16 October 2020
Working in an office right next door to a Centrelink building, ANMF (SA Branch) President Jocelyn Douglass was able to witness first-hand the devastating economic impact of COVID-19.
“During those early weeks there were lines outside going around the building, of people lining up to get benefits,’’ she says.
“People who had never filed for benefits before. People who had lost their income or had lost a significant portion of their income.’’
And where there is economic turmoil and uncertainty, there is, as we are seeing with COVID, also a huge mental health toll.
Ms Douglass has worked in both the public and private sectors in acute inpatient, general and psychiatric, and has spent all of her recent practice in acute community mental health.
“It’s short-term acute presentation, it covers the whole range of mental health disorders,’’ she says.
“We tend to see people often in a crisis presentation which may mean that they’ve had a relationship break-up, they may have lost their job or be in an acute phase of a mental illness.
“You can imagine that COVID has had a big impact on people’s crises; much less money than they used to have, maybe trouble paying their bills, their rent, their mortgage.
“They might end up going to their GP saying ‘I am so overwhelmed I don’t know what to do, I feel suicidal’. They may present to an ED or call Mental Health Triage and they will be referred to an acute community mental health service for acute intervention and support.’’
Ms Douglass says COVID has seen a surge in such presentations and, sadly, the threat of the virus is likely to linger for a long, long time.
“Absolutely, we’ve seen in the world now, even in places that had done really well to bring COVID under control, there’s resurgences all over the place,’’ Ms Douglass said.
“Here in Adelaide we seem to have done better than almost anybody except maybe New Zealand. There is still that potential that once the borders are open and people are moving around there will be outbreaks.’’
“I think that when we see people ramping in EDs, everyone knows that the biggest cohort in an emergency department causing bed block and bed-flow problems tend to be mental health.
“We need more agreed data points, more KPIs (Key Performance Indicators) in mental health service delivery, so we can base our strategic planning and service delivery on evidence to inform evidence-based intervention.’’
During Mental Health Week, Ms Douglass says direct admission pathways would be one way of relieving bed block.
“For some reason there’s always been this idea that every single client has to go to the emergency department to get medically cleared before they get admitted, even if no general health issue has been identified,’’ she says.
“They still have to go and wait hours to get clearance to go to a mental health bed. It’s inefficient and leads to long waiting times and ED overcrowding.
“That’s part of the problem with the bed block and flow problem in emergency departments.
“You really need to be able to get people into a bed ASAP and that may mean if you’ve got pathways where you can do a direct entry from community and not go through the ED, that will make a big difference to the flow in the emergency department.’’
Ms Douglass said one of the most important challenges facing mental health was that it was an ageing workforce, meaning the profession faces a potential shortfall of nurses at a time when demand may never be higher.
“For people interested in pursuing a career in nursing, the current and foreseeable shortages in mental health will open up a lot of career opportunities for people,’’ she said.