More than half of the staff psychiatrists in the Sydney Local Health District – which includes two major psychiatry centres at Royal Prince Alfred and Concord hospitals – have resigned, leaked documents show.
Guardian Australia has seen the district’s work health safety “risk assessment tool” dated 17 January, which states in a “background/context” section that the “resignation of more than 50% of psychiatry staff specialists employed in SLHD may impact the district’s ability to provide safe, high quality, timely, appropriate, consistent and comprehensive health services for mental health consumers”.
In addition to the Professor Marie Bashir Centre, associated with the Royal Prince Alfred hospital, and the Concord Centre for Mental Health (CCMH), the local health district also provides a range of community mental health teams at Redfern, Camperdown, Marrickville, Canterbury, Croydon and Concord.
The documents do not stipulate which facilities the psychiatrists have resigned from.
Another document, containing a slide presentation titled “contingency plans for mass psychiatrist resignations” and seen by Guardian Australia, also dated 17 January, states services at Concord Centre for Mental Health “are planned to be maintained with no bed closures at this stage”.
“Units will operate with skeleton Senior Medical Officer (SMO) coverage,” the document states as the hospital continues to attempt to source visiting medical officers and locums.
“The existing multidisciplinary team (MDT) models of care will be bolstered to allow Allied Health and Nursing clinicians to work to top of scope to support SMO oversight.”
A similar model is proposed for the Professor Marie Bashir Centre.
A third document seen by Guardian Australia – an action plan for the district’s program for staff wellbeing – suggests “talking points” for interactions with patients “aiming to deescalate, protect organisational values etc, ?narrative [sic] around the care is unchanged but it does look different. ‘You will be cared for’, services are not being closed, there may be delays, there will be a process that we are following, and you will not be missed.”
An anonymous experienced public sector psychiatrist, who has previously worked in the Sydney LHD and who spoke with Guardian Australia on the condition of anonymity, said the fact Concord was not closing beds was “irresponsible” given the number of psychiatrist resignations.
“I question whether it’s safe to keep those beds open.”
The psychiatrist said the idea that allied health and nursing staff can be “bolstered” to cover psychiatrists was not true because “these are not interchangeable roles, they are complementary roles” and that the governance structures within hospitals did not allow for this to occur.
Psychiatrists have the training and skills to do a comprehensive assessment for patients and make decisions about being admitted to hospital, changing treatment, moving the patient between wards and about being discharged from hospital, they said.
A psychiatrist’s plan will include interventions from allied health staff, who all have skills in providing treatment, but do not have the expertise to make decisions such as discharging a high-risk patient, the anonymous psychiatrist said.
“The risk management isn’t just, ‘are you going to kill yourself or hurt someone else?’ when someone’s unwell. The risks are really complex.”
after newsletter promotion
The general secretary of the NSW Nurses and Midwives’ Association, Shaye Candish, told Guardian Australia: “We are not being adequately consulted by local health districts and we remain in dispute with NSW Health in the industrial relations commission where we are seeking the full disclosure of relevant information to help provide further advice to our members.”
Candish said it was imperative their members ensure they are not operating outside of their scope of practice.
“It is not up to mental health nurses and emergency department nurses to take on additional workloads and fill the gaps of psychiatrists. They are already run off their feet as it is.”
The anonymous psychiatrist was concerned that the lack of psychiatrists will lead to bed block on the acute units and psychiatry patients waiting for days in the emergency department.
Dr Jackie Huber, the chair of the Australia and New Zealand Emergency Psychiatry Network, said multiple-day stays in emergency departments for psychiatric patients has been going on for years in hospitals across New South Wales. She said it was “undeniable that with this number of psychiatrist resignations, we absolutely expect a length of stay across emergency departments to increase”.
Huber said the ED environment was not appropriate to hold someone for days at a time and was associated with increased rates of restraint – the use of medications and occasionally physical restraints – for people whose overwhelming distress and acute, severe behavioural disturbance had reached a point where they could no longer be de-escalated by any other means.
Jonathan Harms, the CEO of Mental Health Carers NSW, said federal government data showed turning up for a mental health assessment at an ED was already the most common sort of presentation that did not get seen.
“We know that if that happens to you, 50% of people will never seek help again. They go on to fill out other grim statistics in suicide and self harm, alcohol, homelessness and prison,” he said.
When it comes to mental health funding, Harms said NSW “only fund crisis care, and so we have a lot of crises”.
With even fewer psychiatrists working in NSW, “the potential for very serious consequences is great,” Harms said.
“We would really like to see decisive action taken to not only rectify this problem, but to start thinking about how we actually expand the capacity of the mental health system in New South Wales, because the mental health system in New South Wales does not have the scale to deal with the scope of mental illness in this state.”
A spokesperson from Sydney Local Health District said “contingencies have been carefully planned and put in place to ensure we continue to provide the best possible care to any mental health patient who presents to one of our hospitals or community services”.
“It is also paramount for SLHD that our mental health consumers – and community more broadly – know our services remain available and people will continue to receive care from our dedicated and highly skilled mental health staff.”
Article by:Source: Natasha May Health reporter
