Victoria's mental health services 'sink to the absolute bottom' with tragic consequences

Updated

Melbourne woman Chloe Lashay walked out of hospital in a daze, with nothing more than some pamphlets and a bus fare.

Less than 12 hours after the 30-year-old had made what police described as an "extremely serious" attempt on her own life, the hospital had told her it was time to go.

"They said, 'we really need this bed, so we need you to sort of, get out'," Ms Lashay said.

"I didn't have my purse, I didn't have my car … I said, 'I don't know how I'm going to get home'."

She had been planning her suicide for a month.

Matters of State Victoria's broken mental health system

Victoria spends less on mental health per person than any other state in Australia, resulting in thousands of people not getting the care they need. How do you fix a broken system? About



Victoria spends less on mental health per person than any other state in Australia, resulting in thousands of people not getting the care they need. How do you fix a broken system?

She had written letters for family and friends, chosen funeral songs, and cleaned her home.

She had stopped taking orders for her floristry business. They were orders she wouldn't be able to deliver.

Ms Lashay managed to get a friend to take her home that day several weeks ago, but two days after that hospital visit, she once again ended up in emergency.

This time, she was admitted to the psychiatric ward.

Ms Lashay first came into contact with Victoria's public mental health system five years ago, when she was diagnosed with borderline personality disorder and complex trauma.

Despite having a "great GP" who she sees weekly, she is one of thousands of Victorians struggling to access mental health treatment.

Victoria's 'slow erosion of care'

When Victorian Premier Daniel Andrews summoned mental health professionals and advocates to the Kyneton Men's Shed last week, he surprised them by promising a royal commission into mental health.

"Something is wrong with the mental health system," the Premier said. "We have to find it, and we have to fix it."

It was a welcome announcement for many, but there was also some surprise at the Premier's choice of words.

Those who work in the field say there is no mystery about what's wrong.

Patrick McGorry — a professor of youth mental health at Melbourne University and a former Australian of the Year — has been named as the chair of the royal commission's expert advisory panel.

He said that over the past two decades there has been a "slow erosion of care" in the state, to the point where now Victoria spends less per capita on both community-based care and inpatient beds than any other state.

"That's the opposite of the situation 20 years ago," he said.

"It's just sunk to the absolute bottom, and that's having really massive effects on the public.

"Everyone now ends up in the emergency department."

Public hospitals at the frontline

In the past decade, the number of people presenting at Victorian emergency departments with mental health crises has jumped by more than 60 per cent — from 33,743 in 2007 to 54,114 in 2017 — according to the Australian Institute of Health and Welfare.

Mental health emergency presentations have grown by 19 per cent in the past four years alone.

The Australasian College for Emergency Medicine says those who do present are waiting longer to be assessed and treated, and are twice as likely to leave emergency departments before finishing treatment.

"Patients with mental health issues who are coming to emergency departments with a crisis, or trying to access care, we don't help them," Simon Judkins, the college's president and the clinical director of Austin Health's emergency department, said.

"We pretend we do, but we're actually making the situation worse in a lot of cases. We need to recognise that," said Dr Judkins.

"If someone says, 'I'm not ready to go', they shouldn't be made to leave," Ms Lashay said.

Ms Lashay lost a friend to suicide after her friend was discharged from hospital.

"She wasn't ready to go, and now she's gone forever," she said.

Ms Lashay said a single phone call from the hospital was the most she had ever received after being discharged.

"They medicate you, feed you, house you, then push you out the door with a bunch of numbers to call to get help," she said.

"So you're trying to engage with 10 or so different places. For someone who is mentally ill, that is basically an impossible task."

After her last hospital admission, it was Ms Lashay's mother, Sandy, who decided it was time to change tack.

She moved in with her daughter to support her.

"If I really think about it, it's hell, but it's more hell for her," Sandy said.

"But I'm her mother. It doesn't matter about how it's impacted me really, I just need to be there for her."

'The system is full'

Victoria has fewer public mental health beds, of any kind, than any other state, except Tasmania.

Although the number of beds has increased by 7 per cent over the past eight years, population growth has meant there has actually been a 9 per cent reduction in per capita terms.

The Royal Australian and New Zealand College of Psychiatrists said an extra 477 beds — at minimum — are needed to bring Victoria into line with the rest of the nation.

Dr Judkins said the current state of affairs is unacceptable.

"The word 'discrimination' has been used when we talk about mental health, and I think that's true," he said.

"At the moment, the system is full. And if the system is full, it means patients are going to be waiting, somewhere along the line."

The tragic consequences, Dr Judkins said, were too common.

"Every emergency physician has been involved in a situation where a patient with mental health issues has come to the emergency department, they've left, and they've ended their life. We know that happens.

"The system isn't helping these people at all."

While Dr Judkins supports the proposed royal commission, he says the Victorian Government should take action now because patients, carers and staff cannot afford to wait.

"Some of the fixes are so obvious that we don't need a royal commission to tell us," he said.

"We could very easily get a group of experts to meet the Premier next week to talk about some of these.

"We don't need to wait two years. There are measures we could implement tomorrow."

Once a leader, now a laggard

Stephen Duckett, health program director at the independent think tank the Grattan Institute, says Victoria used to lead the nation in mental health.

Now, fewer people are accessing community mental health care services in Victoria than anywhere else in Australia.

"We had a very good network of services. We started to deinstitutionalise — but we didn't just dump the patients in the community," Dr Duckett said.

"We provided services for them."

Now, only one in three Victorians in need of mental health care is able to access such care.

That's nearly 40 per cent lower than the national average, according to Australian Institute of Health and Welfare data, and means more than 120,000 Victorians are unable to access the care they need.

Dr Duckett says the reduction in mental health funding is most apparent in the decline of community mental health services, where funds have been diverted to the National Disability Insurance Scheme (NDIS).

"The police have to actually end up going to people's homes and taking the person to the emergency department. This is not what we should be doing," he said.

"We should be preventing these and managing these things in the community for better care for everybody."

Dr Duckett says the combination of rapid population growth and underinvestment by state governments over the past two decades has had a massive impact on the system.

"I think the royal commission is a really good idea, especially if it investigates the state's interaction with the NDIS," he said.

"The issues are quite complex. Lifting the lid on that, and setting some priorities, is a good thing."

Major funding boost needed

In this year's budget, the Victorian Government committed $705 million, over four years, to mental health and drug and alcohol treatment.

The New South Wales Government committed three times that amount — $2.1 billion over four years, despite that state having a population that's only about one fifth larger than Victoria's.

Victoria's Opposition — which has promised $1.14 million for youth mental health provider Headspace — has not yet committed to supporting a royal commission, nor announced what its own mental health plan will be.

Patrick McGorry says the Victorian system needs closer to $1 billion a year.

"It sounds like a lot, but that will just bring us up to something like two to three per cent coverage of the population," he said.

He compared the state's $700 million mental health package to the $700 million being spent building a new maximum security prison at Lara, north-east of Geelong.

"If we had a proper mental health system, we wouldn't need to be building that new prison," Professor McGorry said.

Dr Judkins says improving community services was crucial — so that patients could be directed there from the hospital, instead of being discharged into the unknown.

"Even the simple thing of somebody leaving the emergency department with an appointment for the next day to go and see a psychologist, instead of saying here's half a dozen numbers and see how you go," said Dr Judkins.

"Clearly that's not working. We really need to look at how we link all those parts of the system together."

'I don't really want to die'

Ms Lashay says her family, friends and flowers have helped her to survive.

Running a successful floristry business has been her constant, even when she has been unwell.

"I've even worked out of the psych ward, because I will not let my clients down," she said.

"I've made big event arrangements in there. I've taken leave to go and do a wedding. I've never ever had to cancel a job, ever. "

But the concerns about her future are ever-present.

"[I worry] I'll go into crisis, that I'll accidentally kill myself. Because I don't really want to die, I don't," she said.

"I have beautiful people in my life. My family, we love each other so much. I have a business that I love. I'm so blessed to have found what I love to do in life and actually get to do it.

Topics: state-elections, mental-health, suicide, psychology, psychosis, doctors-and-medical-professionals, health, royal-commissions, health-policy, health-administration, vic, melbourne-3000, geelong-3220, lara-3212, kyneton-3444

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