Mental Health Crisis Care – where you live, work and play


Just read a news item this morning about a young man with borderline personality disorder presented to hospital needing crisis care and, as is not uncommon, was left waiting for help for long hours with a bulk amount of his medication by his side. The crisis deepened and the easiest way he had to deal with it was to take all of the pills. The result…collapse and into ICU.

This, the day after I read the Productivity Commission Report and recommendations. While it won’t happen immediately, It is pleasing to at least read this problem has been recognised and addressed by:

RECOMMENDATION 13: IMPROVE THE EXPERIENCE OF MENTAL HEALTHCARE FOR PEOPLE IN CRISIS

Hospitals and crisis response services play a vital role in the continuum of care for people with severe and persistent mental illness. It is critical that these services support the recovery of the person in a safe environment which meets their needs.

As a priority:

To minimise unnecessary presentations to hospital emergency departments, State and Territory Governments should provide alternatives for people with mental illness, including peer- and clinician- led after hours services and mobile crisis services

The important distinction to make here is the inclusion of both “peer - and clinician – led”. While I support the call from consumer and carer advocates to provide non-medicalised services, this should not be at the expense of healthcare system reform that delivers quality medical care as and when it is needed.

What we really need are services that form an integrated continuum of care designed to meet the needs of individuals and delivered in an environment that is conducive to recovery. As we all know ED is not an environment that is conducive to recovery – as evidenced by the above story.

The Commission’s report and recommendations are in line with the International Declaration for Mental Health Crisis Care – quality crisis care is available for everyone…everywhere…every time it is needed.

How do we ensure this can happen? These four core elements form an integrated system of care that is tailored to meet the needs of individuals when and where they want and need it.

1. Regional or state-wide crisis call centres

2. Centrally deployed, always available non-law enforcement mobile crisis care close to home

3. Facility-based crisis emergency receiving and short-term stabilisation services; and

4. Essential crisis care principles and practices.

As Don Berwick said when the report Crossing the Quality Chasm was released back in 2001.

“…..on leaving healthcare we want people to say: I got exactly the help I wanted and needed, exactly when I wanted and needed it.”

Of course, the inclusion of this recommendation does not mean it will happen. But it can and we do not need to start from ground zero. My belief is that we have many resources already in place in Australia that can be re-engineered to contribute to building a new system that delivers a continuum of care designed to meet the needs of individuals where they live, work and play.

Will the Government have the strength to implement the required system reforms? Only time will tell.

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