Mental health patients fear being raped and assaulted while receiving care, have been forced to urinate in ward gardens, and are spending days chemically sedated or shackled in emergency departments while waiting for a bed.

The Mental Health Advocacy Service, tasked with oversight of the State’s involuntary mental health patients, has laid bare the horrific conditions faced by some of WA’s most vulnerable people in a scathing report highlighting the lack of services and funding in the sector.

It comes after The Kalgoorlie Miner yesterday revealed staff at Kalgoorlie Hospital had told a probe that they were using so much ketamine to chemically restrain young people that the supply “nearly ran out”.

Despite the surging demand for services, “cost-cutting” by the McGowan Government is forcing the Mental Health Advocacy Service to scale back its efforts to ensure the fair and humane treatment of patients.

“Waiting several days in an ED or associated mental health observation unit is not an occasional or unusual event for a mental health patient — it is a regular occurrence,” the MHAS annual report said.

It includes children. Some are there voluntarily, many are being detained, either shackled or chemically restrained, or in the presence of security guards

“It is unpleasant and highly distressing for the person and their family, and due to the levels of sedation given can be risky for the patient.

“There are often more than 20 people waiting every morning in EDs for a bed, many of whom are being detained.”

In one of a series of shocking cases, a patient in an ED waiting for a mental health bed for more than 66 hours was kept under chemical sedation for so long staff feared their airways would collapse.

In another case, a hospital had to cancel scheduled surgeries after a patient waiting four days for a mental health bed had to be transferred to the intensive care unit.

During 2017-18, advocates helped patients with 7373 issues or complaints — a 22.1 per cent increase on the previous year — mostly related to their treatment, medication and basic rights.

They also dealt with 81 allegations of physical and sexual abuse, including one patient who was assaulted by another patient in the courtyard of their ward and had to “fend off the attack and “thump” on the nurses’ station window to get attention”.

A female patient, fearing for her sexual safety, complained after a male patient entered her room at night as she slept and after reporting her concerns was transferred to a locked ward severely limiting her own personal freedom.

Patients at one hospital took to urinating in the ward garden after changes to the access of toilets were not clearly communicated to patients and staff.

Children were also increasingly held on locked adult wards and in some cases sedated with horse tranquilliser ketamine at regional hospitals because of a lack of Royal Flying Doctor Service flights and adolescent beds in Perth.

MHAS last year requested an expansion to its budget based on “significant and ongoing increases in demand for advocacy services” but was rejected by the McGowan Government, forcing the watchdog to implement cost-cutting measures.

They included shelving planned inquiries into sexual safety and restraint practices, cutting bi-monthly visits to 10 mental health hostels completely, and reducing overall visits to other facilities.

Staff, who have not had a pay rise since 2015, also volunteered to supply their own tea, coffee and milk, and Bunbury advocates agreed to waive their call-out fees.

Over the past decade, the State’s total number of mental health beds has increased by just 102 to 795.

Camera Icon Health Minister Roger Cook. Credit: Sharon Smith

Health Minister Roger Cook said he was “acting now” to cut the time mental health patients spent in emergency departments.

“A new model for mental health patient flow will be introduced next month which means for the first time live data will show the number of available mental health beds across the state,” he said.

“Coupled with this we are expanding the mental health patient transfer service so we can quickly and efficiently move mental health patients to where beds are available.”

A six-bed community mental health step up/step down service, part of a $28 million funding commitment, opened in Albany in October and Mr Cook said similar facilities were on the way for Broome (six beds), Bunbury (10), Geraldton (10), Kalgoorlie (10) and Karratha (six).

He would not comment on whether additional funding would be made available for the MHAS.

Frontline emergency department clinician and former Australian Medical Association WA president Dave Mountain said the State’s mental health system was “completely underdone” and hurting the prospects of recovery for patients.

“Any time a mental health patient has to spend longer than 24 hours in an ED, that is a major breakdown in our system and completely unconscionable,” he said. “There is nothing worse for psychiatric patients than ED, it is bright, loud, noisy and agitating — people that work there are agitated by the end of 10 hours on shift so I can’t even imagine being a patient.”

Dr Mountain said suggestions that cost-neutral solutions could rectify the system were “laughable” and a funding injection was desperately needed.

“To suggest you can adjust things to find efficiencies that will magically cure the problems is bananas. When they say that is how they are going to do it you know they aren’t serious,” he said.

MHAS chief advocate Debora Colvin welcomed a new requirement, announced this week but only coming into effect July 1, that all hospitals alert the Health Minister if a mental health patient has been held in an emergency department for more than 24 hours, but said she was aware of three patients on Thursday alone who had been in EDs for two days.

“At the moment nothing has changed and the number of patients waiting for over a day in EDs is still a major disgrace,” Ms Colvin said.