26 February 2021
The ANMF (SA Branch) is calling on the State Government to urgently address the chronic lack of mental health beds after yet another week of alarming ambulance ramping figures and a huge spike in theatre cancellations.
There were 56 hospital-initiated theatre cancellations in Adelaide on Wednesday, more than double this year’s average. Nearly all were related to hospitals trying to create increased capacity.
Exacerbating the problem of reduced capacity is the constantly high number of mental health patients being housed in emergency departments, often for days at a time.
“There’s a lot of mental health triaging. Like the other day when half our emergency department was full of mental health,’’ one RAH source said.
“It’s getting worse and worse’’, said a Queen Elizabeth Hospital source, adding that mental health patients can take up a third of their ED capacity.
“People with mental health conditions are having to wait longer than other patients to be assessed and treated to access further specialised treatment.’’
Back in September an elderly woman waited almost five days for mental health treatment after presenting to the RAH emergency department.
“The ED is not the right place for a patient experiencing an acute mental health crisis,’’ the QEH source said.
“They are stuck in a blank three-walled cubicle where there is no TV or radio and have nothing to do. Simply put, they receive the bare minimum. Criminals have better conditions. No wonder they get agitated, aggressive and end up assaulting nurses.’’
The source said most nurses were not trained to deal with mental health patients. “Their screams and rage petrify the other patients in the department, who are often elderly and infirmed,’’ the source said, adding that the emergency department did not have adequate security, with staff often left to deal with violent patients.
Significantly, another source from the QEH stated that the situation had gotten worse with COVID, with drug-taking, domestic violence and alcoholism on the rise in the wider community.
“The nurses have had a gutful and are fed up; they feel that nobody listens, and no adequate solutions have been put in place to help these people. The mental health system is in crisis and band-aid fixes are not going to cut it.’’
Ramping in Adelaide shows little sign of abating in 2021 with patients waiting in the back of 24 ambulances parked outside a packed RAH emergency department over a three-hour period in January 5.
All metropolitan hospitals went Code White on February 22, with 88 patients waiting for a bed and 15 ambulances ramped at the RAH at about 8pm. Code White is SA Health’s highest rating for the level of pressure on a hospital, with services and patient safety at risk.
The ANMF (SA Branch) has long agitated for Government to address the dangerous issues of overcapacity, ramping and staff burnout, as well as the follies of Voluntary Separation Packages at a time when nurses are struggling to cope with demand.
There is also a shortage of staff in the back-of-house wards, reducing the ability to take the increased flow from emergency departments.
Due to the chronic understaffing in aged care, nursing home residents are having to stay in acute beds for longer periods, which also contributes to bed blockage.
“We are simply not coping with the workload,’’ wrote one RAH nurse to the ANMF (SA Branch).
“I seriously fear one of us is going to make a dreadful mistake and have to live with it for the rest of our lives. It’s REALLY that serious right now.’’
Only last August the ANMF (SA Branch) issued a press release calling on Health Minister Wade and SA Health to urgently address issues associated with patient flow to avoid preventable deaths or harm to patients. “We are repeatedly seeing our major hospitals overcapacity, with insufficient numbers of senior nurses and doctors available to manage the flow of patients, seven days a week,” the ANMF said.
“We have been advocating for over two years for there to be senior nurses and doctors available on the weekends to help facilitate required complex care as well as the discharging of patients,’’ ANMF (SA Branch) CEO/Secretary Adj. Associate Professor Elizabeth Dabars AM said at the time.
The ANMF (SA Branch) has continually warned that ramping at hospitals will inevitably result in preventable deaths or harm to patients due to increased ambulance response times.
"The average number of people waiting for an inpatient bed in Adelaide emergency departments in 2020 jumped from 60 a morning to around 80 over the course of 12 months. We are deeply concerned at the number of mental health patients being housed ad hoc in emergency departments for long periods of time,’’ Ms Dabars said.
“With the constant commotion 24/7, emergency departments are hopelessly inappropriate environments in which to house mental health patients. They are simply dumped there for lack of alternative, better-suited accommodation. It is unfair for all concerned - for the mental health patients, for emergency health care staff and for other patients affected by bed blockage and violent outbursts.’’
Ms Dabars said the Government urgently needs to invest in suitable mental health facilities, to better address the needs of mental health patients and alleviate the crushing stress on hospital staff and capacity.
Our letter raising this systemic issue to the Health Minister can be viewed
here.