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Mental Health and Wellbeing - Coronial Report, Mental Health Services

Dr Rosalie Woodruff MP

Dr Rosalie Woodruff MP  -  Monday, 6 September 2021

Tags: Mental Health, Hospitals, State Budget

Dr WOODRUFF - Minister, I wrote to you in June this year about a person who presented at the Royal Hobart Hospital after attempting to take their own life. That person had no mental health assessment during their stay in emergency whatsoever, and a doctor told them it would be in their 'best interests to go home' as there were no services the hospital could provide.

Two coronial reports in recent times have painted a dire picture of acute mental health services in our hospital system that have ultimately contributed to the deaths of two Tasmanians. I am referring to the tragic deaths and inquests of Carol Le Roy in 2018 and Joseph Aaron Lattimer in 2016. Coroner McTaggart presented a report in February this year. One recommendation in the Joseph Aaron Lattimer report was that additional psychiatric emergency nurses are needed at the Royal. The ANMF have said 9.58 full-time equivalent statewide PENs are needed. How many of these positions have been filled?

Mr ROCKLIFF - First, thank you for writing to me. You would appreciate we can't talk about individual cases here, but I respect that you write on behalf of constituents and Ms Johnston has advocated as well.

We recognise that people are increasingly seeking support and engaging the services for mental health issues. The number of mental health presentations to emergency departments across Tasmania reached 9621 in the 2020-21 year. This is an increase of 8.5 per cent on the 8870 the previous year. COVID-19 is creating additional challenges for many people. We are responding with investments across the mental health sector, including community-based solutions such as the redevelopment of the Peacock Centre, a new facility that is to be constructed at St Johns Park and the related work of a Tasmanian Mental Health Reform Program in response to the Mental Health Integration Taskforce.

The Mental Health Hospital Avoidance Program, now operational in the south of Tasmania is a key part of this reform and will help people access care in the community and reduce the need to present at the Royal Hobart Hospital emergency department. This is better for people needing care and for Tasmania's mental health system.

With regard to your question on the psychiatric emergency nurses, statewide mental health services provided inreach from clinical nurse specialists, (CNS), formerly known as psychiatric emergency nurses (PEN) to the Royal Hobart Hospital Emergency Department, 24 hours seven days a week. Clinical nurse specialists are based in the new Mental Health Short Stay Unit and operate within a multi-disciplinary team that attends the ED to undertake assessment for all mental health presentations. There are 11.78 FTE of clinical nurse specialist positions on the Mental Health Short Stay Unit, of which 7.15 FTE are permanently filled. Five full-time equivalents are fixed-term agency nurses.

Recruitment to clinical nurse specialist positions has been challenging in the past year. Agency and casual staff are utilised to fill the current vacancies to support the service to be fully operational. This is limited at times, due to a shortage of experienced clinical nurse specialists.

Statewide mental health services have also allocated a consultant psychiatrist and career medical officer to work in ED and the new Mental Health Short Stay Unit. The Mental Health Short Stay Unit commenced in February this year with all six beds operational with a 24-hours seven days a week service from May this year.

The opening of the Mental Health Short Stay Unit and increased medical resourcing to ED is in response to an increase in mental health presentations to the EDs in recent years and is aimed and improving access to acute care, particularly at the Royal Hobart Hospital.

Dr WOODRUFF - Thank you. The 2020-21 report from Coroner McTaggart recommended a dedicated mental health assessment unit be established at the Royal Hobart Hospital ED. I assume that is not what you are talking about. Has this happened?

Mr WEBSTER - The Mental Health Short Stay Unit is 24 hours to 48 hours ideally. It can go beyond that and it can be shorter than that. It is the first step in establishing what we would call an assessment and short stay unit.

The assessment if, if you like, once someone is medically stable, they would move across to Mental Health and Assessment Unit. If they needed a longer period to make sure they were stable or to return to the community then they would move from the assessment side of the unit to the short stay side.

We believed it was urgent to set up the short stay unit because it created greater support to the ED in the short term and we're now working on extending the model. Again, that's clinician led by our chief psychiatrist developing that model.

Dr WOODRUFF - You're saying that the assessment unit hasn't been set up yet; the short stay unit is the first part of that process and the assessment unit is following. When would that be expected to be completed?

Mr WEBSTER - The short stay unit, as I said, is being led by the chief psychiatrist, the work on that and the model of care. We're still at model of care stage. It is really important that we get this right.

We're working very closely with the ED physicians and with Dr John Burgess at the Royal to get this right because we are transferring people from the ED into an assessment unit, so we need to make sure that we do it at the point where they are medically stable. We're putting a fair bit of effort into the model of care. I would hope that it's this financial year but, as I said, I think we need to make sure that we listen to our clinicians and get this step right. The short unit has been the shorter-term activity and we've been able to establish that already. We're looking at the assessment unit as the second step.