The theme of Mental Health Week this year ‘Act-Belong-Commit’ is particularly relevant to the challenge of ensuring people with mental illnesses can access high quality care in the community.
In the following piece Dr Samantha Battams, Associate Professor & Public Health Program Director at Torrens University in South Australia, discusses how governments, health professionals and other mental health stakeholders can work together to improve community-based care for people with mental illnesses in order to improve their mental and physical health reduce the need for hospitalisation. She writes:
It was recently been claimed that in one Adelaide hospital acutely mentally ill patients have been waiting in windowless cubicles for up to 6 days before being admitted to a psychiatric bed. The emergency department is said to be overloaded. Along with this is a focus on the safety of hospital staff with claims of a high number of patients unacceptably ‘’threatening violence.’’ Conversely, one person commenting on the situation said “We’ve had police in the department threaten to shoot people because they can’t contain certain behaviour.”
Hospital staff and health professional organisations have called for more hospital beds. Conversely, the chief psychiatrist in SA has claimed that there was a less than 2% increase in mental health patients presenting to ED over the last year. He has claimed that SA does not need ‘’more beds,’’ but rather a more integrated system within which patients could through move more quickly. Mental health advocacy groups have argued for a focus on keeping people out of hospital.
So why do these patients move to? What supports are there in the community? And how do we ensure that people actually stay out of hospital?
One of the key supports are general practitioners, who can claim ‘’annual cycles of care’’ for people with mental health problems through Medicare. However, the notion of ‘’universal access’’ to Medicare for people with mental illness needs to be reconsidered, especially with the proposed GP co-payment. For a person with a mental illness, this concept of universal access relies on them recognising when they are unwell, being proactive by taking themselves to a GP or specialist practitioner (and having the money to get to the service and pay for it, an issue particularly in rural areas). In many cases, mental illness is associated with a lack of insight into one’s illness, and/or lack of motivation to seek help. This lack of insight or unwillingness to accept the label of mental illness may also preclude the most mentally unwell people from receiving GP and other community based supports.
Where someone has a mental illness leading to psychiatric disability, there are particular issues with accessing health services for both mental illness and for physical health care – health professionals need to be ‘’proactive’’ in following up these patients for physical and mental wellbeing. Smoking rates for people schizophrenia are up to 90%, and despite public health activity/gains and higher smoking costs, many will continue to smoke in the absence of other life activities, such as employment. Morbidity and mortality figures highlight that the ‘’right to health’’ is far from being achieved.
A family member or neighbour may be provided with clues when someone is becoming unwell, although confidentiality protocols and practices may prevent information being passed on or heeded by third parties, or in acting when something is wrong (unless there is a treatment order). People may have to get extremely unwell – to the stage of hospitalisation – before a treatment order is considered.
The notion of universal access also relies on GP awareness of mental illness and risk factors, available and appropriate treatment and supports, and having the time to coordinate supports. Often the person playing a coordination role may be a family carer, although again patient-doctor confidentiality practices may prevent their involvement.
Even where there are community based supports, coordinated housing and support options may be few, and coordination is the key. Community based care has been part of mental health policy since the 1980s. However, recent concerns have been raised with the implementation of SA’s Stepping Up report which was developed during the last mental health reform period. Re-focusing on the implementation of this plan should be a priority of the SA Mental Health Commission which will be established shortly. This includes a renewed focus on accessible, proactive and coordinated community based support.
Connect with Samantha on Twitter @BattamsSamantha