‘Inhumane’: ED wait time blowout for mental health patients

Vulnerable mental health patients are now waiting an average of more than 20 hours in the Royal Adelaide Hospital emergency department for a bed, with a sharp increase across the system in those languishing for 24 hours or more – which even the Health Minister describes as “unacceptable”, InDaily can reveal.

Oct 15, 2021, updated Oct 15, 2021
Photo: AAP/David Mariuz

Photo: AAP/David Mariuz

Doctors and psychiatrists have slammed the “shocking” wait times as “inhumane” and “unacceptable”, accusing health authorities of “failing the South Australians who are desperate for mental health services”.

Health Minister Stephen Wade told InDaily: “It’s not acceptable for anyone to be waiting in an emergency department for more than 24 hours for a mental health bed.”

Yet SA Health data released to InDaily shows the number of mental health patients waiting more than 24 hours for a bed has more than quadrupled in three years, while the average ED wait time across Adelaide hospitals is now 11.6 hours.

The Royal Adelaide Hospital has the worst delays, with mental health patients waiting an average of 20.4 hours, while the Queen Elizabeth Hospital is second worst – patients there now wait 16.5 hours on average for a bed.

“That’s inhumane treatment,” said Australian Medical Association state president Dr Michelle Atchison, who is a psychiatrist.

“For that to become business as usual is shocking and it’s a disgrace that we treat people with mental health problems that way.

“If you came into hospital and you had chest pain or you came into hospital and you had cut your finger off with a circular saw or something like that no one would expect you to wait for 20 hours to be seen.

“Whereas it’s become normal now for it to be expected that if you have a mental health problem you will have a long wait time.

“I hesitate to say discriminatory but it shows that the mental health patients receive lesser care than someone with a physical injury.”

More than 1500 mental health patients waited a full day or more in one of Adelaide’s EDs last year for a bed– a 360 per cent increase in three years, when 327 patients waited more than 24 hours in 2017.

This year is on track to be even worse - with 1048 patients waiting more than 24 hours, from January to August.

The figures don't include patients who leave hospital before getting a bed.

According to additional SA Health data, the number of mental health patients waiting more than 24 hours for a bed has fluctuated significantly over several years, from 517 people in 2009, to 1552 in 2014, to 588 in 2016.

The Opposition says it’s disgraceful that more people with mental illness waited more than 24 hours for a bed last year in South Australia than in Victoria, which has nearly four times SA’s population.

The majority of the 24-hour plus waits occurred at the Royal Adelaide Hospital – affecting 893 patients in 2020, with the Queen Elizabeth Hospital second-worst where 340 patients endured such lengthy waits.

In April, Adjunct Professor John Mendoza resigned from his position as executive director of mental health and prison health services at the Central Adelaide Local Health Network, a year into his three-year contract, blasting the department and State Government for failing to act on reform.

“I’m not going to waste my time in a sense pretending I’m part of some reform effort when it’s not there,” he told InDaily, at the time.

He later described South Australia as “the worst jurisdiction in the world” when it comes to leaving people experiencing mental health crises in emergency departments for more than 24 hours.

The average ED wait time for mental health patients across the system has grown from 7.9 hours in 2017 to 10.7 hours last year and 11.6 hours so far this year.

The total number of mental health presentations has also risen – from 17,169 patients in 2017 to 20,339 last year.

At the Women’s and Children’s Hospital, 3010 mentally unwell children presented to the emergency department last year – a nearly 50 per cent rise from the 2024 children in 2017.

It’s a disgrace that we treat people with mental health problems that way

Atchison said if the State Government could find extra beds for COVID, it should do the same for suffering mental health patients.

“If you are severely suicidal or severely psychotic, to sit in an emergency department for 20 hours waiting for a bed before you actually start your treatment properly and are put in an environment suitable for a mental health patient is inhumane,” she said.

Atchison called on Chief Psychiatrist Dr John Brayley to “pay attention” to these “unacceptable” wait times and do something about it.

“He needs to be working on why these people are waiting for so long,” she said.

“It’s been happening for too many years now. It’s become business as usual. That’s really just not good enough. This is a situation that shouldn’t be tolerated.

“We need extra beds, we need to stop this block in ED.”

Dr Michael Edmonds, SA deputy chair of the Australasian College for Emergency Medicine, accused health authorities of “failing the South Australians who are desperate for mental health services”.

“Dangerous delays in receiving definitive care are part of widespread system failure across acute psychiatric and community-based mental health,” he said.

“The new Urgent Mental Health Care Centres do not assist those patients who need admission.

“Put simply, South Australia has insufficient mental health services, so for those becoming unwell in the community, and after assessment in the emergency department, there is simply nowhere else to go.”

Edmonds said that despite continuous warnings from medical experts the State Government had neglected to fix the problem.

“South Australians needing mental health support continue to suffer unacceptable delays to be admitted to the therapeutic environment required,” he said.

“Emergency department clinicians desperately want to ensure the best – and most efficient – care possible for the many people experiencing distress, or having experienced trauma, who come to us seeking help and care.

“However, after receiving initial treatment and assessment in EDs, too many people needing mental health support are then facing unacceptably long waits for assessment by a mental health clinician and even longer for definitive care and admission.”

Edmonds said many of SA’s emergency departments did not have access to mental health doctors or decision-makers overnight, forcing people to wait long hours for assessment the next day.

“We know that the constantly noisy and brightly-lit emergency department is detrimental to people requiring mental health support,” he said.

“We also know that those with the greatest need of specialised mental health admission and services are often the people that spend the longest in the ED – increasingly for longer than 24 hours, and sometimes for multiple days.

“This has negative impacts on that person’s mental health. It also increases the incidence of frustrated outbursts, posing a potential risk to other patients and staff, and can lead to the use of restraint and seclusion.”

Edmonds said long delays to admission resulted in beds being unavailable for new patients arriving in the emergency department and contributed to ambulance ramping.

“Either this government – or the next - must finally step up and fix this completely unacceptable situation,” he said.

“We need to see genuine vision, better planning and systemic solutions which help to improve patient flow through our system, while also providing a range of suitable alternative care options and supports, particularly out of office hours.”

Edmonds called for “whole-of-system” investment – “especially accessible seven-day community-based care”.

“However, shorter-term solutions while these are being developed include centralised coordination to ensure equitable bed availability, greater access to mental health decision makers in the ED – especially overnight – and investments in inpatient beds,” he said.

Edmonds said SA also needed more staffed forensic, subacute rehabilitation and NDIS mental health beds.

“The use of forensic beds must be limited to those patients who truly need this level of care, coupled with increased provision of care for people in custody with mental health problems, rather than coming to acute hospitals,” he said.

“All these solutions will need investment in workforce to provide a seven-day service to gain efficiency.”

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He said if a person needing mental health care must remain in an ED for longer than 24 hours, this must be reported to the Health Minister.

That’s inhumane treatment

Dr Patrick Clarke, a spokesperson for the SA branch of the Royal Australian and New Zealand College of Psychiatrists, said the increase in mental health presentations during the pandemic was “entirely predictable”.

“The whole population is coping with a large-scale traumatic event and mental health is suffering as a result, particularly for those who were already in a vulnerable state,” he said.

“Long waiting times are symptomatic of larger structural issues within South Australia’s mental health system.”

Clarke called on the State Government to “get real” about funding mental health adequately.

“Other States have recognised this problem and are acting on it, with massive funding increases in NSW, Victoria and WA,” he said.

“South Australia needs to do likewise.

“Our major deficit in SA is in recovery and rehabilitation beds and the workforce to service both those and our existing services. The crisis point is there, and it has a domino effect on broader hospital services such as our Emergency Departments, and community mental health services.

“The doctors, nurses and other staff within both our emergency departments and mental health units are highly competent, dedicated and interested in providing the best possible care to patients – and are becoming increasingly frustrated at not being able to do so, due to a lack of resources and appropriate patient flow pathways.”

Mental Health Coalition of SA executive director Geoff Harris said more alternatives to EDs were needed.

He said the Urgent Mental Health Care Centre which opened in the city earlier this year was a good example and was working well.

“The feedback so far is highly positive from people who’ve used the service and their families,” he said.

Harris said extra community support was also vital.

“If that’s working well then they can avoid crises and get the support to work through how to de-escalate and how to problem-solve and so then they don’t actually get to hospital,” he said.

“I think another key part of this puzzle is really investing in supporting people to leave hospital when they are clinically ready.

“We need to do some more investigation around what are the barriers but they would include access to appropriate housing and access to community support to leave.

“If you increase community supports, then people use the bed-base component of the system less. The evidence is really clear about that. So investing in that reduces the number of people needing those beds and so that should decrease wait times for mental health beds.”

Opposition health spokesperson Chris Picton said “finally we see in black and white" the impact of state government health policies.

"These disgracefully long delays in emergency departments have been described by experts as a human rights abuse - adding further pain, anguish and suffering to those people who have come forward needing help,” he said.

"And it's not only the suffering for that person denied care - these delays for mental health patients are a key reason for our ramping crisis which is at all-time record levels.

"It is nothing other than a disgrace that South Australia now has more mental health patients who wait days for a bed than Victoria which has almost four times our population. There is simply no excuse for how that is even possible.

"Experts from all quarters have been calling on the Marshall Government to take decisive action, however they have fallen on deaf ears.”

Health Minister Stephen Wade told InDaily “it’s not acceptable for anyone to be waiting in an emergency department for more than 24 hours for a mental health bed”.

“We are delivering on the Mental Health Services Plan, which has a focus on reducing these unacceptable wait times by providing clients with more appropriate community treatment pathways,” he said.

“We know that mental health presentations have increased during the COVID-19 pandemic and we are addressing this need with a record $163 million investment to boost the state’s mental health services in this year’s State Budget.

“These investments will add beds, build brand new facilities and help ease pressure on emergency departments across Adelaide.”

In a statement, SA Health said it was “making progress” in improving access to mental health services.

“There is still more work to be done, particularly in reducing the time adult mental health patients spend in emergency departments,” SA Health said.

“We are working hard to reduce the state’s over-reliance on EDs for mental health patients as a key goal in delivering a more effective health system.

“We are working towards having more community based, mobile services that can assist people earlier, before the need to present to an ED arises.”

SA Health said this included a range of initiatives “such as Mental Health CORE, which embeds mental health specialists within SA Ambulance response teams to provide treatment in the community and referral to appropriate community-based services”.

“This service has been able to avoid an emergency department presentation for more than 70 per cent of the patients it responds to,” SA Health said.

“Likewise, the new Urgent Mental Health Care Centre in the CBD, which has seen 1300 patients since it opened in March 2021, provides a more therapeutic environment for people to undertake mental health assessment and treatment.

“Many of the key initiatives in the Mental Health Services Plan 2020-2025, which commenced last year focus on the need to reduce the current wait time for services as well as the time people spend in EDs.

“The plan also provides for the implementation of a range of hospital alternatives, and aims to improve services for all age groups – including implementing recommendations from the Oakden review.”

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