SSWAHS = SWSLHN and mental health in the Southern Highlands - 13

A tick for Opposition’s plans to improve employment services for people with mental illness

April 22, 2011 – 11:09 pm, by Melissa Sweet

With mental health in the news, thanks in part to Tony Abbott’s recent funding promises, below is a Q and A piece with Professor John Mendoza, first published by The Conversation on April 21.

Why do so many mentally ill Australians struggle to maintain employment?

This is a critical policy issue for all Australian governments over the next decade. We’re clearly facing a skills shortage and that’s across the board, it’s not just in the mining sector.

We have to get a lot better at engaging people of working age who are not in employment.

Mental illness, often untreated, is one of the primary causes for the situation that we face.

About 28% of all Australians on the disability support pension have a primary mental health-based disability. Of the remaining 70%, around half have mental health problems as a secondary contributor.

The rate of employment for people with mental health conditions in OECD nations is nearly three times the rate of employment than Australia. Needless to say, Australia does very poorly in this area.

There are a number of reasons for this and the announcement by the Federal Opposition starts to address some of these issues.

***

How does the Coalition’s announcement build on existing infrastructure?

We’re already spending a lot of money increasing employment services for people with mental health disorders.

Commonwealth spending on disability support pensions and employment-related programs is around $5 billion. This provides income and support for people on the disability support pension, Newstart allowance and other benefits who are there because of mental health problems. But we’re not getting good outcomes from that spending.

What today’s announcement does is target a couple of specific areas where we know we can do better.

It’s not just a matter of preparing a person with significant mental illness to enter the workplace.

We need to place people in a workplace where they can receive support. A truly supportive work environment is where the culture recognises the way mental illness presents and manifests.

These workplaces support the employer to help keep that person engaged, modify activities, train co-workers on how to deal with mental health episodes and crises if they occur, and retain that person in employment.

The mental health blueprint, released last month, calls for a minimum investment across 30 targeted programs over four years.

We’ve got to lift our current rate of mental health funding as a proportion of total health spending – from around 6% towards 12% to 13%.

That’s a very big ask and no government of any persuasion is going to be able to do that in one or two terms. I think the Coalition is mindful that what was announced today is not enough.

***

Will we see more than just a bidding war from today’s announcements?

I have to be optimistic that this announcement is more than a bidding war. I certainly believe what the Coalition took to the last election and what they’re building on today could bring about real improvements.

The Rudd Government and, to an extent, the Gillard Government are “blowhards” when it comes to mental health. They’ve talked long and hard but they’ve delivered almost nothing.

Suicide prevention was the cornerstone of their mental health policy leading into the last election, with promises of spending $274m over four years.

In the first year, they’ve spent $10m. There’s a bit of a credibility gap when you say you’re going to deal with an issue and in the first year you spend only 2% of the funding that you’ve allocated.

The situation is similar when we look at the Headspace initiatives for increasing early intervention sites around the country.

Labor is spending most of the money not in the second term, but in the third term of government if they’re re-elected. I think that is gilding the lily on this issue.

We need to see the investment flying through fairly evenly, but building up over the four-year budget cycle.

Tony Abbott has basically picked out elements of the blueprint that were released by the working group last month. Many of the working group’s members are advisors to the Federal Mental Health Minister Mark Butler.

These are things members of this group have said privately to the government about what needs to be done.

Tony Abbott has said, very wisely, we know we’ve got a problem with employment participation for people with mental illness and I’m going to target that because it’s one of the areas where investments will produce dividends. The impact on the budget in the longer term will be a positive one.

We know employment participation is critical to people’s recovery, in lifting them out of poverty and helping them regain their sense of self.

Certainly social inclusion is improved dramatically by participating in work. So I think it’s a wise investment, it’s a smart policy, and it won’t cost the budget bottom line in the first instance.

Over the longer term, it will save an enormous amount in terms of the money we’re spending at the moment on disability support pensions and the like.

We’re spending this money now but without getting any movement on people going back to employment.

• John Mendoza is the Director of ConNetica Consulting Pty Ltd. He is the former chair of the the National Advisory Council on Mental Health (appointed by the Rudd Government in June 2008) and resigned in June 2010 citing a lack of vision or commitment to the issue.

One Comment

1. Murf
   Posted April 22, 2011 at 11:49 pm

   If we’re going to get people who have mental health issues back into the workforce (and most of us who’ve been employed before are really keen to get back to it), we need to start training CentreLink not to send away unemployed females who don’t qualify for a benefit. I haven’t even been able to talk to anyone- just a quick dismissal on the phone, several times over the past 12 years (when I’ve had the occasional part-time job). They say “Use your professional networks- we can’t help people like you. We don’t have the sorts of jobs you’re looking for”. Slam. How can we have networks when we’ve been out of work for months or years? Huh? Will we just happen to bump into an employer who won’t run a mile as soon as we mention mental health issues? Better to keep it to yourself when there’s no one to back you up. Also, no one seems to realise how soul-destroying it is for females who have always been financially independent, to suddenly tie their fate to someone else because there are no supports in the community for them to fall back on. It makes mental health issues worse. Someone has to have a good think. Get back to me when there’s some news.

SSWAHS = SWSLHN and mental health in the Southern Highlands - 9

Brain volume declines with antipsychotic use

15th Feb 2011

Catherine Hanrahan all articles by this author

THE largest and longest study linking the use of antipsychotics to the loss of brain volume has Australian experts divided over the impact of early treatment initiation.

The Iowa Longitudinal Study found the use of antipsychotics was correlated with smaller brain volume after controlling for illness severity, duration of follow-up and substance misuse.

The prospective study, which followed 211 patients with schizophrenia for a median seven years, found higher doses of antipsychotics were associated with smaller brain volume on MRI.

Professor Louise Newman, developmental psychiatrist at Monash University, said the study should flag the need for caution when initiating antipsychotics.

“It suggests very careful consideration of antipsychotic use before we have clearly established symptoms [in individuals],” she said.

The publication of the Iowa study coincides with a British Journal of Psychiatry editorial by Dr Joanna Moncrieff, co-chair of the UK’s Critical Psychiatry Network. She cites mounting evidence that antipsychotics are linked to brain volume reduction, suggesting early use in young people is not justified.

But Professor Patrick McGorry, executive director of Australia’s Orygen Youth Health, said there was no consensus on the clinical significance of brain volume changes. “It would be very destructive to say that just because the brain issue is not clear, young people shouldn’t get any help,” he said.

Professor David Le Couteur, president of the Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists, said the relevant clinical outcome was long-term cognitive effects.

“[Let’s] see whether these changes in brain volume, which are just a surrogate marker, in fact pan out to have an impact clinically,” he said.

Arch Gen Psychiatry 2011; 68:128-37; B J Psychiatry 2011; 198:85-87

Comments:

big bug
15th Feb 2011
7:06pm

Brain shrinkage in drug-treated psychotic patients (both scz and bipolar) is in no way caused by the genes (which are only for mild schizotypy and benign hypomania). The most likely cause is persistently fatty diet--especially chocolate and cheese--often aggravated by co-morbid anxiety (cortisol alone can shrink the hippocampus, given time). The anxiety--about half of this population--comes from fatty maternal diet, in pregnancy, which also promotes gestational diabetes (which, alone, raises scz risk for offspring SEVEN FOLD). Fatty personal diet, which causes the typical insulin resistance in scz, seems to precipitate acute psychotic episodes, by causing brain inflammation--as in depression. The problem with antipsychotic drugs is that they can increase appetite--for fatty foods already on the menu. The result will be weight gain, diabetes, vascular risk, treatment resistance and a shortened lifespan. Drug-based psychiatry has a poor future. Drug-free management of first-episode psychosis at Soteria House in California led to more patients being employable, after 12 months, compared with hospital-treated cases. To convert scz back to the pure, harmless schizotypy phenotype, use a strict low-fat diet, and for co-morbid anxiety use Inositol supplement 5 gm/day. Using this regimen, I now have 5 formerly scz patients showing obvious improvements in cognition and insight, whose drug doses may now be reduced safely, and even stopped.

Amateur Observer
20th Feb 2011
2:47pm

"Big bug" having just searched the medical literature, I can find no randomized controlled trial of low-fat diet as a treatment. There are also several studies suggesting NO benefit of inositol in chronic schizophrenia. Can you confirm that you practice evidence-based medicine?

sceptical
17th Feb 2011
12:24pm

With all due respect to those who are attempting to treat young schizos, bi-polars, uni-polars, anxiety, we have not been told about the social habits of these unfortunate young people. Perhaps recreational substances use, including alcohol from the legal age of 18 (binge-drinking excluded), are the cause of many falling prey to these mental health disorders?

Amateur Observer
20th Feb 2011
2:52pm

Agree - with almost 100% of schizophrenics being cigarette smokers one would have to be suspicious of nicotine having a role in the pathogenesis (in susceptible individuals).

Richard Cranium
21st Feb 2011
3:48pm

I appreciate your viewpoint Big bug. To Amateur Observer, who would fund a randomized controlled trial of a low fat diet anyway? Who funded the several studies suggesting NO benefit of inositol in chronic schizophrenia? I know on the two occasions I have commented on your comments I have asked you to answer questions but I don't get how someone who is seemingly scientifically minded doesn't ask them also.

It is up to each and every scientist (and I'm not but I am definitely interested) to ask the questions: "Says who and why do they say it?" I'm sure those who take the time to look in to it will find out that there are a number of ways to skin a cat and that some are more humane than others so even if it takes longer and costs more, it's better!

Richard Cranium
21st Feb 2011
3:58pm

I appologise Amateur Observer, it was not your comment I commented on last time, it was a comment made by "Another amateur observer", honest mistake.

big bug
21st Feb 2011
7:53pm

To Amateur Observer: Science, said Charles Darwin, consists in grouping facts, so that general laws and conclusions may be drawn from them. Medicine, with no intellectual appetite for nutritional and epidemiological facts, can do no grouping, so cannot explain or prevent disease, but manages to eke out a living on a meagre diet of Random-allocation Controlled Trials. If you want an RCT of healthy (probably low-fat) diet in scz, check Sherryn Evans, 2005 ("evans s and schizophrenia" on PubMed). Her intensive diet group (in Melbourne!) gained only 2 kg in 6 months on Zyprexa, and reported better energy and mental contentment than the control group given minimal diet advice, who gained 9 kg. We know that fatty diet causes diabetes (H Himsworth, CLIN SCI, 1936: The Diet Of Diabetics Prior To The Onset Of The Disease); that glucose intolerance is common in scz (first reported in 1924); and that scz cases do eat fatty diets (several reports), and often develop diabetes. Malcolm Peet, in the UK, claims to have observed worse scz symptoms when the diet is low in polyunsaturated fatty acids, which agrees with studies showing that sat fats impair cognition, reduce dendritic branching, lower BDNF levels in hippocampus, and cause brain inflammation.
As for Inositol, 2 studies in Israel showed no improvement in ANERGIC (deficit cases--untreatable?) scz cases, given Inositol for only 4 weeks, so longer trials are a must, in more typical cases. Inositol has two potential uses in scz: to treat co-morbid anxiety (up to 65% of cases); and to provide specific anti-ageing benefits (J Barger, 2008) for brain, already shown in caloric restriction animal models--increased neurotrophins like BDNF (to enhance synapse formation and plasticity), increased antioxidant enzymes, enhanced neuronal energy (got to be good!), and increased autophagy and replacement of oxidation-damaged mitochondria. NHMRC-funded low fat diet trials are planned for depression and bipolar in Geelong (Prof M Berk), and clearly should be extended to scz as well.

Amateur Observer
25th Feb 2011
5:28pm

I believe the assertion that "Medicine ... no intellectual appetite for nutritional and epidemiological facts ..." is completely false. And respectfully, the criticism of "medicine managing to eke out a living on RCTs" won't earn you much support here in a GP website!

Surprisingly you didn't even mention the one herbal therapy which has good evidence in reducing actual schizophrenia symptoms (ginseng), but strung together a hodge podge of nearly-related studies not supporting your original view. Regarding glucose-intolerance, this is also an unfortunate, but well-known side effects of common anti-schizophrenia medications (eg Olanzepine) thus the obvious "chicken or the egg?" question.

SSWAHS = SWSLHN + SLHN and mental health in the Southern Highlands - 2

Socrates suggests that now the NSW election has produced the outcome that everyone knew was to happen, we carefully watch whether the Liberal-National coalition government delivers on its promised changes to improve mental health in NSW and in particular to the Southern Highlands community. Here is a reminder of what the, then, Government, and the, now, new Government promised the people of NSW.

What is on the table for mental health in the NSW election?

March 20, 2011 – 7:06 pm, by Melissa Sweet

The Mental Health Coordinating Council has been analysing the mental health policies of the major parties in the run-up to the NSW election (at least those released so far).

Thanks to Tully Rosen, the Council’s policy and research officer, and his colleagues for providing this summary.

Tully Rosen and colleagues write:

MHCC has gathered the details from the specific mental health policies announced by the major parties for the NSW election. Although the Greens have a mental health policy listed on their website, as far as we are aware they have made no specific program announcements. As usual, the funding directed by both major parties specifically to community managed organisations is only a fraction of the total new funds promised for mental health.

Liberal/National

• Establish a Mental Health Commission ($30mil)

This Commission will have full responsibility for mental health budget which will be quarantined. It will be able to focus resources on where they are needed and on the most appropriate models of care. The legislation to establish the Commission will be developed by a specially appointed working group. The Commission will have three specialist units to: manage the experience of patients and carers; divert mental health patients away from the prison system; and help ensure a smooth operation of the Mental Health Review Tribunal

• Extra funding for LifeLine ($8mil over 4 years) for telephone and counselling services

  Highlights for Community Managed Organisations – The proposed Mental Health Commission and quarantining of mental health funding will potentially be a good thing in the face of all the other health changes such as new local health areas and the ever present temptation to use mental health funding for other services. How funds for CMOs are quarantined or managed will need to be worked out. Funding for Lifeline is the only specific program or CMO mentioned (so far). All up extra for CMOs is $8mil over 4 years.

  ***

  Labor

• New public perinatal mental health service ($29.6mil over 4 years). This includes a new 8 bed mother and baby inpatient unit (location to be determined) and an expanded maternity and post-natal home visit program to support mothers at risk of post-natal depression.

• Doubling HASI (Housing and Accommodation Support Initiative) ($20.8mil over 4 years). Extra 1,100 places but no indication of support level mix or target groups.

• Setting up Assertive Community Response teams ($14mil over 4 years). Three pilot sites in Western Sydney, the Hunter and the Illawarra to deliver “community based” mental health interventions for children and adolescents.
  

• Family and Carer Mental Health Program extra funding ($8mil over 4 years). Extra funds for NGOs to provide these services.

• Expanding the number of Declared Mental Health Facilities throughout rural and regional NSW ($5.92mil over 4 years).

• Mental health research ($5mil over 4 years). $500K each year for leading schizophrenia researcher Prof Cyndi Shannon Weickert and $3mil to set up a Mental Health Clinical Academic Research Program.

• Expanding specialist Older Persons Mental Health Unit in the Hunter ($3mil).

• Continuing beyond blue national depression initiative in NSW funding for another year ($1.2mil)

• Expanding inpatient mental health infrastructure

  • A new Psychiatric Emergency Care Centre (PECC) at Blacktown Hospital

  • A Safe Assessment Room at Mt Druitt Hospital

  • A 20-bed sub-acute unit at Wyong Hospital

  • An additional 70 beds at Campbelltown Hospital and new mental health services as part of the Liverpool Hospital redevelopment

  Highlights for Community Managed Organisations – The major item for CMOs is the doubling of the HASI packages to 2,200. HASI is an effective program and its expansion is a good thing. The other main item for CMOs is the extra funding for the Family and Carer Mental Health Program. Beyond blue depression initiative is the only CMO specifically mentioned with this program being renewed for another year. Total extra funding announced for CMOs is $30mil over 4 years.

4 Comments

1. Murf
   Posted March 20, 2011 at 7:44 pm

   The MH Commission proposed by Lib/Nats sounds promising, but it would be good to know what sort of staffing they propose and how much salaries for them will cost; how often will they meet, what targets will they monitor, who do they believe will give the best value services to the various diagnostic groups (social workers, psychologists, family therapists, psychiatrists)? The rest of their plan sounds too vague to comment on.
   The Labor proposals are nicely detailed although they don’t state what sort of personnel will be providing services under the funded programs. I don’t like the idea that a specific researcher gets a great lump of funds they haven’t competed for on the open market, no matter how innovative or promising the program so far. Other researchers who compete for ARC and NHMRC money will be put offside! Better to provide salary and facilities for some research officers to be employed while directed by senior personnel already in NSW Mental Health. The Beyond Blue extension doesn’t sound enough to be meaningful since it must cover admin, communications, mental health workers and possible security- 12 months psychiatrist salary takes $250 000 already! The wonderful funding for the mothers/bubs program will have to be carefully allocated across buildings and staff as buildings cost a fortune- usually a lot more than first quoted for, especially when its all custom designed and built, not a couple of project homes cobbled together! I like the Labor proposals better than Libs, but it would help people deeply concerned about making the most of funds to see even more details and any flexibility with funds and personnel that may be shared with other health sub-sectors.

2. Melissa Sweet
   Posted March 21, 2011 at 6:57 pm

   Sally Rose, Blogger-in-Chief, Global Access Partners, asked me to post this comment on her behalf:

   Not working in the field I am only able to judge the relative merits of those lists by tallying the numbers. Painting a rough picture of a $38million + commitment from Lib/Nats VS a $79.52Million + commitment from Labor.

   Given that spending twice as much doesn’t always produce twice as much benefit, and given that there is never enough money in the budget for every worthy initiative to receive funding I’d like to pose a hypothetical question.

   Let’s imagine the funding commitments were met halfway and the Mental Health Coordinating Council was given the opportunity to outline how to spend $60million on improving mental health services in Australia how would you advocate spending it?

3. jass
   Posted March 21, 2011 at 7:32 pm

   At the moment, Western Australia is the only state with a mental health commission. Having been involved in the process – for a part of it anyway – my impression is that there are aspects of it which are quite promising. The old way of doing things in mental health is simply not working, and it is time to start something new. But in WA the commission does not have a legislative basis and the primary motivation is the government’s ‘markets are everything’ philosophy. so the commission becomes a market mechanisms, effectively, and a body that purchases services from mental health providers. the purchaser/provider relationship is thereby sharply divided.

4. Tully Rosen
   Posted March 21, 2011 at 9:12 pm

   Hi Sally,

   As we outline in our “Call to Action” position paper, there are a number of high-priority and cost effective programs that could be immediately invested in that would provide substantial benefit to people living with mental illness in NSW. To date, Labor has been more financially supportive of our identified priority areas, while the Coalition has committed to overdue broad structural reform. Neither is anywhere near enough.

   Our greatest concern, along with many many others in the mental health sector, remains that mental health overall is grossly underfunded – NSW remains around the bottom of the rankings for spending on mental health, for the percentage of mental health funding allocated to community mental health, and for the percentage of mental health funding allocated to NGOs. We need to be talking billions of dollars.

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 18

Socrates says: "Almost one year on! This is still relevant, still do-able, and still to be done!"

Gillard can fix shattered mental health services

25th Jun 2010

Professor Patrick McGorry all articles by this author

2 comments

PRIME Minister Julia Gillard starts her new job faced with many challenges, but also with many opportunities. One of those opportunities is a unique set of circumstances that can enable profound change in mental health.

On Friday 18 June, then Prime Minister Kevin Rudd explicitly stated that mental health and aged care were the two next priority actions in healthcare. Less than a week later, at the exact time he was due to meet with the mental health sector to discuss ways of achieving progress in mental health, he was voted out of office.

But although mental health’s face time with the PM was gazumped by the ALP leadership battle, there is still momentum gathering for action on mental health reform.

Firstly, it helps that Julia Gillard is one of the politicians who “gets it” about mental health – something I observed first hand on her visits to the Orygen youth mental health service for which I work. But more importantly there are now political dynamics in play that are enablers of meaningful reform in mental health. Those enabling dynamics are greater sectoral unity, increased community support and “cut-through” to the national debate.

On the day that Julia Gillard replaced Kevin Rudd, leaders of the mental health sector presented the Government she will now lead with an agreed, common position. More than 60 signatories – virtually every key mental health body, including representatives of doctors, psychiatrists, psychologists, mental health nurses and social workers – made it clear to Government as to what needs to happen next.

Julia Gillard’s Government now has an unprecedented opportunity to work with a unified sector and can seize this opportunity by orienting policy around ending unequal access to quality care between mental and physical health.

Also on the same day that Julia Gillard was voted in to become Australia’s first female Prime Minister, her office was presented with a petition from 80,000 Australians asking her to take urgent action on mental health. These signatories were mobilised in just 48 hours and are an early expression of growing community awareness and concern about mental health.

GetUp!, which organised the petition, also published an Auspoll last month showing 83% of Australians would support a $500m p.a. package of investment to begin implementing the 12 mental health recommendations of the National Health and Hospitals Reform Commission.

Such an investment could be made immediately as a confidence-building measure by Government before working to develop the national reform program in mental health that is one of the core recommendations of the sector to Government.

That wider package of reform will involve a lot more money – probably a doubling of mental health’s share of the health budget (now 6%) to bring it close to or equal to its share of the health burden (13 per cent). This involves several billion dollars a year of public money and can only be accomplished with public support.

However, the national conversation on mental health as reflected in recent media coverage reflects a growing understanding that services are severely underfunded, that this is discriminatory and detrimental to Australian families and that sustained action to address these failings is needed.
Whisper it softly, but we may be close to a tipping point on mental health reform.

Comments:

Shikha

25th Jun 2010
5:49pm

The stumbling block, rate limiting step and bottle-neck to any such health reforms would certainly be the health minister, overlooked in this article. It was this very government and this cabinet and Madam Roxon's department that have deemed only qualified psychologists dish out mental health care under the Mental Health Plan guidelines. They have undermined and side-lined other workers in this area already carrying a large burden and caring for a great many patients, risking fragmentation of care and more burden on the already over-stretched system. Rearranging the proverbial deck chairs won't save this sinking ship under this governance. When the Minister won't listen to legitimate arguments about the flaws in the direction of health reform what difference does it make who's at the top and who she reports to? Nurse prescribing, nurse practitioners setting up next to GP's, midwife indemnity fiasco, superclinics, diabetes budget-holding and so on. Damage already done.

sickofpoliticians

5th Jul 2010
1:40pm

Its just such a pity that it takes a change in Prime Minister to forge us toward a so-called 'tipping point'. Realistically, whoever is in government, the system will still stink until someone with some sort of experience of the mental health system, reforms it. The first question we need to answer is 'How can the mental health system sustain itself when the need clearly outweighs what is given?'.

My name was one of the 80,000 handed to parliament. I did so because I have seen the system at work, I have experienced the frustration, the never-ending cycle because patients are over medicated and dependent. I have experienced the heart ache of carers who struggle to get their person a diagnosis, just so they will be eligible for the hundreds of badly planned out "programs" that the goverment has presented us with.

Spend some money on therapy, spend some money on more staff and start paying the people that work the hardest the money they need to be able to sustain the jobs they face on a daily basis. Spend some more money on research, and put Australia in the running to be best practice for mental health. Spend money to ensure that those who are caring for someone living with a mental illness feels supported. Spend some money to ensure that the person living with the illness can obtain a diagnosis quickly, and without mistake. Train the clinicians, careworkers and stop spening money without doing your research - if you have a spare $1.1 billion dollars lying around somehwere, before you spend the money, ask youself... Where do people need to money the most?

We are a nation of over-weight people already, lets not add increased rates of mental illness to that as well. Stop spending money on opening up Australia to other nations, fix the situation we have here, first! People are taking their own lives everyday, and we are all sitting here arguing about what to do next. Get is right Julia, get it done!

SSWAHS = SWSLHN + SLHN: Will it be different for the people of the Southern Highlands?

Well, apart from two rural LHNs, the Premier and Health Minister have decided upon who will be the Chief Executives of the other 16 Local Health/Hospital Networks.

At this time it is still unclear to the community members as to what will happen to the old SSWAHS Clinical Divisions and, more importantly, whether the people of the Southern Highlands will have the same access to the specialist inpatient beds which they had in the past. Or will the old Central Sydney AHS now re-branded as the Sydney Local Hospital Network (SLHN), manage to set up the barricades again?

Dr Victor Storm must be rubbing his hands with glee that he is back in his old stamping ground with control of his new, beaut "asylum" (you know, the one he said we should do without) the Concord Centre for Mental Health. I wonder if his vision of mental health (and treatment of the mentally ill) still extends southwards to Bowral Hospital and the Southern Highlands.

It's yet too early to get the information as to "who's who in the zoo" when it comes to the lesser mortals in the new 18 Local Hospital/Health Networks. One of the other persons mentioned in this blog, notably for her prolonged silences, appears to have slipped off the radar when it comes to the top jobs. Surprisingly, Jan Whalan appears to have also slipped off the Christmas card list for the Premier and the Minister as she did not get one of the Chief Executive positions published by NSW Health to date. I guess she could still manage to swing into one of the two remaining rural LHNs - if she hasn't trodden on too many toes! Perhaps, (hopefully) Ms Jan Whalan is making a return to running a pharmacy somewhere!

One bright spot in the shuffle of chairs is that the new Chief Executive for the SWSLHN which, according to the blurb, runs from "Fairfield to Bowral" is none other than Ms Amanda Larkin.

Amanda Larkin started her rise up the ranks by being the General Manager of Bowral Hospital for a number of years. She was then asked to manage the Campbelltown/Camden Hospitals when there was a shake-up in the system there a few years ago. She presided over the Macarthur-Wingecarribee health services until the recruitment of the General Manager for Macarthur Health Service took place and then took up the permanent position of General Manager of the Macarthur Health Service, thereby allowing the hardworking Denis Thomas to be appointed to the Bowral Hospital as General Manager. Even though she may be relocating to the Liverpool Hospital campus in her new position as Chief Executive of the SWSLHN I'm happy to report that, unlike her predecessors, Amanda Larkin does know where Bowral is and where the rest of the health services in Southern Highlands happen to be.

Nevertheless, as residents of the Southern Highlands we cannot become complacent about the state of the health services being offered in the Highlands. There are still issues of a more appropriate use of the operating theatres at Bowral Hospital to reduce the waiting list for elective surgery. And while Bowral Hospital is given a tick for renal dialysis does it really happen as much as it should?

Let's keep vigilant about our health service and remember - the NSW State election is only about 43 days away!

SSWAHS and its allies - Part 4

Having come back from a great Christmas/New Year break Socrates was able to discover that one of the SSWAHS allies had decided upon an interesting Christmas present for the person they have recently been engaged in denigrating and defaming in their blog.

"Why", one might ask, should one blogger be so enraged by another's attempt to obtain a response from an unresponsive Area Health Service, that the blogger should lodge frivolous complaints with the Health Care Complaints Commission (HCCC) in an attempt to damage the other's reputation?

Just reading through some of that person's published comments on their blog and on that of the blog of the person they have attacked, provides the answer to the question "why"!

Fortunately it would appear that the HCCC, in a record for possibly the fastest turn-around for all time, has informed the complainant that they were not willing to take up their complaint. I guess the reasons for their decision were obvious in light of the fact that the complainant publicly incited the action.

It makes one wonder if the person, about whom they had made the frivolous complaint to the HCCC, has any legal redress. In light of recent posts about defamatory comments and vilification posted on the internet, the blogger's actions against the person they opposed could be setting an interesting precedent.

Anyway, one has to wonder whether the mind of the antagonist blogger could be better utilised on their own issues. If you think these actions of the complainant blogger were quite sad - they probably are.

SSWAHS and its allies - Part 3

Socrates had hoped that the brother of the adversarial blogger would have attempted to advise his brother against inflaming further the situation he has already ignited with his misdirected and salacious remarks forwarded to Socrates and to another blogger's site. I'm told that the person who moderates the other blog has decided to no longer re-publish my postings, and has allowed to be published the defamatory and denigrating comments previously forwarded to it by the blogger, Paul C.

Today, Paul C launched another attack amounting to bullying and harassment of others. To suggest that this can be validated by stating it is done in the presence of a mental illness or alcoholism is hardly sustainable when the same person has already indicated in his blog that very soon he will have been alcohol free for 18 months and, presumably, also mentally well. As Socrates has no intention of being accused of causing any deterioration of this person's mental state, the following is simply a cut and paste of the blogger's own posting.

Monday, 20 December 2010

he is at it again

The local male psych nurse, who was sacked by the Area Health Service last year for some very strange and very unprofessional behaviour, is involved again in posting material about me and others on the internet.

One of the reasons that this does not really bother me too much is that I know that the two blogs he is involved with will probably never have more than a dozen people in the whole world ever bother to read any of the rubbish they post.

I know over the last four years I have at times posted some pretty insane stuff on this blog but I believe this can often be explained by the fact that I suffer from episodes of bipolar schizoaffective disorder and alcoholism. When I become sober and mentally well again I have often gone back and deleted some of more insane stuff I have posted.

What excuse or explanation can this disgraced male psych nurse have for his very strange, bizarre involvement in two internet blogs?

What is posted on these two blogs is often written in this pompous, grandiose style. It is as though the writer believes he is writing for thousands of readers. If these two blogs become any more grandiose the people involved will probably start to believe that their rambling nonsense is going to bring about something like a Royal Commission into SSWAHS (the Area Health Service) LOL.

I have family members and friends who believe this male psych nurse is mentally unwell. If they are right, I suppose he should probably be pitied. It is a strange situation when someone who used to somehow function as a mental health professional is himself very psychologically flawed and has little or no insight into this truth.

Oh well, I can only wait and see what will appear next on either of the two blogs that this sad, troubled man is involved with.

Posted by Paul C at 3:50 PM; and Posted by Paul C at 6:46 PM - 2 comments

Anonymous Anonymous said...

I have read everything posted on the "Shalwyn" and "Socrates" blogs you are referring to.

Little do you know that they have rocked the very foundations of SSWAHS (the Sydney South West Area Health Service).

I am certain that every morning the first thing the premier, the health minister, the ombudsman, the SSWAHS bosses and many others read is the "Socrates" and "Shalwyn" blogs.

Also, how dare you describe my uncle, who is the finest mental health clinician to ever work in the Southern Highlands, as a sad, troubled, psychologically flawed man. You are defaming a true giant in mental health!

Yours,

Jimmy O'Tool,
forensic patient,
D (Psychiatric) Ward,
Long Bay Jail.

20 December 2010 6:46 PM
Anonymous Anonymous said...

Well said, Jimmy!

I have been a client of your dear uncle.

He truly is as you say, a giant in mental health.

Just prior to my recent hospitalization I had my medication adjusted and reduced and I then wrote many threatening letters to the Nobel committee demanding they award the next Nobel prize for medicine to your dear uncle. I still believe this was reasonable, rational behaviour.

Martha O'Springer,
Locked Ward, Waratah House,
Campbelltown.

20 December 2010 7:20 PM

SSWAHS and its allies - Part 2

Socrates has been "warned off" by the brother of the blogger mentioned in the previous post. This is another person who also thought Socrates' blog was "sad".

"That's not bizarre or crazy. Sounds like a lot of fun actually. For an example of bizarre and crazy, you only have to visit:
http://sswahsandbowralhealth.blogspot.com/
but I wouldn't visit it too much, it's way too sad and pathetic. Give my regards to Willie. Tell him I love the reworking of "Friend of Mine" he did for Brokeback Mountain."

1 December 2010 2:07 PM

When the world's media is currently preoccupied with governments and government agencies being kept accountable (Wikileaks), one would think a simple blog like mine is in keeping with world trends.

If other bloggers can publish comments that can be deemed to be controversial or defamatory surely they can expect to be challenged by their readers. I accept the comments of the brother of the blogger mentioned in my previous posting - but I don't have to engage in any dialogue with them and I choose not to.

I suggest to the blogger's brother that, rather than encouraging his brother to publish derogatory and statements about others, he might consider the laws against vilification and defamation and caution his brother from publishing more of the same.

I have studiously avoided naming the blogger or his brother as I, unlike them, prefer to have nothing to do with either. They both seem to have a perception that Socrates has multiple personalities. In fact, Socrates has one personality but a number of informants who have corroborated the documentation provided in regard to the failure of the SSWAHS Executive to deal with a number of serious complaints made against some of their senior staff members. Complaints which are still to be reported upon by SSWAHS to the complainant. Yes, this is indeed a sad state of affairs when a statutory authority has failed to deliver that which it promises in it's own documentation.

I have no doubt that this blog entry will be scrutinised by the other blogger and his brother. What happens next will be up to them. If both, or either, wish to demonize Socrates (or any others known to him) then they will have to be aware of the consequence of their actions.

SSWAHS has its ally - or some might suggest: "With friends like this who needs enemies"

Socrates has had a short break but now it's back to business. There was one interesting interlude which arrived as a form of comment from a fellow blogger who thought that the information in this blog was "A very sad case". The following is their opening gambit:

"I have been a client of the local mental health service on and off since 1994.

"About two years ago, there was a front page article in a local newspaper that was highly critical of the local mental health service. I stated on this blog that I was one of the people that spoke about my problems with the local mental health service to the journalist who wrote the article."

Below is what the same person stated about the local mental health service on the 23 October 2008 about the time that the blogger refers to in the comment above.

"Another day when I had every opportunity to drink but I didn't. I have the house to myself. I have money and I am feeling a bit stressed with this article coming out in the paper. BTW: the journalist wanted my full name to go into the article. This would not have worried me but some of my family did not want this, which is fair enough. I feel stressed wondering who is talking to this journalist and what they are saying.

Also, I feel stressed worrying that (while I feel nothing about most of the useless clowns that work there) there are three people who work there that are OK and have treated me all right.

Since 1994, there have been a lot of times when either no-one who worked there or maybe only one staff member had any time for me .......... but now, when the article is written there are three working there that are OK. The journo has promised that she will not "hang me out to dry" and she will show me the last draft before the thing is in print.

To repeat myself, I hope the article causes maximum discomfort and embarrassment to most of the people there who have in various ways treated me like shit but I feel bad about helping with this article when three people that work there have treated me OK.

If I was a nicer or better person I would think more of Harry, Alan and Gillian and I would have said "no" to any involvement but as it turns out I could not resist the chance for a bit of pay-back against the majority of BMH (Bowral Mental Health), who I think really deserve it: AND as it turns out, I am not the only one they have done the wrong thing by."

"What happened quite a few times since 1994, was that a local shrink could schedule me to a place like CRC for 4 weeks, but they could discharge me after a week and then I'd come back to this area, still mentally unwell and usually receive zero follow up, support or supervision from the &%$#@S that have worked in the local mental health team.

They are obviously not to blame for everything but on a number of occasions they were a factor in me running around this area (longer than I had to be) off my head, getting into legal trouble and putting some members of my family through hell.

"I hope I can get to November 29 without drinking again; that will mean one year, 365 days, with only three days drinking A 99+% success rate. 2008 will be the most sober year since I was 16. I also will have achieved this without being in jail or rehab ....... and I also did it without "swapping the witch for the bitch" ie: I have not used or abused valium, xanax, pot or any other drug this year."

Socrates simply makes the point that a person affected by a chronic substance abuse may not have the best attitude about the persons who provide health and support to those so affected. The comments from the blogger posting the quoted text from 23 October 2008 would suggest that they have had little interest in taking responsibility for their actions, preferring instead to lay the blame upon the clinical staff that they were so anxious that their action "causes maximum discomfort and embarrassment to most of the people there who have in various ways treated me like shit but I feel bad about helping with this article when three people that work there have treated me OK.

"If I was a nicer or better person I would think more of Harry, Alan and Gillian and I would have said "no" to any involvement but as it turns out I could not resist the chance for a bit of pay-back against the majority of BMH (Bowral Mental Health), who I think really deserve it."

Now, Socrates does think that this is more than a bit sad!

SSWAHS - Dr Victor Storm and security at mental health facilities

Further to the previous post Socrates notes that carers and family members are also asking the same questions. In this report Mr Stevens is stating the obvious - persons with a severe mental illness admitted as involuntary patients under the NSW Mental Health Act (2007) are so admitted because they have been deemed by a psychiatric Registrar or psychiatrist, employed by SSWAHS, to be so mentally impaired that they are not able to make rational decisions.

For SSWAHS staff to make decisions without taking into account their clinical responsibilities and duty of care for the patient is worrying. Equally worrying is that Carers had a significant input into the changes made to the NSW Mental Health Act 2007 to enshrine in it the role of the Carer or other significant person in the Care Plan devised for the person in their care. How is it that Mr Stevens and other Carers are not having a say into the actual and proposed care of their relatives?

Is SSWAHS and its Area Mental Health Directors ignoring the intent of the NSW Act when it comes to listening to the family members and other Carers? And if Dr Angelo Virgona believes that the record of the Liverpool Hospital Mental Health Unit is no worse than any other mental health unit I wonder if that statement was any consolation to Mr Stevens and any other Carer who had a relative "flee" from Liverpool and any other SSWAHS Mental Health facility?

Mental health unit security worries relative

ANNE TARASOV

17 Jun, 2009 05:00 AM
Liverpool City Champion Newspaper

MARK Stevens has seen several patients flee from the high-dependency mental health unit at Liverpool hospital.

The Cabramatta resident, who has a relative that has needed to stay at the unit several times, said he is concerned about the procedures in the unit.

``A lot of the patients are `scheduled', which means they have been brought to the unit against their will, because they're a danger to themselves and others,'' Mr Stevens said.

``But the exits in the unit aren't properly patrolled and it's really easy for them to just run out, without anyone noticing.

``I was standing near an exit speaking to a nurse about the condition of my relative when a female patient ran up to us, pushed us both aside and ran out of the exit, down the corridor and out of the hospital. And who knows when they brought her back. It's just so easy for them to run off. It's really dangerous.''

Mr Stevens said they many of the patients are also let out on leave too early and escape from staff and relatives asked to supervise them.

``My relative has been let out on leave a few times, and they will be with three other patients and only one female nurse watching over them and one time, my relative managed to get away.''

Sydney South West Area Health Services Director of Clinical Services in Mental Health Dr Angelo Virgona said the unit was not designed to be a jail.

``In keeping with the spirit of the Mental Health Act we're not aiming to be too restrictive of our patients. ``We aim to create the best therapeutic environment for people to recover from their illness, so it can't be too restrictive.

``But we upgraded our exits in 2008 and now we have another layer of security so it's even more difficult to flee.

``There is no way to guarantee that patients will never leave the unit,'' Dr Virgona said. ``But we don't have more patients leaving than any other mental health unit.''

SSWAHS - Dr Victor Storm - Deaths in Mental Health Custody

Socrates notes the sentiment expressed by Dr Victor Storm about the death of a young woman in the UK mental health system. In this article published widely by the National Times last year, Dr Storm moralises on the dilemma faced by his colleagues in the UK: "There is a delicate balance between keeping someone under surveillance and giving someone the autonomy to control their own destiny."

He also then states in the same article: "To allow someone to die as this young woman died runs counter to what other clinicians and I attempt to avoid daily: an unnecessary death."

Then comes the extraordinary denial of responsibility: "Sometimes our treatment efforts are not successful. Occasionally people do kill themselves while we are trying to treat them. This may occur because an individual does not tell us what they are planning. At other times, a sensible plan of leave or community care has been decided upon but the situation changes abruptly or a person reverts to a sense of despair and does not seek further help.

Sometimes errors of judgment, or reasonable decisions made on limited information, lead to an adverse event.

Deaths occur in spite of the efforts made by clinicians because of the nature of the illness. Our tools of prediction are not precise. Human behaviour is immensely variable."

Socrates has to say: "Who should be held accountable in this case when death occurs? The medical staff who control the patient's treatment - or the patient whose mental state is deemed to be sufficiently impaired that they are involuntarily admitted to a psychiatric facility by doctors who then, presumably, accept a duty of care for the patient? In my book the very act of detaining a person under the Mental Health Act places the responsibility for the care and protection of that patient clearly and squarely in the hands of the treating doctors.

Perhaps Dr Storm, instead of pointing the accusatory finger at the flaw in the UK Mental Health Act that allowed this death to occur, should look at his actions and those of other medical staff in his SSWAHS Clinical Division, that have led to more than one unnessary death: "Sometimes a person self-harms or commits suicide when moving from hospital to home. This always leads to soul-searching by clinicians. Sometimes recriminations from families are inevitable; as clinicians, we have to accept that. But we also have a responsibility to care and treat - even if our treatment is sometimes controversial."

Victor Storm

October 4, 2009
National Times Newspaper

A young Englishwoman was allowed to commit suicide in hospital over four days. Kerrie Wooltorton had a history of mental illness and had made multiple attempts on her life. Yet it was deemed she had the mental capacity to refuse treatment.

That refusal was legally binding on hospital doctors under the provisions of the British Mental Capacity Act.

The coroner, William Armstrong, found that the doctors involved with her care had acted lawfully by not trying to save her life. Otherwise they may have faced sanction under the Medical Practice Act, been liable to deregistration and charged with assault.

''She had capacity to consent to treatment which, it is more likely than not, would have prevented her death,'' Armstrong said. ''She refused such treatment in full knowledge of the consequences and died as a result.''

Wooltorton was 26.

It is an invidious situation for health professionals to find themselves in. The matters surrounding Wooltorton's death and the coronial inquiry are disturbing. The death by self-poisoning of a disturbed and depressed young woman was sanctioned - a situation that I hope is never repeated.

Medical practice laws in Britain and NSW have many similarities, but we are fortunate that under current legislation in this state a similar situation would not receive legal sanction.

Mental capacity assessments here do not include a legal right to commit suicide in the way Wooltorton chose. If such a clinical situation were to arise in a NSW hospital, the Mental Health Act should usually be invoked and resuscitative treatment given.

Is this a draconian denial of an individual's rights? I think not. There are important reasons for us to reject the legalistic argument used in Britain.

I am a psychiatrist who has worked in mental health for 30 years. I have treated people with complex disorders who have made multiple attempts at suicide, recovered and been grateful for the ongoing care that allowed them another chance to lead a satisfying life. This experience is common for most clinicians.

To allow someone to die as this young woman died runs counter to what other clinicians and I attempt to avoid daily: an unnecessary death.

We are faced regularly with individuals who suffer significant depression and despair for extended periods. People may express a wish to die, and some might make multiple attempts on their lives, but most clinicians will try as hard and as long as they can to help ease a person's suffering and bring on recovery.

In most instances, clinical intervention is successful. Most people who seek the support of our services recover and get on with their lives. It is important for the wider community to understand that even those who suffer serious depression associated with other mental health problems generally get better, even if it takes some years.

Sometimes our treatment efforts are not successful. Occasionally people do kill themselves while we are trying to treat them. This may occur because an individual does not tell us what they are planning. At other times, a sensible plan of leave or community care has been decided upon but the situation changes abruptly or a person reverts to a sense of despair and does not seek further help.

Sometimes errors of judgment, or reasonable decisions made on limited information, lead to an adverse event.

Deaths occur in spite of the efforts made by clinicians because of the nature of the illness. Our tools of prediction are not precise. Human behaviour is immensely variable.

Families and friends suffer enormously when people commit suicide - and society as a whole is diminished. There is a place for compulsory treatment. There is a need for persistent attempts to involve depressed and disturbed individuals in some form of ongoing psychological and psychiatric care. Temporary deprivation of liberty under a mental health act may be required.

There is a delicate balance between keeping someone under surveillance and giving someone the autonomy to control their own destiny.

Sometimes a person self-harms or commits suicide when moving from hospital to home. This always leads to soul-searching by clinicians. Sometimes recriminations from families are inevitable; as clinicians, we have to accept that. But we also have a responsibility to care and treat - even if our treatment is sometimes controversial.

Even if Wooltorton had no current sense of hope, there would have been good grounds for us to work towards her recovery.

Her suicide is quite different from people who decide to cease active treatment when their lives are ending due to general debility or failure of bodily systems and there is no feasible possibility of recovery.

Her death leaves a nagging doubt: that in spite of what she said verbally and in writing, she took measures of self-harm that were not immediately fatal. She asked to be in hospital, where she could have received treatment and another chance at life.

Perhaps her non-verbal cues were missed. Her father has expressed a wish that the mental capacity law be changed. I support his wish. I am grateful no such law exists in NSW.

Associate Professor Victor Storm is clinical director of mental health at the Sydney South West Area Health Service. For help, call Lifeline on 13 11 14.

Perhaps Dr Storm would like to give another article to the National Times in which he would like to give the number of patients, actively in the care of the SSWAHS Mental Health Service, who have died in one of his mental health facilities, or while on approved leave from one, or in the care of his community mental health teams after they have returned home.

Let us see if it is only the UK mental health system that misses "the non-verbal cues" of their patients. Then I would like to see how much soul-searching by SSWAHS clinicians takes place, and what explanation has been given to the families of those who have died while in the care of SSWAHS.

SSWAHS - Dr Victor Storm and those problems of files lost in the public domain!

Socrates's internet trawl to find even more evidence of the stumbling efforts of SSWAHS to manage even the simplest tasks came up with this gripping expose by "The Age" newspaper about the time when Dr Storm was doing his best to organise the transfer of the Rozelle "asylum" to his new Concord "asylum" - the one that he thought the Liberal Party should not build in 2002!

Private files put on street for all to read

Matthew Moore "The Age"
Freedom of Information Editor
May 6, 2008

PLASTIC wheelie bins full of confidential documents were left outside Rozelle Hospital in a last-minute rush to move the hospital to its new site at Concord.

Staff records, including details of criminal convictions and personal medical histories, were jammed into the bins along with minutes of meetings and disciplinary proceedings.

A letter lying at the top of one of the bins details an altercation in January 1991 between a cleaner and his supervisor, who had asked him to clean some windows.

"Mr A [name deleted] … threw a garbage tin of rubbish on the ground and also said he would kill Mr S … [name deleted]," an exasperated manager notes.

Other documents detail the property staff members have failed to return over decades.

Records from the Child Support Agency detailing maintenance deductions the hospital was required to make for individual employees are also included in the thousand of pages of personal documents.

Anyone wandering through the open hospital grounds, popular with dog walkers, was free to leaf through decades of documents left in the driveway of the administrative and information building, which closed its doors at the site last week.

Half a dozen wheelie bins left in the driveway of the administration block were locked but six others were open or secured only with adhesive tape applied by desperate staff members unable to get enough bins to secure documents they knew to be confidential. Two of those bins carried notes headed "Confidential documents".

The notes, written by a staff doctor, Graeme Halliday, said: "To Whom It May Concern, Ive been requesting confidential paper bins for at least a week before the hospital closed but could not get any. Transport kindly delivered these on Thursday May 1st, but I didnt realise until I had filled them - they are in fact not for the disposal of confidential documents. Quite happy to return to help transfer these to confidential bins if someone can help me obtain these."

Yesterday Dr Halliday was furious the bins had been left outside the building and said he had done his best to ensure their contents were properly disposed of.

He said he had worked until midnight on Saturday trying to dispose of documents he had no time to finish packing as he had had a full patient load during preparations for the move.

He had left all the bins locked inside the building on Saturday night and was uncertain who had moved them outside.

Dr Halliday drove immediately to Rozelle Hospital when he heard the documents were outside to ensure they were secured.

In other parts of the hospital grounds staff record cards spilled from torn plastic bags before a compactor truck arrived yesterday afternoon.

The director of mental health for the Sydney South West Area Health Service, Dr Victor Storm, said only two normal bins had been used for confidential waste. The bins had been put outside by accident yesterday morning.

"Both the secure and general waste bins have since been locked away, and a collection is now expected later this week."

I suppose we should be grateful that "only two normal bins had been used for confidential waste."

There, doesn't that make us all feel better? Obviously, Dr Storm and SSWAHS seem to think so.

SSWAHS - Dr Victor Storm - The Federal Government's not the only one to ignore a significant need!

Socrates found this piece of spin by Dr Victor Storm, the SSWAHS Executive member who seems more interested in protecting his poor performing senior staff members who fail in their duty towards the consumers of their mental health services. Instead of decrying the lower Federal budget commitment to mental health, perhaps Dr Storm should be less committed to building his SSWAHS empire's infrastructure (his Concord Centre for Mental Health Services) and for machines that go "ping" he should use some of funds his Area Health Service gets from the State and Federal governments on those integrated specialist community-based mental health services that he suggests will be championed by the likes of Morris Iemma.

Socrates finds it somewhat prophetic of Drs Storm and O'Connor seemed to pre-empt the choice of the current NSW Premier in the recent selection of Morris Iemma to one of the key positions in the NSW Local Health Networks.

Budget has ignored a significant health need
Nick O'Connor and Victor Storm
May 14, 2010

Have Kevin Rudd and Nicola Roxon forgotten about mental health? You are certainly left with this impression after the budget and health reform announcements.

There is nothing in the budget for mental health. Little came out of the Council of Australian Governments negotiations except for some important but hardly central enhancements for youth mental health and expanded access to psychological services for people suffering anxiety and other high-prevalence disorders.

Mental health represents more than 10 per cent of community morbidity, yet it received only 2 per cent of the health reform funding increases.

The Senate select committee inquiry into mental health called for its budget to be 9 to 12 per cent of the health budget by 2012. This now looks impossible.

Even more concerning is the split of community services from acute hospital services and the dismantling of area health services. This could break up the integrated mental health services it has taken decades to build. That would be a catastrophe for mental health, which at federal and state levels has seen opportunities for real improvement slip away.

The COAG meeting asked for a report on mental health next year, seemingly because at the last minute the Commonwealth realised its schema for the health system - which included acute hospitals, primary and community care and a sub-acute sector - failed to acknowledge the pivotal importance of specialist community mental health services.

These clinicians care for a large number of people living with serious mental illnesses such as schizophrenia. Some work in inpatient and community settings, some do intensive follow-up and treat people in their homes and community centres.

Despite growing need in most states, and NSW in particular, these services have not been improved for decades. They are the backbone that supports young people who need continuing care and they are at breaking point.

How could this omission happen? How could some of the most marginalised in our society be ignored? Every politician in our parliaments - state or federal - knows someone who needs specialist mental healthcare. Too many don't get it.

Several steps are necessary if Australia's mental health services are not to become a disaster - a champion, a plan and three enabling conditions.

We need a champion, much like Morris Iemma was on this issue when dealing with the Commonwealth as premier in 2006.

We need agreement on the mental health priorities. Nationally, it is a complex jigsaw of human services - disability, employment, housing, GPs, hospitals, services for children, youth and older people, prevention - all have a role.

Central to it are integrated specialist community mental health services. To date, there have been four national mental health plans and still we have no coherent national plan for delivering specialist mental healthcare.

The general principles and core requirements are generally understood by consumers, carers and clinicians. We need to increase community understanding of mental health problems, and do more prevention. We need more services for younger and older Australians and recovery programs to provide intensive treatment in the community, with secure housing and employment to sustain that recovery.

The states and territories need to articulate these priorities in a 10-year plan, and implement it. And we need to manage three barriers to such a plan.

Specialist mental healthcare is best delivered when integrated, including local community services, hospitals and specialty programs. These can be aligned with the new local hospital networks but need co-ordination at state level and to be administered regionally - where tertiary services cover a cluster of local networks. There appears to be sufficient wriggle room in the COAG communique to allow for this sort of arrangement.

Mental health funding needs to be quarantined to stop its being siphoned off and the shortage of mental health nurses and doctors needs to be reversed.

Mental health is dressed up ready to go to the big health ball. She is just waiting for a strong and courageous partner.

Dr Nick O'Connor and Associate Professor Victor Storm are Sydney psychiatrists, representing the NSW branch of the Royal Australian and New Zealand College of Psychiatrists.

SSWAHS - Dr Victor Storm - The Federal Government's not the only one to ignore a significant need!

Socrates found this piece of spin by Dr Victor Storm, the SSWAHS Executive member who seems more interested in protecting his poor performing senior staff members who fail in their duty towards the consumers of their mental health services. Instead of decrying the lower Federal budget commitment to mental health, perhaps Dr Storm should be less committed to building his SSWAHS empire's infrastructure (his Concord Centre for Mental Health Services) and for machines that go "ping" he should use some of funds his Area Health Service gets from the State and Federal governments on those integrated specialist community-based mental health services that he suggests will be championed by the likes of Morris Iemma.

Socrates finds it somewhat prophetic of Drs Storm and O'Connor seemed to pre-empt the choice of the current NSW Premier in the recent selection of Morris Iemma to one of the key positions in the NSW Local Health Networks.

Budget has ignored a significant health need

Nick O'Connor and Victor Storm

May 14, 2010

Have Kevin Rudd and Nicola Roxon forgotten about mental health? You are certainly left with this impression after the budget and health reform announcements.

There is nothing in the budget for mental health. Little came out of the Council of Australian Governments negotiations except for some important but hardly central enhancements for youth mental health and expanded access to psychological services for people suffering anxiety and other high-prevalence disorders.

Mental health represents more than 10 per cent of community morbidity, yet it received only 2 per cent of the health reform funding increases.

The Senate select committee inquiry into mental health called for its budget to be 9 to 12 per cent of the health budget by 2012. This now looks impossible.

Even more concerning is the split of community services from acute hospital services and the dismantling of area health services. This could break up the integrated mental health services it has taken decades to build. That would be a catastrophe for mental health, which at federal and state levels has seen opportunities for real improvement slip away.

The COAG meeting asked for a report on mental health next year, seemingly because at the last minute the Commonwealth realised its schema for the health system - which included acute hospitals, primary and community care and a sub-acute sector - failed to acknowledge the pivotal importance of specialist community mental health services.

These clinicians care for a large number of people living with serious mental illnesses such as schizophrenia. Some work in inpatient and community settings, some do intensive follow-up and treat people in their homes and community centres.

Despite growing need in most states, and NSW in particular, these services have not been improved for decades. They are the backbone that supports young people who need continuing care and they are at breaking point.

How could this omission happen? How could some of the most marginalised in our society be ignored? Every politician in our parliaments - state or federal - knows someone who needs specialist mental healthcare. Too many don't get it.

Several steps are necessary if Australia's mental health services are not to become a disaster - a champion, a plan and three enabling conditions.

We need a champion, much like Morris Iemma was on this issue when dealing with the Commonwealth as premier in 2006.

We need agreement on the mental health priorities. Nationally, it is a complex jigsaw of human services - disability, employment, housing, GPs, hospitals, services for children, youth and older people, prevention - all have a role.

Central to it are integrated specialist community mental health services. To date, there have been four national mental health plans and still we have no coherent national plan for delivering specialist mental healthcare.

The general principles and core requirements are generally understood by consumers, carers and clinicians. We need to increase community understanding of mental health problems, and do more prevention. We need more services for younger and older Australians and recovery programs to provide intensive treatment in the community, with secure housing and employment to sustain that recovery.

The states and territories need to articulate these priorities in a 10-year plan, and implement it. And we need to manage three barriers to such a plan.

Specialist mental healthcare is best delivered when integrated, including local community services, hospitals and specialty programs. These can be aligned with the new local hospital networks but need co-ordination at state level and to be administered regionally - where tertiary services cover a cluster of local networks. There appears to be sufficient wriggle room in the COAG communique to allow for this sort of arrangement.

Mental health funding needs to be quarantined to stop its being siphoned off and the shortage of mental health nurses and doctors needs to be reversed.

Mental health is dressed up ready to go to the big health ball. She is just waiting for a strong and courageous partner.

Dr Nick O'Connor and Associate Professor Victor Storm are Sydney psychiatrists, representing the NSW branch of the Royal Australian and New Zealand College of Psychiatrists.

SSWAHS - Mr Scott Fanker and the NSW Health Care Complaints Commission

Socrates again looks at how a complaint from a dying Southern Highlands woman, supported by a concerned person, can be ignored by an unfeeling SSWAHS Executive - until after she had died. Then the complaint against one of their own was dismissed because the victim of the behaviour was now dead. How callous is that!

Mr Ian Thurgood

Director

Complaint Assessment Branch

Health Care Complaints Commission

Locked Mail Bag 18

Strawberry Hills NSW 2012

12 April 2010

Dear Mr Thurgood,

Thank you for your response to my complaint in which I act as an advocate for the late Ms B P. On the basis of the information provided in your response I wish to request a review of the decision the Commission has taken for not proceeding.

I must confess that I remain appalled at the way in which the SSWAHS has dealt with this serious complaint and the way in which it dealt with the original complaint made by Ms B P in 2007.

In respect of my complaint lodged with the Commission in November 2009 I made the following statement:

“In late 2007 or early 2008 the person affected and named above was a client of the Bowral Community Mental Health Service. She was being treated by a psychiatrist at the Browne Street Community Mental Health Service with whom she had elected to be treated while she remained residing in her home at Bundanoon. She had formed a good therapeutic relationship with that doctor who, nevertheless, requested care coordination and support be offered to the patient by the local Bowral Mental Health Service.”

In your response you note that I reported that Ms B P had reported her concerns about the alleged professional misconduct by Mrs T K, her assigned care coordinator in late 2007. I recall making a record of Ms P’s exchanges of text messages with me and placing a transcript of the messages in her file, at that time held at the Bowral Community Health Centre. I am unable to confirm the exact dates and the exact content of those text messages because I do not have access to her clinical file. I do note that I did enter the complaint in the NSW Health incident reporting system (IMMS) which would have made it available to the SSWAHS Area Executive and the Area Mental Health Service. A record of the incident and its subsequent management would be available on the electronic history of the incident held by the SSWAHS and NSW Health.

I suggest that if the Commission gained access to the clinical file of Ms BP and of the IMMS report of the alleged incident of professional misconduct they would have a better understanding and timeframe of the events associated with the original complaint made by Ms BP.

Mr Thurgood, there are some issues with the SSWAHS response which, singly and collectively, cause me great concern.

When the issue of the alleged professional misconduct was first raised by Ms B P and lodged with the electronic incident monitoring system, Mrs T K was still employed by SSWAHS. I can confirm that she was asked by me to withdraw from her role as care coordinator to Ms B P as a result of my receiving the texted information which was recorded in the clinical notes. Mrs T K was advised that this was due to a complaint received although she was not informed of the substance of the complaint. She was, however, informed that the complaint would be investigated. Subsequently, Mrs T K resigned from her position in April 2008 and commenced working for the Southern Highlands Division of General Practice, providing clinical services as a registered nurse and psychologist to the present day.

I believe the complaint made by Ms B P to the General Manager’s Unit of Bowral District Hospital on 13 August 2008 was, in part, due to the reluctance of Ms B P to continue to be care coordinated by the Bowral Mental Health Service. The fact that she may have again raised the matter of the earlier allegation of professional misconduct would be, to a reasonable person, indicative that she was not satisfied of the actions of the SSWAHS Executive in general, and of Mr Scott Fanker of the SSWAHS Area Mental Health Service in respect of her earlier complaint.

There was a meeting scheduled by the General Manager of the Bowral District Hospital in late 2007 in response of her earlier complaint. This would suggest that Ms B P’s complaint was seen as having some urgency and there was an attempt then to deal with it before Mrs T K resigned in April 2008. It does not surprise me that Ms B P postponed that meeting due to the fact that she was both emotionally and physically unwell and that she had the support of her treating psychiatrist Dr Kim Nguyen of the Browne Street Mental Health Service in Campbelltown.

With the subsequent diagnosis of the inoperable large cell lung cancer in late 20 08 or early 2009 it could be reasonably assumed that Ms B P would be less preoccupied with the complaint originally made in 2007 and the apparent lack of diligence on the part of Mr Fanker and of SSWAHS and the Area Mental Health Service to deal with the issue of an alleged serious professional misconduct made against Mrs T K.

Mr Thurgood, you note in your response that there was an emailed response to my letter to Ms B P in November 2009. You report her statement about her inoperable cancer and that she had other things to occupy her mind than pursuing the complaint. The email also indicated that her mental state was more stable and that she had been living at her home in Bundanoon since the diagnosis was made. She also makes a pointed statement about her perception of Mr Scott Fanker of the SSWAHS Area Mental Health Service and his actions and attitude to her complaint. A reasonable person could suggest that with her diminished confidence in the processes of complaint resolution in SSWAHS she would be unlikely to take up any offer made by Mr Fanker.

Finally, I find it extraordinary that SSWAHS, with its access to Ms B P’s clinical record and the electronic incident monitoring system could not respond to the Commission’s request for a response in a period of four months, but could only do so a short time after they knew of Ms B P’s death in early February in Bowral District Hospital. A reasonable person would have some difficulty in seeing any serious intent on the part of SSWAHS to deal in a timely way, with diligence and transparency with the Commission’s request for a response and for bringing some appropriate resolution to Ms B P’s first complaint in late 2007.

In summary then, I wish to make the following observations as the basis for my request for a review:

Ø It may be appropriate for the Commission to question why the SSWAHS was unable to respond any earlier than after the death of Ms B P when they appeared to have ready access to the limited information and facts that they appear to have provided to the Commission.

Ø The Commission may wish to ask the SSWAHS Area Mental Health Service why they did not use the services of their Patient Advocate, Mrs Gillian Holt, to visit Ms Pickersgill at her home or to gain further information about the complaint of 2007 and 2008. Mrs Holt lives in the Southern Highlands, is a Carer of a person with a mental illness and has regularly worked with people with a mental illness. This option of interviewing Ms B P does not appear to have been considered by SSWAHS even up to the time of Ms B P’s death in February 2010.

Ø The Commission may wish to consider whether or not SSWAHS attempted to use Ms B P’s treating psychiatrist, Dr Kim Nguyen, a SSWAHS employee who was a person of confidence to Ms B P during her treatment between 2007 and 2009 and possibly to 2010, in order to elicit an understanding of the complaint made by Ms B P.

Ø The Commission may wish to ask SSWAHS why they did not report the alleged professional misconduct of Mrs T K to the Nurse’s and Midwive’s Registration Board and to the Psychologist’s Registration Board as required by the reporting requirements of NSW Health Code of Conduct (9.1).

Ø The Commission may wish to ask the SSWAHS why Mr Scott Fanker and the SSWAHS did not show fairness in dealing with Ms B P’s complaint of 2007/2008 consistently, promptly, transparently and fairly as required by the NSW Code of Conduct (6.1).

Ø The Commission may wish to ask Mr Scott Fanker (SSWAHS)whether his decision and/or professional behaviour to Ms B P was lawful; is in line with the policies of SSWAHS; and whether his decision or behaviour can be justified in terms of public interest and whether it could withstand public examination (NSW Health Code of Conduct 1.1.1; 1.1.2; 1.1.6).

Yours sincerely,

Kevin O’Neill

Socrates reports this information for the information of all who might be concerned about the way in which this Area Health Service treats complaints by the consumers of their health services. You be the judge!