RAH intervention order shows systemic failure 

29 June 2020

The intervention order, issued last week by the state’s chief psychiatrist Dr John Brayley, demands improvements at the RAH within a three-month time frame following under-reporting of incidents.

The order requires the Central Adelaide Local Health Network (CALHN) to monitor and manage the quality and safety of mental-health care in the ED, where high-stimulus activity can cause patients to become agitated and aggressive, resulting in restraints.

“The ANMF (SA Branch) supports the minimum use of restraint,’’ ANMF (SA Branch) CEO/Secretary Adj. Associate Professor Elizabeth Dabars AM said.

“In fact, as an organisation we have assisted in implementing best practice guidelines in a number of locations including mental health settings.

“Our view is it is completely unacceptable and inappropriate for mental health patients to be housed and treated in emergency departments for long periods of time and the reality is that is what is happening. This results in staff feeling that they have no option but to restrain people with mental health concerns because the environment is not suitable to meet their needs.’’

Ms Dabars said housing mental health patients in a “high-stimulus” ED “where there is a lot of noise, a lot of light and a lot of activity is actually exacerbating their condition and making it worse’’.

“Quite frankly what is currently happening is a recipe for disaster. You are setting up, by virtue of the system, a situation where there are only two outcomes of patients that become behaviourally challenging,’’ she said.

“One is that the person is either restrained or the other outcome is that the staff receive abuse - or worse - due to an unacceptable care and work environment.

“It is deeply distressing from both a patient safety and staff safety perspective and it does need urgent resolution. We have been advocating on these issues for a long time.

“We believe that staff have a right to report, should be reporting and should be supported in their reporting of clinical events - but we understand there has been a culture in some settings where that has been discouraged.
“When people do report there does not seem to be any action taken on it.

“This is a systems problem, it requires a system-wide solution. This is not something that is just merely limited to the RAH or CALHN.

“This is something that needs a state-wide strategy.’