Page 4536 - Week 13 - Tuesday, 26 November 2019
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Approximately 50 per cent of people referred by the courts for a section 309 of the Crimes Act assessment do not require admission to the Canberra Hospital.
Another initiative has been the creation of a four-bed area within ward 7B at Canberra Hospital, which often accommodates patients with physical health conditions that are concurrent to their mental illness, such as the physical effects of suicide attempts or eating disorders. There is a four-bed pod within ward 7B that has been identified as suitable and used intermittently for “surge” capacity for people with a mental illness. A risk assessment has been undertaken for the space, with some ligature risks found, and a plan of works has been developed to address these, with works due to be undertaken prior to Christmas. In the interim the identified risks are being managed through increased staffing levels and supervision. Preliminary work is also underway to investigate medium and long-term options to increase overall acute capacity across the territory.
Despite the strategies that I have just discussed being introduced, the management of some individual patients remains difficult, particularly in relation to those requiring seclusion and sedation in the emergency department. This creates challenges for their safe transfer to the high dependency unit within the adult mental health unit. For example, when patients are particularly aggressive and require significant amounts of sedation to manage their aggression, their transfer to the adult mental health unit requires medical supervision by an emergency department physician and transport by an ambulance, rather than by routine Canberra Health Services transport.
Canberra Health Services are working on a plan to manage these types of patients, including the consideration of individual management plans for known high-risk individuals to facilitate direct admission to the adult mental health unit. It is important to remember, when discussing services for people with mental illness, that the service must operate with the fundamental principle of least restrictive care at front of mind. This means inpatient admission is not and should never be the default decision for people presenting to the emergency department.
The adult community model of care is designed on a number of key principles which ensure that services adopt flexible practices and structures that best support the recovery choices of an individual and consider mental health care from a holistic perspective. This includes promotion of social inclusion, attention to physical wellbeing, the provision of culturally sensitive and appropriate services, and greater consideration of vulnerable populations and the social determinants of mental health.
In practice this provides for a stepped approach to care, with the aim of avoiding hospital admission whenever possible. The community program offers a range of services, including the assertive community outreach service, which works with people with complex needs to support them in the community. The home assessment and acute response team, HAART, offers intensive support for people in their homes and can visit people up to twice per day to either avoid an acute admission or to support early discharge following an admission.
There has also been investment in infrastructure in recent years to support this stepped approach to care. On 1 November I had the pleasure of turning the first sod on the site
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