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Emergency Department Responses to Mental Health Emergencies

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Cate Faehrmann
NSW Greens MP
20 June 2019


That private members' business item No. 113 outside the order of precedence be considered in a short form format.

Motion agreed to.


1. That this House notes that:

(a) research shows that the quality of care someone receives from the Emergency Department following a suicide attempt can influence their risk of attempting or dying by suicide in the future;

(b) in 2015, a comprehensive review by the NHMRC of care for those who had attempted suicide found very low levels of satisfaction with emergency department care and that low levels of satisfaction was correlated with being half as likely to disclose future suicidality;

(c) in 2018, the Australasian College for Emergency Medicine found that 30 percent of mental health patients wait for more than eight hours for an inpatient bed; and

(d) while the Government's plan to implement the recommendations of the review of seclusion, restraint and observation of consumers with a mental illness in NSW Health facilities included a deadline to plan for minor infrastructure upgrades and to review safe assessment rooms, there is no plan or deadline to upgrade any significant issues found.

2. That this House calls on the Government to improve emergency department and frontline responses to mental health emergencies in New South Wales by:

(a) finalising the review of the design and use of safe assessment rooms in mental health units, as per the recommendations of the review of seclusion, restraint and observation of consumers with a mental illness in NSW Health facilities, and developing a strategy to action any necessary infrastructure upgrades by 2021, funded by the Statewide Mental Health Infrastructure Fund; and

(b) reviewing the reasons for delays for mental health patients to be admitted from emergency departments to inpatient beds, and the effectiveness of existing frontline responses to mental health incidents in the community.

This motion is about ensuring that emergency departments in hospitals are suitable for people presenting with mental health issues, particularly suicidal ideations. Suicide affects many people. It has affected my family as well and it has affected me personally. When I was 12 my brother was diagnosed with paranoid schizophrenia and I had many years dealing with his mental illness in the 1980s in a family who were extremely affected by his diagnosis. Unfortunately in 1995 my brother committed suicide, which is why I am very passionate about ensuring that we have the right type of investment to ensure that we reduce suicide, particularly amongst young people across New South Wales.

Suicide has a devastating impact on families. I saw the impact myself, particularly on my mother. Right now in Australia statistics unfortunately show that suicide is increasing. Particularly and alarmingly it is the most common cause of death for people aged between five and 17 years. In fact, 11 per cent of 12- to 17‑year‑olds in Australia have attempted self-harm at some point in their lives. It is an absolutely heartbreaking statistic. This motion is particularly about emergency departments because what people encounter when they go to emergency departments really matters. Research has found that 60 per cent of all people who present with mental health presentations are triaged as urgent or potentially life-threatening.

A review was conducted into seclusion, restraint and observation of consumers with a mental illness following the terrible, tragic death of Miriam Merten in 2014 after she was admitted to Lismore Base Hospital. She essentially died of a brain injury after falling more than 20 times whilst in a mental health care unit for hours without seeing anybody at that hospital. The Government commissioned a review and recommendation 17 of that review states that "there should be an immediate review of the design and use of safe assessment rooms", which is what Ms Merten was in, "using a co-design methodology". The review team visited 20 emergency departments and were very alarmed by what they found. They had significant concerns about the design and use of these rooms. Typically the review team was confronted by small, noisy, cold rooms with no natural light, no activities to distract, no chair to sit on, no-one to talk to, potentially only a foam mattress and blanket on the floor. So the recommendation was for an immediate review.

I turn now to look at what the Government has done. In March 2018 the Government made suggestions as to what action it was taking in relation to that recommendation. In March 2018 the Government involved consumers in reviewing the design and use of safe assessment rooms in emergency departments. Stakeholders have told me that nothing has happened. Of the $700 million that has been allocated to the Statewide Mental Health Infrastructure Program, only $14.68 million was spent last financial year and only $22.4 million was allocated this year. This is a mental health crisis. This motion is about fast-tracking this investment and looking at the reasons why the Government has not fast-tracked this and also reviewing the reasons for delays for patients who should be admitted to inpatient beds in emergency departments.

The Hon. BRONNIE TAYLOR (Minister for Mental Health, Regional Youth and Women) (23:25): Mental health is a key priority for this Government. I acknowledge the need to reduce the rates of suicide in New South Wales and I am committed to tackling this immense social issue. The 2019-20 health budget includes $19.7 million to support key initiatives to drive suicides towards zero in New South Wales, the first stage of a three-year $87 million commitment. This is the largest commitment towards reducing suicide made by the New South Wales Government.

People presenting to New South Wales health services who may be at risk of suicide must be kept as safe as possible and assessed and treated effectively. Suicide prevention is considered to be core business for mental health services. A number of services and supports are in place including the 24-hour Mental Health Line which provides access to mental health services through triage, referral and advice; comprehensive assessment of people presenting to mental health services for risk of suicide followed by careful monitoring, treatment and support if they are at risk; continuity of care when a person with a mental health care need is transitioning from one healthcare setting to another or returning to the community; additional training for all New South Wales mental health clinicians in suicide assessment and management; and awareness of suicide prevention training within alcohol and drug services. The New South Wales Government takes a whole-of-government, system-wide approach to suicide prevention because we acknowledge that suicide is a complex issue with neither a single cause nor a simple solution. It requires governments at all levels, community-managed organisations, the private sector and communities to work together to develop suicide prevention services and activities designed to support local need.

In October 2018, the New South Wales Government released the Strategic Framework for Suicide Prevention in NSW 2018-23. To support the Strategic Framework for Suicide Prevention 2018-23 and New South Wales' journey towards zero suicides in 2019-20, eight new initiatives will begin to be rolled out with full implementation by 2020-21. As I mentioned, the budget commitment that was announced is $87.085 million over three years, $10.2 million for zero suicides in care to strengthen practices within the mental health system to eliminate suicide attempts by people in care— [Time expired.]

The Hon. WALT SECORD (23:28): I commend and support Ms Cate Faehrmann's motion on mental health and emergency departments in New South Wales. I also support the sentiments of the motion. I think everyone in this Chamber, or in every family, has been touched by suicide or mental illness. I acknowledge that recent studies have shown that one-third of people who report to an emergency department in Australia find that they spend more than 8 hours in an emergency department. In New South Wales our emergency departments are under enormous pressure.

The most recent quarterly report from the Bureau of Health Information showed that more than 750,000 people presented to emergency departments in New South Wales. A significant chuck of those people presented with mental health problems and mental illness episodes. As the shadow Minister for Mental Health, I can say that the number of representations of concerns in the community has increased significantly in the past year. Yesterday a case was brought to my attention where a person had to travel eight hours from Lightning Ridge to Orange to get mental health treatment and mental health support. That is a typical story in rural and regional areas. Several years ago—keeping in mind the confidence of patients—my office assisted a person who needed to get into treatment. We could not find a place for them. They lived on the mid North Coast and we secured a place for them in the Central West. That put incredible pressure on their family because they had to visit them. Again, we have a health and hospital system under enormous pressure. The State Government is not supporting mental health services appropriately. Once again, I thank Ms Cate Faehrmann and commend her for bringing the matter to the attention of the House.

Ms CATE FAEHRMANN (23:30): In reply: I thank the Hon. Walt Secord and the Minister for their contributions. The Minister's contribution did not address why the Government does not support finalising the review of the design and use of safe assessment rooms in mental health facilities. Miriam Merten died in 2014. The recommendation was made in 2017. The review panel was very alarmed at what it saw. It stated that the use of safe assessment rooms was a significant factor in self-harm and suicidal ideations after inpatients left the hospital. There is nothing to suggest that this issue is going to be fast tracked. In fact, a question asked in the House today about the $700 million referred to a 10-year period. Every year in Australia 3,000 people take their own lives. This is a crisis. I urge the House to support this motion. It is not a big ask. It asks the Government to finalise the review of the design and use of safe assessment rooms in mental health units and to develop a strategy to use the State's mental health infrastructure fund for necessary upgrades by 2021. Given the state of mental health in New South Wales, 10 years is too long to wait.

The ASSISTANT PRESIDENT (The Hon. Shaoquett Moselmane): The question is that the motion be agreed to.

Motion agreed to.

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Cate Faehrmann
NSW Greens MP
20 June 2019



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