Victorians with severe mental illness are spending day in emergency departments waiting for a bed as doctors warn rising numbers of mental health cases are surpassing every other hospital presentation.
"The biggest thing for us in emergency is access to mental health beds," Footscray Hospital’s emergency department director, Dr Ainslie Senz, said.
A rising tide of people with severe mental illness are waiting in emergency departments for days for a hospital bed as doctors observe that mental health-related patients are surpassing every other emergency presentation. Credit:Damian Shaw
“There has also been a real increase in the severity of patients coming in. It has been incredibly challenging. We are seeing patients stay in emergency departments for a long time because we just don't have the beds for them to go to. At the worst, that can be multi-day stays in emergency."
Emergency physicians have also observed a troubling spike in drug use and self harm incidents.
"We’ve had some very serious overdoses recently," Dr Senz said. "Often, the overdoses we see can be generally fairly mild to moderate and usually more a cry for help. But we have seen several cases recently, where there has obviously been some serious intent with people being quite unwell and even dying from their overdoses."
High rates of COVID-19 among healthcare workers have also shut down beds.
"We’ve had mental healthcare worker clusters which have closed mental health beds and that’s actually part of the reason we really struggled in the last few months because the beds were there but they didn’t have any staff," Dr Senz said.
There has been an estimated 33 per cent increase in young people presenting to emergency departments for intentional self-harm compared to same time last year.
Cracks in Victoria' healthcare system were exposed again last week after a 32-year-old man in the grips of a mental health episode presented at Northern Hospital's emergency department in Epping and waited more than 19 hours to be admitted.
Footage shows a Victoria Police officer allegedly stomping on the man's head.Credit:Jake Edwards
At 4pm last Sunday, while he was still waiting for treatment, the glass doors at the hospital were smashed by the man and police were called. Disturbing video footage shows the man being allegedly hit by a police car before his head was stomped on by an officer.
The family of the man, who was put in an induced coma, later revealed he had bipolar disorder. Victoria's anti-corruption watchdog is probing the conduct of two police officers.
“When you’ve got acute mania or acute psychosis you just can’t wait 24 hours for treatment," Psychiatrist and former Australian of the Year Patrick McGorry said.
“If that was happening with chest pain, cancer or even coronavirus, there would be an absolute outcry. You get a better response these days with a runny nose than an acute medical episode."
Professor McGorry said emergency departments were "the worst place for people to be seeking help because they were not set-up for mental health care," but it was one the only places people could get help at the moment.
Describing the incident in Epping as "deeply distressing and completely unacceptable," Professor McGorry called for the fast-tracking of findings of the Royal Commission into Victoria's Mental Health System.
"We just can’t wait for another six months for real action because it means we are more likely to have preventable suicides," he said. "We already know that people have been turned away from services and then they die."
Dr Senz believes the incident in Epping could have occurred at any hospital.
"It is the system's problem, it is not an individual hospital’s problem,” Dr Senz said. “We provide the best care we can. But [we] feel powerless to be able to fix it, because we can’t create a bed and we can't create more staff.”
She suspects people were not only delaying medical care due to the pandemic, but they had also lost critical social and community support due to harsh isolation measures aimed at curbing spread of the coronavirus.
"Sunshine Hospital had several multi-day stays recently and that’s just awful," she said. "It is very distressing for the patient and for the staff caring for them. It makes us feel like we are not doing a good job for these patients."
Health and Community Services Union state secretary Paul Healey said healthcare workers were working overtime to treat the rising wave of patients with complex mental health issues.
"There is just not the beds or the staff to support people," said Mr Healey, who was worked in mental health services for 26 years.
"All these cracks in the systems were there before the pandemic, but COVID has just made everything worse. It has stretched the elastic band even further."
Mr Healey said police should not be the first responders to incidents involving mental illness over trained health professionals, but he noted there were currently about 450 mental health nurse job vacancies in Victoria.
Police are attending mental health incidents every 10 minutes in Victoria.
In the first surge of COVID-19 infections in March and April, patient numbers in hospital emergency departments plummeted to a record low as people delayed treatment amid fears they would burden the healthcare system or be exposed to the virus.
While overall emergency presentations have remained low, mental health cases have soared in the second surge of infections as Victorians weather stage-four restrictions.
Victorian faculty chair of the Australasian College for Emergency Medicine, Dr Mya Cubitt, said the state's mental health system was already at crisis point before the pandemic.
"In Victoria, there are clear signs that these numbers are increasing," Dr Cubitt said. "The pandemic has further reduced the system’s capacity to manage these issues. We need some urgent solutions, to provide help to those who need care now. "
A state government spokeswoman said almost $200 million had been invested in mental health support in response to the pandemic. Reforms recommended by the mental health royal commission, including the roll-out of 144 new acute mental health beds, had also being fast-tracked.
"We are continually increasing the number of clinical staff we have available to help support additional demand in our hospitals as a result of the coronavirus pandemic," she said.
The government has also invested more than $14 million in outreach programs for high-risk patients and more than $4 million in suicide prevention, including a statewide Hospital Outreach Post-Suicide Engagement program, established at seven sites across the state.
If you are troubled by this report or experiencing a personal crisis, you can call Lifeline 131 114 or Beyond Blue 1300 224 636 or visit lifeline.org.au or beyondblue.com.au
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