuable but use us properly. Some psychiatrists have no idea how to cooperate with consumers or carers.

(Consumer, Tasmania, Hobart Forum #21)

Concern was also expressed that many consumers may not be aware that they have the opportunity to participate in the MHS (Standard 3.1) and that consumers and service providers may not have a shared understanding about what participation means (Standard 3.3). Both these factors would limit the potential contribution by consumers and carers in planning, implementing and evaluating the delivery of mental health services in order to makes services more responsive to the needs of consumers and the community:

...many consumers are unaware of their right to "participate". Many service providers do not have a shared understanding of the term consumer participation particularly with respect to WHO declaration of Alma-Ata. Participation is an ethical and democratic right and makes the services more responsive to the consumer needs.

(Anonymous, Tasmania, Submission #290)

6.8.3.2 Lack of meaningful consultation with consumers and carers

Associated with concerns expressed above were suggestions that other factors are inhibiting maximum participation by consumers and carers. These included: limited representation of consumer subgroups (Standard 3.6); lack of resources (Standard 3.4); lack of organisational commitment (Standard 3.2); fear of repercussions for speaking out during such activities; fears that privacy and confidentiality are not ensured (Standard 3.1); feelings that participation was tokenistic; and limited review and evaluation of participation processes (Standard 3.7):

It is still the case that dominant groups decide for consumers what kind of services should be provided, if any, without any meaningful consultations and when consumers are quite able to speak for themselves. This leads to a situation such as we have in Tasmania where consumers feel excluded and their different needs are overlooked or even worse dismissed. The anger and grief that results from such indifference then surfaces and very often labelling of those who complain then occurs.

(Anonymous, Tasmania, Submission #254)

There is a perception among consumers that more time and opportunities are given to consumers who are well, literate and not experiencing co-occurring disorders. Another concern is that consultation tends to focus on surveys, suggestion boxes and complaint forms.

(Anonymous, Tasmania, Submission #290)

To remove barriers to participation more resources need to be dedicated for consultation, organisational commitment and leadership and consumer participant.

(Anonymous, Tasmania, Submission #290)

I would like to submit to you the findings of a consultation with providers and consumers of mental health in the north and particularly in the Launceston area ...consultation with 40 consumers and 28 service providers to potential barriers to effective consumer participation...Barriers identified:

1. Limited participation opportunities and mechanisms

2. Consumer concerns regarding confidentiality and fear of repercussion

3. Consumer perception that their participation is not valued, [just] lip service

4. Limited awareness of consumer rights to participate

5. Limited shared agreement and understanding of effective consumer participation

6. limited consumer initiated participation

7. limited review and evaluation of effectiveness of participation methods

8. limited resources to begin, create or improve consumer participation methods

9. differing interpretation by consumers and service providers as to what constitutes appropriate feedback

(Anonymous, Tasmania , Submission #290)

6.8.4 STANDARD 4: PROMOTING COMMUNITY ACCEPTANCE

The MHS promotes community acceptance and the reduction of stigma for people affected by mental disorders and/or mental health problems.

Under this Standard, submissions and presentations indicate concerns about:

  • the high levels of stigma still prevalent within the community;
  • offensive remarks made by police and accident and emergency staff towards consumers;
  • exclusion by family members;
  • discrimination in the workplace; and,
  • activities to promote community acceptance of people with mental illness are not being supported.

6.8.4.1 High levels of stigma still prevalent within the community

Standard 4.1 states: 'The MHS works collaboratively with the defined community to initiate and participate in a range of activities designed to promote acceptance of people with mental disorders and/or mental health problems by reducing stigma in the community'. Consumers expressed concerns about the high level of stigma and ostracism still being experienced by people with mental illness, to the extent that the rights and needs of the people with mental illness who are homeless or in the criminal justice system are being ignored by society. These high levels of stigma would indicate that campaigns and activities to date to address community acceptance and reduce stigma have not been able to turn community attitudes around.

As described below, a lack of community acceptance is a key barrier to people with mental illness from accessing treatment and gaining employment or having a voice and thus being able to participate socially, economically and politically in society. The need for community education is evidenced by the following comments:

It is disgraceful that we don't do anything about the people on our streets or in our prisons - it's a bad reflection on our society.

(Consumer, Tasmania, Hobart Forum #21)

There is still a need for community education about mental illness to combat stigma and promote understanding of the needs of people with mental illness.

(Anonymous, Tasmania, Submission #254)

I'm a recovering alcoholic but as soon as I put that on the form I get excluded.

(Consumer, Tasmania, Hobart Forum #11)

6.8.4.2 Offensive remarks by police and accident and emergency staff

ARAFMI Hobart expressed concern about the lack of acceptance and understanding and discriminatory attitudes shown by police and emergency staff towards people with mental illness. This is of particular concern given that consumers in crises frequently come into contact with the police and staff in accident and emergency departments. Their views impact directly upon consumers, their carers and influences the attitudes held by other members of the community:

...that some police appear to be insulting people who appear to have obstreperous behaviour, using terms such as psycho for a young client of mine last week who does have mental illness and anger management problems & according to the client, a rather brutal take down, standing on his head for instance. Police need to have more MH education / training.

(ARAFMI Hobart, Tasmania, Submission #214)

Ditto for Accident & Emergency staff including medical heads of dept about personality disordered people in crisis. I was told personally by a medical head of DEM that 'they're arseholes', so imagine the working culture if that view is held at the top.

(ARAFMI Hobart, Tasmania, Submission #214)

6.8.4.3 Exclusion by family members

Consumers frequently expressed concern that not only does stigma and lack of understanding still shape community behaviour and result in the exclusion of people with mental illness in social and workplace settings, but that often this behaviour extends to close family members and intimate partners resulting in relationship breakdown:

The issue for me is stigma. I've been excluded from a couple of family functions since Christmas because of my behaviour and it's ended my relationship with someone I really love.

(Consumer, Tasmania, Hobart Forum #12)

6.8.4.4 Discrimination in the workplace

Being employed and working in a supportive workplace are seen as key factors in preventing relapse or deterioration of mental illness and essential in the process of rehabilitation and reintegration into society during the recovery phase. However, acceptance and understanding of mental illness seem to be lacking in the workplace and, according to one submission received, the perception is that if a history of mental illness or mental health problems is disclosed, this information will be used to the applicant's / employee's detriment. This suggests observance of Standard 4.2 is poor. Standard 4.2 states: 'The MHS provides understandable information to mainstream workers and the defined community about mental disorders and mental health problems'.

...the rejection letters...was it because [I] answered the question ...YES "Do you have a disability which is likely to last two years or more?" for this recovering alcoholic a Question like this one coupled with '(even if you personally have not been disadvantaged as a result of your disability)? Is VERY DANGEROUS STUFF ...Therefore you didn't get the Job because you told the Truth & how scary is that ... [Department of Health and Human Services Form ..."It is not intended that information in this form will be used in any decisions on appointments, promotions or transfers. The information will only be used to monitor and develop Workplace Diversity policy and programs.] (author's emphasis)

(Consumer, Tasmania, Submission #165)

...Commonwealth requirements for employment require people to identify whether they have been institutionalised or not because people are afraid to disclose.

(MP, Tasmania, Hobart Forum #2)

6.8.4.5 Activities to promote community acceptance of people with mental illness are not being supported

A submission by Cadence FM Inc. Community Radio and presentations by community radio providers at the Hobart Forum indicate concerns that activities that could be used to promote acceptance of people with mental illness and give people with mental illness a voice can be better supported. It was suggested that radio is an excellent medium to give people with mental illness a voice, promote acceptance and educate the community and that these activities are not occurring:

Lack of programs being hosted by people with a mental illness.

(Community Radio provider, Tasmania, Hobart Forum #6)

It is difficult for people with a mental illness to have a voice on radio.

(Community Radio Provider, Tasmania, Hobart Forum #7)

Cadence FM was uniquely placed supporting radio programmes for people with a mental disability. Our station commenced in 1997 entirely staffed by volunteer effort. A licence decision by the Australian Broadcasting Authority (ABA) in December of 2002, prevented our station continuing broadcast. Our submission is presented from first hand knowledge of the empowerment and benefit that broadcasting can bring to people with a mental disability. The aims of this submission are to address the ongoing rights of these people, to be heard.

(Cadence FM Inc, Community Radio, Tasmania, Submission #190)

We wrote letters to a number of stations representing each of these traditional broadcasting categories asking if they represented programmes hosted by people with a mental disability allowing for such programmes to be guided by persons with normal capacity. As of this submission date, none had replied affirmly ...The peak body representing Community Radio in Australia is the Community Broadcasting Association of Australia (CBAA). We looked at the CBAA website and searched for Mental Disability no entries were found. We searched for Mental Disability Radio programmes no entries were found.

(Cadence FM Inc, Community Radio, Tasmania, Submission #190)

There appear to be no broadcasting stations now in Australia extending effort to provide their facility for people with mental disability to directly host their own programmes, allowing for programmes to be assisted by a person with normal capacity.

(Cadence FM Inc, Community Radio, Tasmania, Submission #190)

There are only a few programmes on Radio dedicating airtime to understanding mental health containing interviews, involvement and actual care for the mentally disabled. These programmes deserve reward and attention to continue and develop yet more inclusive programming.

(Cadence FM Inc, Community Radio, Tasmania, Submission #190)

A number of programmes are presented with Community Health focus not necessarily contributed by persons with a mental disability in any manner, or embracing their actual needs. These programmes require reassessment to refine their aims where mental health is discussed.

(Cadence FM Inc, Community Radio, Tasmania, Submission #190)

6.8.5 STANDARD 5: PRIVACY AND CONFIDENTIALITY

The MHS ensures the privacy and confidentiality of consumers and carers.

Under this Standard, submissions and presentations indicate concerns about:

  • application of privacy and confidentiality rules without authority or failing to request permission from a consumer to share information or involve carers.

6.8.5.1 Application of privacy and confidentiality rules

Family carers indicate they have all responsibility but no rights. They are key players in caring for sick family members. The confidentiality / privacy act is an aberration. Carers observe a loved one's illness daily and can warn when episodes / relapses are imminent. Professionals deny themselves access to the wisdom of carers and hinder early diagnosis and accurate diagnosis.

(ARAFMI Tasmania, Tasmania, Submission #245)

Carers, carer advocates and a consumer advocate expressed concerns that a misunderstanding of policies and procedures to protect the confidentiality and privacy of consumers is impeding communication between consumers, carers and clinicians in the provision of treatment and the sharing of vital information. These concerns indicate that policies and procedures related to privacy and confidentiality are not being made available to consumers and carers in an understandable language and format (Standard 5.2) and that the mental health system is not encouraging and providing opportunities for consumers to involve others in their care (Standard 5.3). The following quotes indicate the level of frustration and despair experienced by carers:

We get a lot of calls from carers trying to get the person into care but the carer often isn't listened to and so valuable information isn't shared and this is done under the guise of the clinician is breeching the Privacy Act. The carers also need to know (from clinicians) how to respond to particular difficulties without / instead of just responding intuitively. The diagnosis itself isn't important - it's more the behaviours and how we should best respond.

(Carer Advocate, Tasmania, Hobart Forum #9)

There shouldn't be anything that the doctors can't disclose to carers. I think some doctors want to retain the power.

(Consumer Advocate, Tasmania, Hobart Forum #9)

Dual diagnosis. My life was in disarray when my wife was dealing with alcoholism and because of privacy I couldn't find out what was wrong with her.

(Carer, Husband, Tasmania, Hobart Forum #13)

My son disappeared. Centrelink couldn't tell me if they knew where he was.

(Carer, Mother, Tasmania, Hobart Forum #16)

6.8.6 STANDARD 6: PREVENTION AND MENTAL HEALTH PROMOTION

The MHS works with the defined community in prevention, early detection, early intervention and mental health promotion.

Under this Standard, submissions and presentations indicated concerns about:

  • the lack of focus on early intervention or prevention (reactive, crisis driven approach); and
  • the lack of rehabilitation programs.

6.8.6.1 Lack of focus on early intervention or prevention - reactive, crisis driven approach

Concern was expressed about the lack of focus on early intervention or prevention in the delivery of mental health services. This is reportedly occurring despite the rhetoric of 'capacity to identify and respond to the most vulnerable consumers in the community' (Standard 6.4), as early as possible (Standard 6.5), and that treatment and support is to occur in a community setting in preference to an institutional setting (Standard 6.6):

Burden of care on families. Department of Health documents specifically confirm that "families of people who need rehabilitation and find it hard to access are also disadvantaged themselves as a result". Government reports state that "earlier rehabilitation and the hope and purpose it generates are important for families who have to support a member long tern with resultant family stress and economic disadvantage."

(Sue Napier, MHA, Liberal Shadow Minister for Health, Tasmania, Submission #261)

We simply don't have the community services to help people before they become acutely unwell.

(MP, Tasmania, Hobart Forum #25)

Services are currently reactive as opposed to proactive, which leads to a "Band-Aid" resolution of any crises or issues. Needs to be a focus on prevention and management instead.

(Anonymous, Tasmania, Submission #254)

The Tasmanian Suicide Prevention Steering Committee, in its Annual Report, notes the steady and substantial increase in suicide rates in Tasmania and identifies the need to focus on relapse prevention, and for greater community support. The Committee also raises concerns about the lack of intervention strategies and undiagnosed depression ...

(Sue Napier, MHA, Liberal Shadow Minister for Health, Tasmania, Submission #261)

These views can be contrasted with the positive progress reported in the Sane Mental Health Report 2004 for suicide prevention strategies:

Community and school education on suicide prevention has been well-implemented in the State, and has been widely praised.

(SANE Australia, National, Submission #302)

6.8.6.2 Lack of rehabilitation programs

Standard 6.8 states: 'The MHS ensures that the consumer has access to rehabilitation programs which aim to minimise psychiatric disability and prevent relapse'. Yet, similarly to above, concern was expressed that the mental health system places little emphasis on rehabilitation programs or other programs to prevent relapse or promote recovery and instead waits for a crisis to occur before responding:

The lack of ongoing rehabilitation programs also means that we see a lot of young people, especially, being discharged after treatment but then without the necessary support, quickly becoming unwell again and the cycle constantly being repeated.

(Carer, Mother, Tasmania, Submission #315)

Staff also describe a "Revolving Door Syndrome" where only short-term crises are dealt with and long-term structured support for clients is not obtainable.

(Anonymous, Tasmania, Submission #254)

Concern was also expressed by a carer that insufficient funding is being provided to support non-government organisations who are offering rehabilitation programs that are working well and meeting the needs of consumers. The lack of funding jeopardises the quality and sustainability of such programs:

I support a lady from Devonport. The only rehab program functioning well in Tasmania is the Richmond Fellowship but funding is abysmal.

(Carer, Tasmania, Hobart Forum #17)

6.8.7 STANDARD 7: CULTURAL AWARENESS

The MHS delivers non-discriminatory treatment and support which are sensitive to the social and cultural values of the consumer and the consumer's family and community.

No submissions or comments were received pertaining to this Standard.

6.8.8 STANDARD 8: INTEGRATION

6.8.8.1 Service Integration

The MHS is integrated and coordinated to provide a balanced mix of services which ensure continuity of care for the consumer.

Under this Standard, submissions and presentations indicate concerns about:

  • the chronic under-resourcing of mental health services resulting in an inability for consumers to access integrated and coordinated care.
6.8.8.1.1 Chronic under-resourcing of MHS resulting in an inability for consumers to access integrated and coordinated care

Concern was expressed regarding the shortage of clinical staff to provide the necessary treatment and support services to deliver integrated and coordinated care. This was reported by consumers trying to access care and service providers trying to organise referrals for treatment:

We live in Devonport, 30,000 population. We have one psychiatrist at the service one day a week. It's not enough! They are beautiful people but they are under resourced.

(Carer, Mother, Tasmania, Hobart Forum #15)

Limited psychiatrists in community team for clients to access. If a client misses an appointment they may not be able to have another appointment for several weeks.

(Colony 47, Tasmania, Submission #227)

A Consumer Survey, conducted in September 2003, found that 49% of respondents mentioned they had experienced barriers when attempting to access mental health rehabilitation services. The most common barriers identified were the long distances travelled to access services (29%), the necessity to have a case manager in order to participate (29%) and the long wait time incurred before entering such services (13%). Further, in that survey 24 consumers voiced their opinions about the negative aspects of current services, including 'there isn't enough resources and there is a lack of access to psychologists", 'the need for services to be offered on more days for a greater length of time', and 'the absence of staff'.

(Sue Napier, MHA, Liberal Shadow Minister for Health, Tasmania, Submission #261)

The Southern Tasmania GP Practice Division also report earlier in 2004 that 'due to overload in MHS generally, it can take up to three months for patients to receive CBT or case management' and "best practice would allow the CATT team to have a psychiatrist to attend on-site crises and review cases, but this is currently impossible. The team had a locum psychiatrist for 6 hours a week until recently. Now, they are waiting some months for another locum."

(Sue Napier, MHA, Liberal Shadow Minister for Health, Tasmania, Submission #261)

The Australian Nurses Federation have said their members are unable to deliver `the standards of care because of inappropriate resourcing and back-up in the mental health system.

(Sue Napier, MHA, Liberal Shadow Minister for Health, Tasmania, Submission #261)

The scarcity of staff and resources was also cited as the principle reason for fragmented service delivery and lack of cohesion between government and non-government service providers in the provision of holistic and integrated care:

Those reports state: "the lack of a definitive model of rehabilitation and of case management impacted on the clients who were not receiving adequate care as a consequence. The members were concerned that clients fell through the net by no one person taking overall coordination for the care of the client in the community".

(Sue Napier, MHA, Liberal Shadow Minister for Health, Tasmania, Submission #261)

The sector is currently very fragmented. Continuity of care between Government services and NGOs is difficult to maintain given the current restrictions of time and scarce resources.

(Anonymous, Tasmania, Submission #254)

These comments are backed by the Chair of the Mental Health Council of Tasmania who has publicly said that organisations such as Anglicare and Colony 47 were in urgent need of more funds for mobile counselling teams and group homes. "Demand for these services [is] now more than three times the level of services provided'.

(Sue Napier, MHA, Liberal Shadow Minister for Health, Tasmania, Submission #261)

Concern was also expressed about the lack of accessible information for clinicians and consumers to assist consumers who can not afford to pay for treatment in the private sector or who have complex needs (for example consumers who are homeless):

As service providers it is difficult to support clients to access special assistance from GP's regarding their mental health - in relation to involving them in coordinating care or being able to access programs such as the 'Integrated Care for Better Mental Health'. We know that there are additional services that are available - but that information is not in the public domain. This is less than helpful, particularly when working with clients who may be homeless and or transient and may not have a regular GP. These are scarce resources that people who are on income security payments need to have access to.

(Colony 47, Tasmania, Submission #227)

6.8.8.2 Integration within the health system

The MHS develops and maintains links with other health service providers at local, state and national levels to ensure specialised coordinated care and promote community integration for people with mental disorders and/or mental health problems.

No submissions or comments were received pertaining to this Standard.

6.8.8.3 Integration with other sectors

The MHS develops and maintains links with other sectors at local, state and national levels to ensure specialised coordinated care and promote community integration for people with mental disorders and/or mental health problems.

Under this Standard, submissions and presentations indicate concerns about:

  • housing and accommodation options;
  • home and community services;
  • employment;
  • lack of support from Centrelink; and
  • the need for a whole-of-government approach to tackle poverty and mental illness.
6.8.8.3.1 Housing and accommodation options

The lack of available housing and accommodation options for people with mental illness was repeatedly raised as a critical gap in the achievement of mental, physical and social well-being. Concerns were expressed that the lack of available supported accommodation or other accommodation options resulted in people becoming homeless or remaining in care for longer periods of time than necessary because there were no viable alternatives (see also stories described in Standard 11.4.B Supported Accommodation). Access to secure and safe accommodation is seen as an essential component in the process of reintegration into the community and improved mental health. The lack of available housing and accommodation options and the process of deinstitutionalisation and consequent lack of community services, have resulted in many people with mental illness becoming homeless; placed intolerable strain on families; and contributed to a decline in health and quality of life:

Accommodation is inadequate for crisis and long term demand.

(Colony 47, Tasmania, Submission #227)

Caroline House Hobart (which moved from its prime purpose as a women's shelter) to concentrate on offering medium to long term accommodation for women, is regularly (at least twice a week) contacted by hospitals, GPs, the police looking for short term accommodation for people needing to have their medication stabilised; those who are at risk of suicide should they return home - this request usually from a GP as the psychiatric wards are full.

(The Australian Family Association Tasmanian Branch, Tasmania, Submission # 263)

A major crisis exists in the supported accommodation area. Not only has there been very little growth in the number of beds available but also many of the previous options have disappeared.

(Anonymous, Tasmania, Submission #254)

Caroline House in southern Tasmania has five beds dedicated to mental health clients, and only accept referrals from mental health services. The service will not take referrals from transitional services, including SAAP services.

(Colony 47, Tasmania, Submission #227)

Our organisation wishes to stress the need for substantially more respite places, as against either acute care or long term assistance for those with a mental health problem and for their families.

(The Australian Family Association Tasmanian Branch, Tasmania, Submission # 263)

Multiple reports obtained from the Department of Health in Tasmania reveal "there is widespread agreements across the State that there is a lack of supported accommodation which inhibits rehabilitation for people who need stability and security when pursuing longer term rehabilitation goals" and "confirm the belief that there is a lack of supported accommodation choice in MHS supported accommodation".

(Sue Napier, MHA, Liberal Shadow Minister for Health, Tasmania, Submission #261)
6.8.8.3.2 Home and community services

The ineligibility of people with mental illness to qualify for Home and Community Care (HACC) services was described as an example of direct discrimination when compared with people with physical illness if both are unable to perform the same tasks of daily living. An inability to access HACC services makes it difficult, if not impossible, for some people with mental illness to continue or chose to live independently or adds additional strain to their parenting role:

Some support services such as some HCC programmes still discriminate against people with mental illnesses by denying them access to needed services for a range of reasons i.e. 1) lack of knowledge about mental illness and how to care for those effected 2) lack of understanding of their needs and the way in which certain conditions affect their ability to care for themselves, i.e. an attitude that a person is lazy when they lack the motivation to clean their home.

(Anonymous, Tasmania, Submission #254)
6.8.8.3.3 Employment

Access to welfare, the supported wage and finding suitable employment are all critical components in the process of social inclusion and living a meaningful life with dignity in the community. However, many concerns were raised regarding difficulties with the current welfare and employment systems and models to support consumers to gain employment and employers to alter their practices:

Governments must find a way to support & foster encouragement for folk who feel, that discrimination is directed at them because of their age (AGEism) or their addictive personality (alcohol / drugs). Often the bi-products are some form of mental illness. i.e. Depression ... We must try to convince Governments that they have no option but to FUND PROJECTS and try harder to persuade the system AND employers to change their habits / attitudes. (author's emphasis)

(Consumer, Tasmania, Submission #165)

This in turn feeds the Bureaucrats' fascination with "Recovery" which, again, sounds very noble but is used to justify withdrawal and denial of service to all those who are unable to assert themselves, thus achieving budget savings within the mutual obligation framework. Clinicians can be trusted to use "Recovery" concepts with fair expectations but anyone who has encountered a bean counter challenging the need for increased support in terms of it restricting a clients right to recovery will know the depths of cynicism that persists.

(Anonymous, Tasmania, Submission #254)
6.8.8.3.4 Lack of support from Centrelink

With limited access to mental health services, supported accommodation and access to early intervention treatment and support, the burden on families and carers to provide long-term and crisis support is immense. This often impacts on the financial income of the family by a reduced ability of carers to work. The shifting of care by governments to carers fails to recognise that carers are providing a significant cost-free service that is not being shouldered by the community. Concerns were raised with regard to the financial hardship experienced by carers due to the lack of services in the community to provide appropriate treatment and support to people with mental illness and/or mental health problems:

This nexus between poverty and serious mental illness extended to the lives of the carers. The task of caring for people with serious mental illness tends to fall heavily on their families, usually parents. This research highlights the high toll taken in terms of their health in addition to their social, emotional and financial wellbeing. The dollar cost of care is no measure of the real price of anxiety and grief expressed by carers, yet it is a significant and largely unmeasured impost on families. This report documents the real cost for carers of providing accommodation, food, clothing and support to people with serious mental illness. This significant cost remains largely hidden, picked up by carers, who, if they are themselves on a low fixed income, may be forced on to income support, emergency relief services, charities, and crisis accommodation services. In addition to the financial impost of caring, carers report a critical lack of support in the form of community-based services, clinical, counselling, information and respite options. In particular they identified the lack of appropriate supported accommodation which denied their adult son or daughter the chance to live a meaningful independent life.

(Anglicare Tasmania, "Thin Ice: Living with Serious Mental Illness and Poverty in Tasmania", Tasmania, Submission #144)
6.8.8.3.5 Whole-of-government approach - tackling poverty and mental illness

As a worker what I see is that poverty and mental health go hand-in-hand.

(Carer, Mother and NGO Service Provider, Tasmania, Hobart Forum #14)

Concern was expressed about the link between poverty and mental illness and the need for a whole-of-government approach to tackle the myriad layers of social, economic and personal disadvantage experienced by this group. The submission by Anglicare Tasmania "Thin Ice: Living with Serious Mental Illness and Poverty in Tasmania" outlines some of the issues to be addressed by cross-government approaches:

The research uncovered a disturbing cycle of poverty and ill-health for many people with serious mental illness in Tasmania. Participants reported patterns of unstable housing, food insecurity, with a heavy reliance on emergency relief agencies, inadequate clothing, and regular disconnections from essentials such as telephones and electricity. Access to services such as general practitioners, the public dental service and public transport is made difficult by issues of cost. Without adequate support in the community to manage their accommodation, their finances and the tasks of everyday living, many found the stress of trying to survive alone exacerbated the symptoms of their illness, often resulting in relapse and re-hospitalisation.

(Anglicare Tasmania, "Thin Ice: Living with Serious Mental Illness and Poverty in Tasmania", Tasmania, Submission #144)

Although representing a relatively small proportion of the population, approximately three percent, the social, economic and personal disadvantages experienced by this group are multiple and extreme.

(Anglicare Tasmania, "Thin Ice: Living with Serious Mental Illness and Poverty in Tasmania", Tasmania, Submission #144)

This report confirms that people with serious mental illness are among the most disadvantaged in the community. They face significant difficulties in finding and maintaining stable housing. They are often extremely socially isolated and face multiple barriers to participating in the community. A high proportion of people with serious mental illness are not able to study or find full-time employment and as a result the majority are dependent on government pensions or benefits as their sole source of income. Generally their physical health is much worse than the rest of the community.

(Anglicare Tasmania, "Thin Ice: Living with Serious Mental Illness and Poverty in Tasmania", Tasmania, Submission #144)

A number of emergent factors over the past decade have created a socio-political context that makes life very difficult for many people with serious mental illness. The size of this group is growing at a time of significant cutbacks in real terms in government expenditure to health and community services; there is a national crisis in the availability of affordable housing and the agenda of both mental health reform and welfare reform is pushing towards greater social independence and individual financial autonomy. As a result people with serious mental illness are increasingly reliant on under-resourced carers in the community, either family or non-government support services.

(Anglicare Tasmania, "Thin Ice: Living with Serious Mental Illness and Poverty in Tasmania", Tasmania, Submission #144)

6.8.9 STANDARD 9: SERVICE DEVELOPMENT

The MHS is managed effectively and efficiently to facilitate the delivery of coordinated and integrated services.

Under this Standard, submissions and presentations indicate concerns about:

  • the current state of mental health services in Tasmania;
  • lack of resources to support community based care following deinstitutionalisation;
  • lack of funding;
  • lack of staff and the impact this has on staff work practices;
  • staff recruitment and retention issues;
  • lack of education and training of workforce;
  • training programs for GPs;
  • lack of consultation with consumers staff and NGO service providers in the planning and delivery of services;
  • management and accountability problems; and
  • the need for more research.

6.8.9.1 Concerns about the current state of mental health services in Tasmania

The majority of submissions and presentations at forums conveyed feelings of anger that since the Burdekin Report and the closure of institutions and promise of community care, services have been seriously declining and deteriorating rather than any noteworthy improvements to improve service delivery or protect the rights of consumers. The following quotes highlight these problems:

The momentum built around Burdekin but then it fizzled away.

(Consumer, Tasmania, Hobart Forum #21)

I have been a consumer since 1995. I have had some particularly bad experiences. I think the move away from institutional care was a good one but no resources in the community.

(Consumer, Tasmania, Hobart Forum #3)

I've been associated with RD [Royal Derwent] Hospital for 50 years. What I have noticed since 5 years ago is that they have been closing down services.

(NESB & Ageing Worker, Tasmania, Hobart Forum #5)

Funding for mental health is the Cinderella in health and funding for NGO's is the worst of the worst.

(Carer, Tasmania, Hobart Forum #17)

That the government is having a review of mental health services is great but people are falling through the cracks now.

(MP, Tasmania, Hobart Forum #25)

But at present there is no where to send such people should they need a place to stay.

(The Australian Family Association Tasmanian Branch, Tasmania, Submission # 263)

The dream of closing psychiatric institutions and moving towards community based care has turned into a nightmare. Community care is under resourced and integrated services are lacking. Too many people are denied treatment and slip through the gaps.

(ARAFMI Tasmania, Tasmania, Submission #245)

Thin Ice is an examination of the failure of systems to support people with serious mental illness. It outlines how this systems failure ultimately makes people sick and forces them into the costly acute care sector. The conclusion of the report is the urgent need for an increased range and supply of support services in the community to support people and assist recovery.

(Anglicare Tasmania, Tasmania, Submission #144)

Documents obtained through FOI - the State Government's Rehabilitation Plan (dated 29/8/03) - states that "coherent infrastructure and processes to address clinical issues, operational issues and provide transparent systems of entry, exit and follow-up for clients is not there. It is urgent that these issues are addressed."

(Sue Napier, MHA, Liberal Shadow Minister for Health, Tasmania, Submission #261)

The Tasmanian Council of Social Services in its 2004 pre-Budget submission told the State Government that "mental health continues to be the poor relation of health services, with people with a mental health problem often left unsupported and without adequate services".

(Sue Napier, MHA, Liberal Shadow Minister for Health, Tasmania, Submission #261)

6.8.9.2 Lack of resources to support community based care following deinstitutionalisation

The lack of community based services across Tasmania was reported extensively in most submissions and at the community consultation in Hobart. As discussed in more detail later in this report (see particularly Standard 11.4, Treatment and Support), the lack of community based services to deliver treatment and support throughout the course of the illness to prevent a crisis, or to assist with recovery and prevent relapse, was reported across Tasmania.

In particular, the following services were noted as lacking: services in rural and regional areas; child and adolescent services; services for the elderly; and supported accommodation. This would indicate that planning is not occurring 'through a process of consultation with staff, consumers, carers, other appropriate service providers and the defined community' (Standard 9.8) and that resources are not being allocated 'in a manner which follow the consumer and allows the MHS to respond promptly to the changing needs of the defined community' (Standard 9.15). The following comments describe the extent of need and current limited capacity to respond due to lack of resources:

There was never enough funding to support the move from institutions to community based care. Very little funding for ongoing support followed the clients into the community. Mostly their needs were expected to be absorbed by the existing community resources. This placed enormous stress on the community sector in terms of accommodation, support services and Staff. While the policy, undoubtedly, had its merits, some people with mental illness and their families were left unsupported in the community, and without a range of meaningful activities to occupy their time. Some clients preferred the asylum that the old facilities had to offer. With the exit from the hospitals also went much of the State's responsibility to care for those most vulnerable. There is nowhere to go if a safe place is needed for any length of time.

(Anonymous, Tasmania, Submission #254)

Mental health services have been successfully mainstreamed in Tasmania, but the system remains severely under-resourced.

(SANE Australia, National, Submission #302)

The mental health sector understands the pressing need for a comprehensive range of support services in the community. Policies specifically address the benefits of clinical and social support in the community to ensure the wellbeing of people with mental illness. Nonetheless there is no commensurate commitment in funding from governments at either the State or Commonwealth level, and the system of community support fails for the lack of resources. Specifically, the expenditure on mental health services represents only 5.6% of state health expenditure; the Tasmanian Government funded financial administration service for people under guardianship has the highest client costs in Australia; co-payments to the public dental services have recently been increased; funding to carer and community support services is woefully inadequate and proposed changes to the income support system appears set to drive people with serious mental illness further into stress and poverty.

(Anglicare Tasmania, "Thin Ice: Living with Serious Mental Illness and Poverty in Tasmania", Tasmania, Submission #144)

Mrs Napier said as well as increased community-based support, and long-term strategic planning, the State Government's package must include better discharge procedures to ensure that people with mental illness who do present to hospital, and are then released, have support mechanisms in the community to prevent them falling into a situation where they require repeat hospitalisation.

(Media Release, Sue Napier, MHA, Shadow Minister for Health, 13 October 2004, Tasmania, Submission #261)

'Projectitis' funding is rampant now, one year's funding for a new project that is then expected to self sustain for the future but no Gov Dept wants to fund ongoing new services to meet rising need.

(ARAFMI Hobart, Tasmania, Submission #214)

6.8.9.3 Lack of funding

Concern was expressed that insufficient funding had been allocated to mental health within the overall health budget to meet the needs of people with mental illness and that their needs will continue to be neglected in comparison people with physical illness while this deficit continues. Concern was also expressed that continual budget cuts and lack of funding to community based care had further reduced the quality of mental health services. This indicates the level and model of funding needs to change in order that appropriate services are delivered and the rights of people with mental illness are protected. These concerns suggest resources were not being allocated to reflect national mental health policies (Standard 9.14) or in manner which allows the MHS to respond promptly to the changing needs of the defined community (Standard 9.15). The lack of funding was cited as a concern for both government services and services provided by non-government organisations:

Deinstitutionalisation has not failed. What has failed is the political will to fund essential support services in the community. The existing services are overwhelmed by the heavy demand they currently face and they are not able to provide the level of care and support required to assist recovery. This lack of support options dramatically increases the hardships faced by people who have a mental illness and their families, in terms of their health and their budgets. Ultimately, it is a failure of systems which is making people sick and forcing them into the costly acute care sector.

(Anglicare Tasmania, "Thin Ice: Living with Serious Mental Illness and Poverty in Tasmania", Tasmania, Submission #144)

Neglect of the mentally ill will continue until Mental Health is seen as a legitimate component of public health. It is vital that Mental Health not remain the poor relation attracting less than 7% of the health budget. Implementing mental health reform is an investment not an expense.

(ARAFMI Tasmania, Tasmania, Submission #245)

The ability of Mental Health Services to deliver quality care has been severely restricted by continual budget cuts and the lack of funding to community services.

(Anonymous, Tasmania, Submission #254)

The Mental Health Council of Tasmania has called for the State Government to increase its funding on mental health services to represent 12% of the total health budget within the next five years. The Council has said "there are no savings to be obtained from neglecting this issue, only a transfer of the burden to other health, correctional justice and community service systems".

(Sue Napier, MHA, Liberal Shadow Minister for Health, Tasmania, Submission #261)

A colleague is running 7 groups. Participation growing at a rate of knots - there's an increase in demand but no increase in funding. I'm a group facilitator, PR, receptionist. State Government funding is about $53,000 per year.

(NGO Service Provider, Tasmania, Hobart Forum #19)

Both government and private sector services are finding themselves having to band-aid the gaps in services, which takes them away from their core business.

(Anonymous, Tasmania, Submission #254)

Documents obtained through Freedom of Information show Departmental reports and plans dating back to 2001, which clearly spell out the service gaps, yet despite this, no meaningful increase in funding in corresponding budgetary years occurred.

(Sue Napier, MHA, Liberal Shadow Minister for Health, Tasmania, Submission #261)

While the mental health budget increased by $1.9 million to $63.8 million in 2004-05, this still represents less than 6% of State health expenditure, and services suffer accordingly. (Tasmanians concerned about services contrasted this increase with grants of $26.5 million to prop up the horseracing industry.)

(SANE Australia, National, Submission #302)

Community services provided by non-government organisations are poorly funded, leading to a shortage of supported accommodation, rehabilitation, and support for carers.

(SANE Australia, National, Submission #302)

6.8.9.4 Lack of staff and the impact this has on staff work practices

As mentioned previously concern was expressed about insufficient staff numbers and resources to ensure the delivery of quality treatment and integrated and coordinated support to consumers and their carers. Feelings of burnout were reported as a result of staff shortage, and as also mentioned earlier in this Report (Standard 2 - Safety). Lack of staff also raises safety concerns for consumers and staff. High caseloads and decreased opportunities were also mentioned as areas of concern:

There is not only a need for bricks and mortar but more importantly there is the need for staff - not necessarily as stated earlier - staff trained to a high professional level but the staff must be able to offer twenty-four hours a day seven days a week supervision.

(The Australian Family Association Tasmanian Branch, Tasmania, Submission # 263)

Additional staffing has been made available for CAT (Crisis and Treatment) Teams which are now available in the north as well as the south of the Island, although not around-the-clock in all locations.

(SANE Australia, National, Submission #302)

There is a shortage of psychiatrists.

(Anonymous, Tasmania, Submission #254)

Day workers are currently not replaced, unless they are absent for three or more weeks. This puts further pressure on teams and creates an inability to deliver quality service. It also results in "burnout" for Staff having to increase their workload and difficulties getting relief Staff.

(Anonymous, Tasmania, Submission #254)

Staff do not have opportunities for supervision and debriefing, due to the workload.

(Anonymous, Tasmania, Submission #254)

More "outreach" workers have been employed but their case loads are beyond what can reasonably be coped with then several of their clients are experiencing severe bouts of illness. At present, such clients deteriorate to the extent that they then need acute care in a hospital setting. Earlier intervention in a respite situation with access to professional care plus supervision by staff, familiar with their needs but not necessarily fully trained professionals would be quite appropriate and less costly.

(The Australian Family Association Tasmanian Branch, Tasmania, Submission # 263)

High case loads for community Mental Health teams for example Gavitt House, Bellerive Centre. Clients in the past state that they get to spend very little time with their case worker.

(Colony 47, Tasmania, Submission #227)

6.8.9.5 Staff recruitment and retention issues

Concerns were expressed with regard to the ability of under-resourced services to retain current staff and successfully recruit new and experienced staff:

I don't think the acute services people should be blamed. We are losing the staff we have. Ward 1 is a huge problem.

(MP, Tasmania, Hobart Forum #25)

There is a crisis in attracting all disciplines to work in Mental Health due to lack of support / training and poor working conditions and a lack of attractive career paths.

(Anonymous, Tasmania, Submission #254)

Filling of positions here also seems to take an incredibly long time, with one currently outstanding for over a year.

(Carer, Mother, Tasmania, Submission #315)

Can't attract psychiatrists to North West, though can get one from ethnic background but difficult for our consumers to understand.

(NGO Worker, Tasmania, Hobart Forum #18)

The retention and recruitment of workers in mental health is also a problem. One former employee wrote to us: "I left the Mental Health in September 2003 (in the North-West), my old position was advertised only last week (April 2004). It will take 12 weeks to complete the recruitment cycle, if it runs smoothly. 11 months to fill a vacancy - a critical front line position" ...

(Sue Napier, MHA, Liberal Shadow Minister for Health, Tasmania, Submission #261)

6.8.9.6 Lack of education and training of workforce

Concern was expressed that due to staff shortages, services are often unable to release staff to attend training or professional development based on identified needs (Standard 9.17) or funding is not available to pay for training or replacement staff:

While Mental Health policies promote the need for furthering the skill level of Staff the reality is that they are often unable to attend such training due to: (1) the lack of funding to do so or (2) the lack of replacement Staff in the agency.

(Anonymous, Tasmania, Submission #254)

6.8.9.7 Training programs for GPs

With regards to mental health training for general practitioners, one general practitioner noted concerns with the lack of committed funding to ensure the continued delivery of such programs. It was suggested that the 'stop-start approach' had the potential to jeopardise completion of such programs and impede the delivery of improved treatment and support by general practitioners to consumers and their carers in the community:

I am writing as a mental health education provider. The mental health program in the North West Tasmania Division of General Practice has been very active with good GP participation. Unfortunately at this time of year, while giving lip service to funding for mental health programs, neither the State Govt or Federal Govt have said what the funding will be for the forthcoming 12 months. As a result, the programs have largely ground to a halt. This stop-start approach is not helpful to the community as a whole, to the GPs or to the program managers and educators attempting to deliver on-going education to the GPs. This is disappointing, as the mental health programs in NW Tasmania have been some of the most successful and well-attended by GPs in Australia. I feel that while the spirit of government is willing (I applaud that), the practicalities are weak.

(General Practitioner, Tasmania, Submission #111)

The Federal government has already commenced some good moves in addressing the mental health problems e.g. the training of GPs in becoming more expert in handling patients so afflicted.

(The Australian Family Association Tasmanian Branch, Tasmania, Submission # 263)

6.8.9.8 Lack of consultation with consumers, staff and NGO service providers in the planning and delivery of services

Concern was expressed that consumers, staff and NGO service providers are not being consulted about key changes to service delivery. As a result staff confidence in management and morale has plummeted. For NGO service providers, associated with concerns about an inability to contribute in a positive manner to service improvement, were concerns about speaking up and consequent withdrawal of funding. Standard 9.8 states: 'The strategic plan is developed and reviewed through a process of consultation with staff, consumers, carers, other appropriate service providers and the defined community'. However, as the following quotes from one extensive submission highlight, this was not occurring at some services:

As funding decreases, NGO services have been reluctant to speak up about the current crisis and their lack of resources due to the fear of having what little funding they have cut even further.

(Anonymous, Tasmania, Submission #254)

During the last four years there has been a lack of acknowledgement and even denial of the developing crisis in Mental Health. Staff and consumers have continually warned of the consequences of some of Managements decisions. Some of the major issues the Mental Health Services were warned about prior to the redevelopment of Royal Derwent Hospital were: - (1) The underestimation of the number of beds needed in the new development (2) The configuration and locations of some of the new establishments were in some cases not appropriate for the needs of the proposed client groups (3) There were too few inpatient beds to provide for the needs of the existing client group much less any increased need. (4) There was no extra provision made for support services for clients who moved back into the community in terms of ADL support or supported accommodation.

(Anonymous, Tasmania, Submission #254)

Staff confidence in senior management involved in the redevelopment is at an all time low due to their refusal to listen to grass roots workers, consumers and carers. Front line continue to be pressured to provide more with less, services are fragmented, Staff are burning out, and positions are vacant for long periods due to the appalling pressure and conditions.

(Anonymous, Tasmania, Submission #254)

Some Mental Health Services Managers in Tasmania have reframed any attempt to change the system as "misinformed" or "nefarious". Consumers, carers, Staff and concerned members of the community have therefore been forced to take to the streets to have their voices heard.

(Anonymous, Tasmania, Submission #254)

There is a perception and fear that funding will be threatened if an individual or organisation speaks out. Many NGO volunteers make enormous contributions with a pittance of funding from Mental Health volunteers.

(Anonymous, Tasmania, Submission #254)

6.8.9.9 Management and accountability problems

Failure to ensure accountability jeopardises protection of rights of people with mental illness and delivery of quality care. Concern was expressed regarding the lack of accountability and the lack of resources to implement policies (Standard 9.2). Problems with accountability also impedes the resolution of complaints and inhibits processes which allow for continuous quality improvement to ensure the best outcomes for consumers, carers and the community as indicated by the following comments:

At the same time the constant struggle to achieve best practice has been fraught with difficulties against a backdrop of increased accountability and devolution of administrative duties to clinical Staff. We have wonderful policies but no resources to implement them.

(Anonymous, Tasmania, Submission #254)

For the Mental Health system in Tasmania to improve the system has to change. Those who wield the power need to take responsibility for their decisions and the outcomes of those decisions. They need to stop trying to silence those who complain and to engage in open and honest dialogue and shared projects identified by those who have an interest in developing them.

(Anonymous, Tasmania, Submission #254)

Our Political leaders may have achieved fine ends in terms of our economy but they have been ruthless in the cost that they have been willing to impose on others esp. the mentally ill, to achieve this. Their actions have been ably supported by the senior management in Mental Health who have been negligent in their advocacy for the people they have been charged to care for. It is interesting to note how many of those individuals have been successfully promoted for their efforts.

(Anonymous, Tasmania, Submission #254)

6.8.9.10 More research needed

Concern was expressed at the Hobart Forum that more funding needs to be allocated to research (Standard 9.31) to determine the rise in mental illness in the community (Standard 9.30):

I am appalled at the increase in mental illness in the community but there seems to be a real lack of research in this area.

(Carer, Mother, Tasmania, Hobart Forum #4)

We are also informed that "there seems to be no knowledge of the extent of mental illness in Tasmania, nor the level of unmet need. Records are kept, but only at the ground level and generally not collated."

(Sue Napier, MHA, Liberal Shadow Minister for Health, Tasmania, Submission #261)

6.8.10 STANDARD 10: DOCUMENTATION

Clinical activities and service development activities are documented to assist in the delivery of care and in the management of services.

Under this Standard, submissions and presentations indicate concerns about:

  • the data collected to assist in the delivery of care and management of services.

6.8.10.1 Problems with the data collected and its usefulness in the delivery of care and management of services

Concern was expressed about current data collection methods and tools used. Specifically, concern was raised about the extent to which the data provides valuable information to guide the appropriate delivery of care to consumers or the identification of systemic issues to assist with decisions to improve service delivery. Concern was also raised about lack of action when systemic issues have been identified:

There has been a failure to address issues identified by current Mental Health reporting. There has been no commitment to instigate long-term change when gaps have been identified. Lots of ideas - very little action.

(Anonymous, Tasmania, Submission #254)

Management Key Performance Indicators (KPIs) are disconnected from what clients identify as their needs. For example, management regard the rate of people that are discharged from a service 'throughput' as a significant KPI. However, this notion not only does not reflect client feedback about what they consider to be a measure of success but actually creates fear in some clients. Anyway, what does throughput tell you about client satisfaction or if their needs were actually met? This type of KPI encourages the revolving door syndrome. Opposition to these mindless directions have led to derogatory comments i.e. "creating dependence," Instead, clients have identified that the time they spend well (i.e. out of hospital) is a more appropriate KPI. The pressure on inpatient beds forces hospital Staff to discharge clients early, often before they are well enough. This practice puts clients at risk and increases the pressure on the overstretched community resources.

(Anonymous, Tasmania, Submission #254)

There is an obvious lack of consultation between management and clients or those who advocate for clients. What happened to the client-focused approach? There is no reliable data collection program as yet, despite the time spent by clinicians collecting information. Decisions appear to be made based on economic rather than clinical reasons.

(Anonymous, Tasmania, Submission #254)

6.8.11 STANDARD 11: DELIVERY OF CARE

Principles guiding the delivery of care: The care, treatment and support delivered by the mental health service is guided by: choice; social, cultural and developmental context; continuous and coordinated care; comprehensive care; individual care; least restriction.

Under this global Standard outlining the principles underlying care, one consumer spoke of the fragility of the 'whole package of treatment and support' needed to promote and protect the rights of people with mental illness to participate socially and economically in the community. This consumer outlined the marked improvements in her life since the Burdekin Report and deinstitutionalisation through community based treatment, and access to educational programs and employment, and the threat to this posed by changes to her treatment choices:

I'm a person with a severe mental illness and I appeared before the Burdekin Inquiry many years ago. Following the inquiry I got an education and part-time employment. About a year ago there was a very strong rumour that I cannot legally be prescribed certain drugs. It seems to me that if deinstitutionalisation is to work then medications need to work.

(Consumer, Tasmania, Hobart Forum #8)

6.8.11.1 Access

The MHS is accessible to the defined community.

Under this Standard, submissions and presentations indicate concerns about:

  • inability to access services during a crisis;
  • lack of access to treatment resulting in entry into the criminal justice system;
  • lack of access to treatment and support for people diagnosed with personality disorders; and,
  • lack of access to psychologists for those who cannot afford to purchase care in the private sector.

Problems with access to treatment and support services, both within the community and inpatient care, resulted in a whole series of rights being infringed for consumers, carers and the community. Consumers reported that as a result of these infringements, a range of consequences occurred, such as increasing disability and hence consequent inability to care for oneself or others, barriers to participating socially or work or study, in some cases, the potential for harm to self or others, incarceration, and becoming homeless and poor.

Similarly, increased burdens on carers disrupted their ability to participate socially and work when their family member became increasingly ill and required increasing care. When unable to access care for their family member, the mental health of carers also suffered. Increasing disability also exposed the consumer and their family to discrimination and social exclusion. This often resulted in the further deterioration of the consumers' mental illness. For consumers in rural and smaller regional areas, their inability to access care often required long trips to metropolitan or large regional centres and social dislocation if hospitalisation was also required.

6.8.11.1.1 Inability to access services during a crisis

A constant theme throughout many submissions was not only an inability to access services when needed throughout the course of illness, but that access was also difficult when consumers were experiencing a crisis or at risk of self harm or harm to others. This stands in contrast to Standards 11.1.2 ('the community to be served is defined, its needs regularly identified and services are planned and delivered to meet those needs') and 11.1.4 ('the MHS is available on a 24 hour basis, 7 days per week'). Lengthy delays in emergency departments were experienced with inappropriate treatment and support being given or organised:

When unwell we travel to Burnie for hospital treatment. Here the problems are similar with lack of doctors as well as number of available beds being critical issues. The admittance to hospital for mental cases also badly needs reviewing. Currently, even though previous episodes are well documented, distraught and in crisis patients (and family members) must wait in the emergency department to see a resident doctor before admission. This frequently takes hours.

(Carer, Mother, Tasmania, Submission #315)

One pressing issue applies to people in the acute system don't have the resources or capacity to deal with the people who need care, who have been referred by CAT teams.

(MP, Tasmania, Hobart Forum #25)

Shadow Health Minister Sue Napier said the number of people with mental illnesses presenting to hospital emergency departments was a tragic demonstration of how badly existing services were failing the community.

(Media Release, Sue Napier, MHA, Shadow Minister for Health, 13 October 2004, Tasmania,
Submission #261)

Figures contained in response to a Question on Notice placed by the State Liberals reveal that only half of the 2642 people presenting to Emergency Departments were admitted in the first nine months of the 2003 / 04 financial year.

(Media Release, Sue Napier, MHA, Shadow Minister for Health, 13 October 2004, Tasmania,
Submission #261)

The inadequate resourcing of the non-government sector - and the fantastic people who work in the area - can be summed up by these comments (letters to the Liberals in 2004):

"I spent the early part of yesterday evening providing crisis counselling to a man contemplating killing himself. The man had been referred to (a non-Government agency) by another professional because they could not get an appointment for him at Mental Health Services in the North-West and did not know what to do. I could have said we were closed, not funded to provide this service or referred him on. Instead I listened to him and his despair and helped him tease out his options. In my own time ..."

(Sue Napier, MHA, Liberal Shadow Minister for Health, Tasmania , Submission #261)

The State Liberals have heard from many consumers, families and mental health workers / supporters about the revolving door of hospitalisation for many with a mental illness in the State. One worker in the non-government sector put it like this:

"What happens is this: because mental illness is episodic in nature, when a person with a mental illness has an episode, police are called to escort that person down to the local emergency sector of the hospital. Because of bed shortages, people are often not admitted and police spend several hours waiting with them in Emergency waiting rooms. Then comes the issue of finding them a bed for the night. Often they cannot go back to their own homes (if they're lucky enough to have them) so the police do the ring-around of emergency crisis accommodation and if there's nothing to be found (which is often the case) they go into a hotel for the night using State Government brokerage funding. Quite often the police are called back to the hotel again during the night. Police effectively have become mental health babysitters".

(Sue Napier, MHA, Liberal Shadow Minister for Health, Tasmania , Submission #261)
6.8.11.1.2 Lack of access to treatment resulting in entry into the criminal justice system

ARAFMI Tasmania expressed concern regarding the increasing number of people with mental illness ending up in the criminal justice system due to the inability of mental health services to respond to people needing to access treatment and support services. Submissions and presentations pointed to an inability to access services when needed, which in some instances resulted in consumers entering the criminal justice system because of their deteriorating and untreated mental illness. The failure of services to respond and intervene in these instances has had the regrettable outcome of consumers being incarcerated because of the consequences of their untreated illness and the right to safety of the community being infringed and, in extreme cases, homicide:

As psychiatric services struggle to respond to the needs of the mentally ill the criminal justice system becomes a substitute. Prisons are now accommodation for more mentally ill people. How many will remain incorrectly diagnosed and return to the community without psychiatric treatment? Adolescents detained in Ashley detention centre present with mental health issues. The criminal justice system is a bleak future for their young lives.

(ARAFMI Tasmania, Tasmania, Submission #245)
6.8.11.1.3 Lack of access to treatment and support for people diagnosed with personality disorders

One consumer expressed concern regarding the difficulties faced by people with Borderline Personality Disorder when seeking treatment and their pleas for help have been ignored:

I suffer from Borderline Personality Disorder - real lack of access to treatment and my pleas for help have been ignored.

(Consumer, Tasmania, Hobart Forum #3)
6.8.11.1.4 Equity - lack of access to psychologists for those who cannot afford to purchase care in the private sector

While access to mental health services is assumed regardless of socio-economic status (Standard 11.1.1), ARAFMI Tasmania expressed concern that access to psychologists is not routinely an option for consumers living in Tasmania. If consumers required access to psychologists, these services were only available in the private sector, and scarce. This would prohibit people who could not afford to pay for such services in receiving the treatment they require. ARAFMI Tasmania described this situation as 'immoral':

The Burdekin report stated that "restriction to access to psychologists results in important treatment options being denied to many individuals affected by mental illness and that the lack of access is incompatible with human rights and is economically unsound". It seems immoral that in 2004 clinical psychologists are not routinely available to people suffering mental disorders.

(ARAFMI Tasmania, Tasmania, Submission #245)

6.8.11.2 Entry

The process of entry to the MHS meets the needs of the defined community and facilitates timely and ongoing assessment.

Under this Standard, submissions and presentations indicate concerns about:

  • the long wait times with entry via emergency departments and the lack of appropriately qualified mental health professionals.
6.8.11.2.1 Long wait times with entry via emergency departments and lack of appropriately qualified mental health professionals

Standard 11.2.4 states: 'The entry process to the MHS can be undertaken in a variety of ways which are sensitive to the needs of the consumer, their carers and the defined community'. Concerns were expressed about entry via hospital emergency departments including problems with the assessment process and consumers having to repeat their stories many times even though their history is documented with the service. Notes to this Standard state that this process should be non-traumatic and non-damaging. Concern was also expressed that often appropriately qualified mental health professionals are not available, in contravention of Standard 11.2.6:

For an emergency you'd go to the hospital at Burnie and sit there for however long it takes. You've always got to go through casualty before you get into the service - even though he has a long history of mental illness. Then he sees a registrar who knows nothing about mental illness.

(Carer, Mother, Tasmania, Hobart Forum #15)

6.8.11.3 Assessment and review

Consumers and their carers receive a comprehensive, timely and accurate assessment and a regular review of progress.

Under this Standard, submissions and presentations indicate concerns about:

  • assessment problems for children and youth under the age of 18; and
  • large staff caseloads.
6.8.11.3.1 Assessment problems for children and youth under the age of 18 with mental illness and/or mental health problems

Concern was expressed regarding the difficulty in obtaining proper assessments for children and youth under the age of 18. This could be due to the lack of child and adolescent services (Standards 11.3.1 and 11.4.3) and appropriate methods and tools not being available to assess this age group (Standard 11.3.6):

[T]he inability to get proper assessments for children under the age of 18.

(MP, Tasmania, Hobart Forum #25)
6.8.11.3.2 Large staff caseloads

As mentioned previously (Standard 9: Service Development) many submissions acknowledged that the failure to deliver quality treatment and support services was not the fault of individual staff but more related to broader systemic issues such as large caseloads, management of work and overall lack of resources that restricted the ability of clinicians to deliver timely and accessible quality care. The following quote indicates that services may not be routinely 'monitoring of staff case loads in terms of number and mix of cases, frequency of contact and outcomes of care' (Standard 11.3.19):

Case managers carry large caseloads and I understand that these can be in excess of 70/80 with some even over 100 clients. The majority of the focus is crisis centred which leaves very little time for the other much-needed issues.

(Carer, Mother, Tasmania, Submission #315)

6.8.11.4 Treatment and support

The defined community has access to a range of high quality mental health treatment and support services.

The thing that concerns me most is that moral judgements are made about our illness and used to exclude us from treatments, yet we are told that our illnesses are like diabetes but no one with diabetes is told to just convince themselves to fix their insulin levels.

(Consumer, Tasmania, Hobart Forum #21)

Under this Standard, submissions and presentations indicate concerns about:

  • lack of treatment and support services only available when in a crisis;
  • lack of services for people living in rural and regional areas;
  • lack of services for children and youth;
  • lack of services for people with dual diagnosis - mental illness and drug and alcohol;
  • difficulties for consumers from a non-English speaking background (NESB);
  • lack of services for people diagnosed with personality disorders;
  • lack of treatment and support services for consumers who are homeless; and
  • lack of forensic care in separate facilities.
6.8.11.4.1 Lack of treatment and support services only available when in crisis

Many consumers and carers expressed feelings of frustration at being unable to access any treatment or support services from the MHS in metropolitan, rural and regional areas. This included the whole spectrum of interventions throughout the course of illness and recovery regardless of age and stage of development (Standard 11.4.3), stage in the recovery process (Standard 11.4.4), presence of diagnosis (Standard 11.4.7) and which address 'the physical, social, cultural, emotional, spiritual, gender and lifestyle aspects of the consumer' (Standard 11.4.6).

Reports that services were not available until the consumer's health had deteriorated to the point requiring hospitalisation need to be considered in light of reports that access was often not possible even when the consumer had reached crisis point (Standard 11.4.10). Concern was expressed that this pattern of service delivery led to consumers continuously being readmitted to hospital with no long-term structured support to assist with recovery and prevention:

The Mental Health Act fails to deal with community treatment and only really provides for acute intervention. The client has to fall over completely before they are eligible for help, that is, the Act does not help unless that client is in crisis.

(Anonymous, Tasmania, Submission #254)

Staff also describe a "Revolving Door Syndrome" where only short-term crises are dealt with and long-term structured support for clients is not obtainable.

(Anonymous, Tasmania, Submission #254)

Mrs Napier said the lack of support services in the community for people with mental illness created a shocking merry-go-round. "The lack of support services in the community means people's health deteriorates to such an extent that they then require emergency hospital treatment," Mrs Napier said.

(Media Release, Sue Napier, MHA, Shadow Minister for Health, 13 October 2004, Tasmania,

Submission #261)

6.8.11.4.2 Lack of services for people living in rural and regional areas

Standard 11.1.5 states: 'The MHS ensures effective equitable access to services for each person in the defined community'. Concerns were expressed regarding problems with access to services in rural and regional areas. For people living in many areas of Tasmania there were no services which were convenient and local. Reports also indicated a lack of accommodation options in these areas and a lack of rehabilitation services and recreational and vocational programs. Delivery of care for many consumers effectively meant delivery of inpatient care some distance away and being isolated from social and support networks during this period:

There is a lack of community outreach to rural areas and for specific programs such as child and adolescent, forensic. The focus is on inpatient care rather than community support

(Anonymous, Tasmania, Submission #254)

People in rural and isolated areas have very little access to services due to the shortage of appropriately trained Staff allocated to rural teams

(Anonymous, Tasmania, Submission #254)

My son (33) has severe schizophrenia. We are from the North West Coast and we have a real lack of services, accommodation. There is nowhere that my son can go apart from home. There is a lack of rehab and recreational services. I see people going into hospital and then coming out but no support in community so they end up back in hospital. There is nothing for him to do to keep him occupied.

(Carer, Mother, Tasmania, Hobart Forum #15)

Documents obtained through FOI show that the State Government had been aware for some time of "lack of services for the rural population". Reports state that "for rural consumers, there is no access to MHS rehabilitation outside of Launceston and Hobart" and "inconsistency with access and equity to rehabilitation services between the north and south rehabilitation services", there was "no access to rehabilitation e.g. Midlands area, Burnie and West Coast. In the south, the East Coast, Huon and Oatlands has no rehabilitation MHS local services. There are insufficient resources for the provision of a specialist rehabilitation team to work outside of the Launceston region" and "most access to MHS rehabilitation is very limited or non-existent outside of urban areas".

(Sue Napier, MHA, Liberal Shadow Minister for Health, Tasmania, Submission #261)

Documents obtained through FOI point to a consumer survey conducted in 2002 which indicated that 29% of respondents said that having to travel a long distance in order to access rehabilitation services was a barrier for them (Project Management Plan v. 1.4 dated 20 September 2002 regarding rehabilitation planning for 2002).

(Sue Napier, MHA, Liberal Shadow Minister for Health, Tasmania, Submission #261)
6.8.11.4.3 Lack of services for children and youth

Standard 11.4.3 ensures access to a 'comprehensive range of treatment and support services which are, wherever possible, specialised in regard to a person's age and stage of development'. Carers expressed concern at the paucity of services for children and youth and indicated that adult services were inappropriate to fill the gap. In particular, concern was expressed that services for children and youth need to be broader in their approach than treatment just for 'mental illness' as other mental health problems and life crises were generally associated with this age group:

Parents have difficulty accessing limited child psychiatrists and psychologists for their disturbed youngsters. Adult facilities are inappropriate, overburdened and inaccessible. Early intervention and accurate diagnosis, stressed as priorities in the National Mental Health Plan 2003 - 2008, remain as rhetoric instead of reality.

(ARAFMI Tasmania, Tasmania, Submission #245)

I have 2 teenagers who self-harm. It's very hard to understand and hard to get care. When we have sought care the service providers say 'they don't want help, bring them back when they want help'. Why are so many girls self-harming and having eating disorders?

(Carer, Mother and NGO Service Provider, Tasmania, Hobart Forum #14)

Young people with mental health and substance use issues have no specific programs/facilities for early intervention or long-term recovery. This group have no appropriate accommodation options in the community.

(Anonymous, Tasmania, Submission #254)

Inpatient facilities for young people are nonexistent and they are placed in the general children's ward or in adult facilities.

(Anonymous, Tasmania, Submission #254)
6.8.11.4.4 Lack of services for people with dual diagnosis - mental illness and drug and alcohol

Standard 11.4.7 states: 'The MHS ensures access to a comprehensive range of services which are, wherever possible, specialised in regard to dual diagnosis'. Concern was expressed that there were an insufficient number of such services to provide treatment and support either directly or in dual management with alcohol and other drug services to these consumers with complex needs. As the following quotes highlight these consumers continuously 'fall between the gaps':

There are no services that deal specifically with mental illness and drug and alcohol problems, or abuse and emotional control issues. These groups are put into the "too hard" basket and fall through the cracks in service provision. People with these issues have specific needs and thus require a separate service with specialist Staff.

(Anonymous, Tasmania, Submission #254)

Young people with mental health and substance use issues have no specific programs / facilities for early intervention or long-term recovery. This group have no appropriate accommodation options in the community

(Anonymous, Tasmania, Submission #254)

People with co-existing mental health / drug and alcohol also fall between the gaps. Mental health services in the past state that they are unable to work with these people and often referrals are made to Alcohol and Drug services. The reverse can occur from A&D services.

(Colony 47, Tasmania, Submission #227)

Services are lacking to help consumers, of all ages, with combined drug addiction and mental illness. Drug and alcohol services and psychiatric services still work in isolation. This causes additional trauma to the sick person and families.

(ARAFMI Tasmania, Tasmania, Submission #245)

The State has a particular need for specialised services, for people with a dual diagnosis of mental illness and a drug or alcohol problem, for example. Frequent liaison problems between drug and alcohol services and mental health services were reported in Tasmania.

(SANE Australia, National, Submission #302)
6.8.11.4.5 Difficulties for consumers from a non-English speaking background (NESB) in accessing treatment and support

Concerns were expressed that consumers from a NESB are experiencing difficulties in accessing appropriate treatment and support services and that due to language and cultural barriers, these consumers are 'isolated in their houses' (Standard 11.4.8):

People are isolated in their houses and no one is coming to their homes. They can't express themselves and everyone is in a hurry.

(NESB & Ageing Worker, Tasmania, Hobart Forum #5)
6.8.11.4.6 Lack of services for people diagnosed with personality disorders

Concerns were raised about the lack of treatment and support services for people with personality disorder and that problems associated with the disorder are not being recognised or acknowledged by some clinicians and services. The carer reported that treatment programs are available in other states but not in Tasmania, and that lobbying for these has not resulted in these therapies being made available. The devastating consequences of services failing to provide adequate treatment and support for people with Borderline Personality Disorders was recounted by one consumer:

My early release from PCU [Psychiatric Intensive Care Unit] led to my current disfigurement [extensive burns and scarring]. I was positively excluded from care because I self harm a lot. They said it wasn't a positive thing for me to be there and I wasn't interviewed about my own safely so I went home and poured metho over myself and that's a much greater cost to the health system.

(Consumer, Tasmania, Hobart Forum #3)

People who have a personality disorder are rarely treated by mental health services due to this condition not being identified as a mental illness. People with a personality disorder/s often fall between service delivery gaps and due to their behaviour, at times their housing and mental health / well being needs are not met.

(Colony 47, Tasmania, Submission #227)

Programs in Sydney more helpful than here. I've been to the Minister here and others asking for different therapies but they're not available.

(Carer, Mother, Tasmania, Hobart Forum #4)
6.8.11.4.7 Lack of treatment and support services for consumers who are homeless

Standard 11.4.6 states: 'The MHS ensure access to a comprehensive range of treatment and support services which address physical, social, cultural, emotional, spiritual, gender and lifestyle aspects of the consumer'. Concerns were expressed regarding the lack of treatment and support services for consumers who are homeless. The increasing number of people who are homeless and who have a mental illness and/or mental health problems has also risen with deinstitutionalisation and the subsequent lack of community based treatment and support services to meet the community's needs.

One mother described her frustration at trying to organise support for her son who had become homeless. She was horrified at the response she had been given by mental health services and Centrelink when they said to her: 'how do you know he needs help if you don't live with him?'. Problems regarding the lack of supported accommodation and services to provide structured support and follow-up to this group were identified as follows:

Clients who most often "fall through the gaps". People who are: Homeless; Take prescribed medication.

(Colony 47, Tasmania, Submission #227)

My son was contacted by a social worker who found him in Devonport. He wouldn't speak to anyone in the family, he was completely isolated. The Caravan Park kicked him out and he ended up in a tent in the bush, then moved on by the police. Many years later I was informed that my son's pension was cut off because he hadn't returned his forms. My husband passed away and left him some money so I sent him the cheque, but he didn't cash it. When I contacted Centrelink again I pleaded with them to go and see him. He was scared of meeting people. He snuck out at closing time to get his groceries. Centrelink and the mental health service couldn't do anything for him. They said to me 'how do you know he needs help if you don't live with him?' At Easter the shop keeper noticed my son hadn't been in the shop for a number of days so he called the hospital and they went out and found my son who couldn't get out of bed with leg ulcers, dehydration. He was very ill and was taken to hospital. I saw him twice in the hospital but I didn't recognise him as the son I knew.

(Carer, Mother, Tasmania, Hobart Forum #16)

The issues some of these people may face

•  Unable to access medication due to homelessness or take erratically
•  Vulnerable and stressed
•  No structured support
•  Limited or no accommodation options to match needs.

(Colony 47, Tasmania , Submission #227)

Hobart has few places where the homeless can shower or wash their clothes if they don't have any money or have been banned from the few places that provide this type of service.

(Anonymous, Tasmania, Submission #254)
6.8.11.4.8 Lack of forensic care in separate facilities

Standard 11.4.7 states: 'The MHS ensures access to a comprehensive range of treatment and support services which are, wherever possible, specialised in regard to ...consumers who are subject to the criminal justice system'. Concern was expressed regarding the lack of separate facilities to provide treatment and support to people with mental illness or mental health problems who have become subject to the criminal justice system. In the absence of separate forensic facilities housing of these consumers with the general prison population was described as an inappropriate environment in which to receive treatment and support:

People who have been found guilty of crimes by reason of insanity are still being housed in prisons because there is no secure facility to treat them.

(Anonymous, Tasmania, Submission #254)

It should have been good news that Tasmania has started work a new forensic hospital, but this is now being built within the Risdon Vale prison grounds. As in NSW, this co-location sends a clear message to the community that the patients are effectively 'prison inmates' with all that that implies about culpability and punishment - regardless of which Department actually administers the Secure Mental Health Unit when it opens in 2005.

(SANE Australia, National, Submission #302)

6.8.11.4.A Community living

The MHS provides consumers with access to a range of treatment and support programs which maximise the consumer's quality of community living.

Under this Standard, submissions and presentations indicate concerns about:

  • lack of treatment and support services to maximise consumer's quality of living in the community;
  • lack of access to family centred approaches;
  • lack of support for children of parents with mental illness;
  • lack of vocational programs and employment opportunities; and,
  • lack of recreational, social and rehabilitation programs.
6.8.11.4.A.1 Lack of treatment and support services to maximise consumer's quality of living in the community

The aim of deinstitutionalisation was to provide treatment and support in the least restrictive setting, which for most people means living in the community. However, as described above (Standard 11.4 - Treatment and Support), concerns have been expressed that the necessary treatment and support services and effective systems have not materialised. This is true for both people with serious mental illness living in the community and people who, as a consequence of failure to access treatment and support services at the onset of illness, develop significant disability and require additional community support services to live independently or with their family. The reality being experienced by consumers and carers after being discharged from acute care is revealed by the following account by a carer:

The thing I found is that once he walked out the door of the MHS no one cared about him or what happened to him ... He got very depressed, very ill and became very violent. He broke someone's arm and was arrested and taken to the hospital. They said he was okay and released him with no shoes, no where to go and blood all over him. I spoke to the Dr and [X] died 10 days later - he jumped. There are so many suiciding. Nobody to help me. I should have had more help, I couldn't do it ...Everybody like that needs someone to care for them.

(Carer, Tasmania, Hobart Forum #22)

The overwhelming conclusion from this research is the urgent need for an increased range and supply of support services to assist people with serious mental illness and their families to live successfully in the community.

(Anglicare Tasmania, "Thin Ice: Living with Serious Mental Illness and Poverty in Tasmania", Tasmania, Submission #144)

In addition to the financial impost of caring, carers report a critical lack of support in the form of community-based services, clinical, counselling, information and respite options.

(Anglicare Tasmania, "Thin Ice: Living with Serious Mental Illness and Poverty in Tasmania", Tasmania, Submission #144)

In summary I feel the main factors inhibiting the provision of effective mental health care on the North-West coast of Tasmania are: a critical lack of trained, competent staff both in treatment and rehabilitation areas , an urgent need for increased activity and rehabilitation programs, and the lack of professional support available to affected families ...

(Carer, Mother, Tasmania, Submission #315)
6.8.11.4.A.2 Lack of access to family centred approaches

Standard 11.4.A.11 states: 'The consumer has the opportunity to strengthen their valued relationships through the treatment and support effected by the MHS'. Standard 11.4.A.12 states 'The MHS ensures that the consumer and their family have access to a range of family-centred approaches to treatment and support'. However, many reports were received from carers and NGO service providers describing the incredible strain that is being experienced by families. In particular, the lack of access to family-centred approaches was repeatedly mentioned. Also, the lack of access to other support services for the consumer and the family (e.g. respite, leisure, recreation, education, training, work, employment, home and community care) also contributed to this. Of most serious concern was a report regarding the lack of support provided to single parents with mental illness, often resulting in the removal of the children causing further distress to the children and the parent:

Single parents with a mental illness have very little help (if any) to care for their children and are usually forced to put them into state care. Sometimes the children are split up causing further trauma to both the parent and the children

(Anonymous, Tasmania, Submission #254)

There is a lack of education and support for families of people with a mental illness.

(Anonymous, Tasmania, Submission #254)

There is a severe lack of services that support families, especially packages to keep families in their own home.

(Anonymous, Tasmania, Submission #254)

I work primarily with boys and their families. Many of our client's families have mental health problems and it's very difficult to get help for their family.

(NGO Service Provider, Tasmania, Hobart Forum #20)

I found it very difficult in the early stages of [X]'s illness particularly to get information - it was suggested to me that I should go and see a psychologist. I think communications is so important. We need back up for the whole family.

(Carer, Mother, Tasmania, Hobart Forum #4)

Bi-Polar disorder is often difficult to treat. We have six children, three boys and three girls, and these illnesses have a ripple effect on them ... I've found there's been little support for me as well. Found out about a camp for them and that's great but only part time worker. Mediation between parents if one has a mental illness is very difficult. She has spent time in and out of hospital for rehab - it's something I have to deal with too. I get depressed, no one explained the term bi-polar to me.

(Carer, Husband, Tasmania, Hobart Forum #13)

[O]ur eldest son was diagnosed with OCD and found the bottle. Our son found activities through AA. He was a high achiever until he became ill and then it all fell apart. I felt very guilty as a mother. I thought 'what have I done?' The professionals also tried to help our family. I didn't feel understood by the counsellors. It was only through AA that I felt understood and supported. Our family is now divided. The first two children are unemployed. The eldest is completely broken. She's 44 and she has not had 1 single offer of a job even after being on Job Search.

(Carer, Mother, Tasmania, Hobart Forum #16)
6.8.11.4.A.3 Lack of support for children of parents with mental illness

Standard 11.4.A.12 states: 'The MHS ensures that the family has access to a range of family centred approaches to treatment and support'. The notes to this standard refer to ' ...support for children of parents with a mental disorder'.

Concern was expressed regarding the lack of support being provided to children of parents with mental illness both while the parent is receiving treatment and support while living at home and as an inpatient. Specifically concerns were expressed that support is not being provided to minimise the impact on children, about children having trouble with attending school, completing homework and lacking overall family support. This jeopardises educational achievement and risks negative life outcomes for these children as indicated by these reports:

Especially vulnerable are the children who are being cared for by parents with a mental illness. Should the parent (quite often the mother) be admitted to hospital then the children need either a person to come into the home to "take over" the normal household chores. Too often, there is a single parent involved. As one such parent stated "a holistic in-home help in the real life environment of the family home is of much greater value than "counselling" in an office environment.

(The Australian Family Association Tasmanian Branch, Tasmania, Submission # 263)

One child whose mum has a mental illness can't get to school and has requested to be placed in care. But nowhere for him to go - no help with homework. Also had problems with the CAT team who fobbed off as behaviour problems.

(NGO Service Provider, Tasmania, Hobart Forum #20)
6.8.11.4.A.4 Lack of vocational programs and employment opportunities

Access to education, training, work and employment programs are seen as critical for consumers to live in the community with opportunities to participate socially and economically. Concerns were expressed regarding the lack of access to a wide variety of programs, activities and agencies to maximise the consumer's success in these endeavours (see Standards 11.4.A4-9). Concern was also expressed that these programs and employment opportunities are scarce in Tasmania and generally only offered to consumers who are 'high functioning':

Throughput and allowing "fair access" to all clients, means that those who need much longer training and support time, as well as much lower expectations, are excluded and doomed to fail with recurrent loss of self-esteem. This structural approach almost guarantees the clients will self identify with failure in the face of all the noble rhetoric about empowerment. This in turn feeds the Bureaucrats' fascination with "Recovery" which, again, sounds very noble but is used to justify withdrawal and denial of service to all those who are unable to assert themselves, thus achieving budget savings within the mutual obligation framework.

(Anonymous, Tasmania, Submission #254)

Employment services that advocate for people with mental illness are scarce. They don't seem interested in putting in the effort unless clients are very high functioning (Few get jobs).

(Anonymous, Tasmania, Submission #254)
6.8.11.4.A.5 Lack of recreational, social and rehabilitation programs

Despite Standard 11.4.A.4, which states: 'The MHS ensures that the consumer has access to an appropriate range of agencies, programs and/or interventions to meet their needs for leisure, recreation, education, training, work, accommodation and employment', consumers in the community are described as bored and having little opportunity to develop social and employment skills. This points to a lack of lack programs to meet needs for leisure, recreation and rehabilitation. Access to such programs is seen as critical for consumers to reintegrate and live in the community and carers and consumers reported the benefits from involvement and access to such programs. One carer described the spiralling negative consequences that resulted from their son being excluded from a recreational program due to lack of funding:

The lack of ongoing rehabilitation programs also means that we see a lot of young people, especially, being discharged after treatment but then without the necessary support, quickly becoming unwell again and the cycle constantly being repeated.

(Carer, Mother, Tasmania, Submission #315)

Apart from accommodation our biggest problem is the lack of recreation and rehabilitation programs available. [X] struggles at the best of times with no real motivation to do much at all and this coupled with constant tiredness leaves him incredibly bored for most of the time ... There have been a couple of programs run over the last year by the Richmond Fellowship of Tasmania Inc During these [X] would get to go out with the group twice a week. Not only did he really enjoy it and looked forward to it, but it was beneficial for him ... the 'Kicking Goals Program' ... the rapport he has built up with the coordinator has made such a difference to his behaviour and to our family unit.

(Carer, Mother, Tasmania, Submission #315)

He had support through Eureka. He looked forward to it - he did it for 2 years then they told him he had to stop because there wasn't enough funding and someone else had to have a go. He got very depressed, very ill and became very violent. He broke someone's arm and was arrested and taken to the hospital.

(Carer, Tasmania, Hobart Forum #22)

Eureka Clubhouse - I love that place and what they have done for me. I have friends but not many friends; I have 2 boys who have stuck by me.

(Consumer, Tasmania, Hobart Forum #1)

Richmond Fellowship has been great but due to the lack of funding their programs are ending. Once a week, for a full hour, a lady from RF comes and picks up my son and others and they do activities. Myself, my husband and my family don't know enough about programs or education to help ordinary people to cope. You lose your life looking after someone who is that disabled.

(Carer, Mother, Tasmania, Hobart Forum #15)

Further Department of Health reports state there is "not enough activities for people with long-term needs - e.g. social needs. Longer-term meaningful activity is necessary through social groups, recreational groups, work skills groups, which aim to target stress, boredom and increase socialisation".

(Sue Napier, MHA, Liberal Shadow Minister for Health, Tasmania, Submission #261)

6.8.11.4.B Supported accommodation

Supported accommodation is provided and/or supported in a manner which promotes choice, safety, and maximum possible quality of life for the consumer.

Under this Standard, submissions and presentations indicate concerns about the:

  • lack of supported accommodation;
  • need for interim and step-down accommodations options;
  • lack of respite options; and,
  • lack of respite options for parents with mental illness who have children.
6.8.11.4.B.1 Lack of supported accommodation

As noted previously in this Report (8.3 Integration), the lack of housing and accommodation options, and supported accommodation options in particular, for people with mental illness is a serious barrier to consumers attaining the 'maximum possible quality of life' and integrating and contributing to the community. Many consumers who could not access supported accommodation returned to live with their families, and many became homeless, complicating access to treatment and support and increasing their chances of entry into the criminal justice system. Overall, numerous submissions and presentations at the Hobart Forum spoke of the need to increase the range of options and number of places available to protect the rights of people with mental illness and those of their families and carers:

In addition to the financial impost of caring, carers report a critical lack of support in the form of community-based services, clinical, counselling, information and respite options. In particular they identified the lack of appropriate supported accommodation which denied their adult son or daughter the chance to live a meaningful independent life.

(Anglicare Tasmania, "Thin Ice: Living with Serious Mental Illness and Poverty in Tasmania", Tasmania, Submission #144)

There is very little supported accommodation ...I recently left a 50 year old man in a hotel room with a bed and a wardrobe. It's so humiliating for me to leave him there so how did he feel. There are models that work - for example, a cluster system.

(NGO Worker, Tasmania, Hobart Forum #18)

I would like to see some supported accommodation that has someone to help with cooking and tasks and social comfort. Someone to check on medications. My son can never remember whether he's taken his medication. I'd like one of those as soon as possible. He was sick for a couple of years before he was diagnosed - he's been sick for 10 years.

(Carer, Mother, Tasmania, Hobart Forum #15)

There is a lack of different models of supported accommodation.

(Anonymous, Tasmania, Submission #254)

Consumers are only consulted in a tokenistic way. When they have been consulted and have reached agreement about plans often they find that the bureaucracy has changed their plans. Mostly their identified needs are denied and they are told what they can have.

(Anonymous, Tasmania, Submission #254)

Gaps in long-term tenancy support for clients with mental health issues.

(Colony 47, Tasmania, Submission #227)

Duty of care issues for clients who present as "unwell" at transitional services for accommodation, including SAAP services. May not be able to be accommodated appropriately to match the level of support required.

(Colony 47, Tasmania, Submission #227)

...son [X], who was diagnosed with schizophrenia some 10 years ago. His condition is such that he requires a supported environment to ensure he has the basics of life and in the absence of this type of accommodation anywhere on the coast, he lives at home with my husband and I. While this is far from satisfactory for both [X] and ourselves we are currently coping.

(Carer, Mother, Tasmania, Submission #315)

We have considered arranging alternative accommodation for our son, possibly even in partnership with other Devonport families, with the idea of sourcing staff who could assist with his / their care. However there are not the people in the area with the necessary skills and certainly not in the number that would be required to successfully run such a place / home ...

(Carer, Mother, Tasmania, Submission #315)

In summary I feel the main factors inhibiting the provision of effective mental health care on the North-West coast of Tasmania are: ...the unavailability of private and supported accommodation for people with mental illness ...

(Carer, Mother, Tasmania, Submission #315)

The Liberals are informed that case managers in mental health are overloaded - "some managing up to 70 clients" and also spend hours searching for accommodation for their clients. "I recently spent three days trying to find accommodation for a mental health client whose [family member] had fallen ill and was no longer able to care for the consumer. There was no supported accommodation, nor crisis accommodation, to be found".

(Sue Napier, MHA, Liberal Shadow Minister for Health, Tasmania, Submission #261)

Families and carers of people with a mental illness are concerned that the Tasmanian Government is opting for boarding houses over other supported accommodation options. One commented to us: "this will become a one-stop-shop for mental health- quite similar to institutionalisation". Another has said "this is a cost-saving measure and an insult to what is needed in terms of support for people with a mental illness". The non-government sector in Tasmania acknowledge the need for alternative options, commenting to us that a "massive revenue injection is needed in the area of supported accommodation" and that "some of the waiting lists for long-term supported accommodation have been closed off for two or three years now - accommodation is usually only available if someone dies".

(Sue Napier, MHA, Liberal Shadow Minister for Health, Tasmania, Submission #261)
6.8.11.4.B.2 Need for interim and step-down accommodations options

There is a need for appropriate transitional models of care between hospital and community.

(Anonymous, Tasmania, Submission #254)

ARAFMI Tasmania also argued that a range of accommodation options was desperately needed and that these needed to be flexible; for example, interim step-down facilities after consumers have been discharged from acute care, long and short-stay settings and transitional accommodation (Standard 11.4.B.8):

Supported and step down accommodation is desperately needed for clients requiring support after leaving acute care and for those people who have difficulty living by themselves or are too big a burden on their family members (often aged parents).

(ARAFMI Tasmania, Tasmania, Submission #245)
6.8.11.4.B.3 Lack of respite options

Included in the notes to Standard 11.4.B.8 is respite accommodation. Standard 11.4.B.8 states: 'There is a range of accommodation options available and consumers have the opportunity to choose and move between options if needed'. Concern was also expressed that there is insufficient accommodation geared to provide respite care:

The client must feel safe and the families of those who are mentally ill need respite not only from the care of their loved ones but also from the knowledge that they may be in harm's way.

(The Australian Family Association Tasmanian Branch, Tasmania, Submission # 263)

But the pressing need is for accommodation geared to respite care.

(The Australian Family Association Tasmanian Branch, Tasmania, Submission # 263)

Clients cannot be accommodated in "respite" without a mental health case worker.

(Colony 47, Tasmania, Submission #227)

Yet another problem we experience is where to leave [X] when we go away for any length of time. Until recently my husband's mother assisted but she has since died ...

(Carer, Mother, Tasmania, Submission #315)
6.8.11.4.B.4 Lack of respite options for parents with mental illness who have children

Concern was also expressed regarding the lack of respite accommodation to support parents with mental illness and their children (Standard 11.4.B.8):

There are no respite facilities where a mother with mental illness can be cared for with her children

(Anonymous, Tasmania, Submission #254)

Access for respite for clients with children is non-existent.

(Anonymous, Tasmania, Submission #254)

6.8.11.4.C Medication and other medical technologies

Medication and other medical technologies are provided in a manner which promotes choice, safety and maximum possible quality of life for the consumer.

No submissions or comments were received pertaining to this Standard.

6.8.11.4.D Therapies

The consumer and consumer's family/carer have access to a range of safe and effective therapies

Under this Standard, submissions and presentations indicate concerns about:

  • the lack of access to psychologists (emphasis on medication); and
  • lack of access to treatment programs for people diagnosed with Borderline Personality Disorder.
6.8.11.4.D.1 Lack of access to psychologists - emphasis on medication

Concern was expressed that access to a range of accepted therapies according to the needs of the consumer and their carers is not being provided by the mental health service (Standard 11.4.D.2). Specifically one consumer reported that many people cannot afford to access such therapies as access via the public mental health system is difficult and Medicare rebates are not available for treatment by psychologists. Concern was also expressed that the major focus of treatment for mental illness is a reliance on medication without consideration for other necessary treatment and supports and overall well-being:

Psychologists are not available in the public health system. It's inaccessible and it's impossible to ask people to do that themselves. People with a mental illness don't get help to deal with normal life stress - they get their meds increased.

(Carer, Mother and NGO Service Provider, Tasmania, Hobart Forum #14)
6.8.11.4.D.2 Lack of access to therapies for people diagnosed with Borderline Personality Disorder

One carer expressed concern that therapies to assist people with Borderline Personality Disorder were not available in either the public sector or at private hospitals. According to Standard 11.4.D.2: 'The MHS provides access to a range of accepted therapies according to the needs of the consumer and their carers'.

Dialectical Support Programs need to be available in the public sector and perhaps at private hospitals.

(Carer, Mother, Tasmania, Hobart Forum #4)

6.8.11.4.E Inpatient care

The MHS ensures access to high quality, safe and comfortable inpatient care for consumers.

Under this standard, submissions and presentations indicate concerns about:

  • the lack of beds.
6.8.11.4.E.1 Lack of beds

As noted in other sections of this Report (e.g. Standard 11.1 - Access and Standard 11.4 - Treatment and Support) a lack of available beds for acute care was also raised as a concern. For consumers in rural and regional areas this was particularly problematical as this was often the only care they could access due to the lack of community-based services. Patients requiring admission were generally in desperate need of medical care, often life-saving medical care. It appears that due to the inability to access care at an earlier point in the course of the illness, the demand for acute care exceeded the number of beds available. This resulted in a whole series of other decisions which jeopardised the safety and rights of consumers including: non-admission and being returned 'home', admission and someone else who was still unwell was discharged to vacate a bed, lengthy waits in emergency departments and being held in seclusion.

The Psychiatric Care Unit is pretty full all the time and it could certainly do with more beds.

(Carer, Mother, Tasmania, Hobart Forum #4)

6.8.11.5 Planning for exit

Consumers are assisted to plan for their exit from the MHS to ensure that ongoing follow-up is available if required.

Under this Standard, submissions and presentations indicate concerns about:

  • planning for exit on the basis of need to vacate beds; and
  • discharge occurring without adequate planning.
6.8.11.5.1 Planning for exit on the basis of need to vacate beds

Concerns were expressed that discharge was not occurring to an agreed exit plan (Standard 11.5.2) or health status of the consumer (Standard 11.3.18) but rather according to the need to vacate beds for new admissions. Such exits could jeopardise the safety of the consumer, especially as entry is almost always on the basis of risk or actual self-harm, or harm to others, and frequently results in almost immediate readmission:

It should be noted that discharge is largely driven by the assessment that another incoming client has a greater need rather than the client is ready for discharge.

(Anonymous, Tasmania, Submission #254)
6.8.11.5.2 Discharge without adequate planning

Concern was expressed about the inadequacy of discharge plans and that sometimes they do not exist at all. Concerns were expressed that indicate that discharge plans have not been developed in collaboration with the consumer or carer (consistent with Standard 11.5.2), that understandable information about the range of relevant services and supports had not been provided (Standard 11.5.4) and established contact with the service providers had not been arranged prior to discharge (Standard 11.5.6):

The Hospital (e.g. RHH) is outside the community mental health structure and therefore has no commitment to the care of clients once it perceives them as ready for discharge. Despite frequent attempts to establish coordinated discharge planning ("discharge planning begins on admission") the community services are still often left out of the loop and find the client has been discharged without proper arrangements for continued support.

(Anonymous, Tasmania, Submission #254)

Figures contained in response to a Question on Notice placed by the State Liberals reveal that only half of the 2642 people presenting to Emergency Departments were admitted in the first nine months of the 2003/04 financial year ... Half were treated and discharged with little apparent follow-up as to where they are going, and no apparent plans to provide ongoing support. What these figures also do not reveal is how many of the 2642 presentations involve the same person, representing over and over again ... Yet even with these figures now in the public domain, Labor has still not acted to address the crisis in mental health.

(Media Release, Sue Napier, MHA, Shadow Minister for Health, 13 October 2004, Tasmania,
Submission #261)

Similarly, Department of Health reports state that "discharge planning from hospital is problematic due to lack of case management" and recommend that "adequate resources of case managers [is required}" and "case manger need to follow their clients through the system from in-patient to out-patient and to community client status".

(Sue Napier, MHA, Liberal Shadow Minister for Health, Tasmania, Submission #261)

6.8.11.6 Exit and re-entry

The MHS assists consumers to exit the service and ensures re-entry according to the consumer's needs.

Under this Standard, submissions and presentations indicate concerns about:

  • consumers being discharged while still very ill with no arrangements for ongoing treatment and support.
6.8.11.6.1 Discharge while still very ill with no planning for treatment and support

Standard 11.6.1 states: 'Staff review the outcomes of treatment and support as well as ongoing follow-up arrangements for each consumer prior to their exit from the MHS. Concerns were expressed that discharge was occurring without staff reviewing the outcomes of treatment and support. One carer reported her disbelief that consumers could be discharged while still very ill with out any plans being made for ongoing treatment and support. This would indicate that an individual care plan had not been devised and an exit plan (see Standard 11.5.1) and a clinical review of the consumer had not been conducted prior to discharge (see Standard 11.3.18):

The thing I found is that once he walked out the door of the MHS no one cared about him or what happened to him ... They said he was okay and released him with no shoes, no where to go and blood all over him. I spoke to the Dr and [X] died 10 days later - he jumped. There are so many suiciding. Nobody to help me. I should have had more help, I couldn't do it ... Everybody like that needs someone to care for them.

(Carer, Tasmania, Hobart Forum #22)

And other mental workers confirm the story of the revolving door of hospitalisation and hopelessness for people with mental illness in Tasmania :

"One client was in Psychiatric Intensive Care Unit (PICU) in hospital on weekend, transferred to Department of Psychological Medicine (DPM) of hospital on Monday, sent back over to Mistral House on Tuesday, sent back to PICU, then discharged into the community. Still unwell, MH services told him to go back to hospital (Emergency Services), admitted again to PICU, discharged into the community and readmitted within 6 hours".

(Sue Napier, MHA, Liberal Shadow Minister for Health, Tasmania , Submission #261)

One mental health client who contacted the Liberals said he was held for 72 hours, discharged with bare feet and no money and was back hours later in hospital after a suicide attempt.

(Sue Napier, MHA, Liberal Shadow Minister for Health, Tasmania , Submission #261)
© Mental Health Council of Australia 2005. Last updated 29 August 2005.
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