Tuesday, 16 October 2018
Tasmania: Mental Health
I wish to bring to the parliament's attention the recent report by the Australasian College for Emergency Medicine. Just this month they released the report The long wait: an analysis of mental health presentations to Australian emergency departments. I regret to say that what the report contains is not good news. It's in fact a damning report on the situation for mental health patients in emergency departments in Tasmania. Indeed, the college has found in this month's report that about 50 per cent of mental health patients in Tasmania are not being seen within the standard waiting time, or the required waiting time, at the hospitals. Moreover, the college found that Tasmania is the worst of the states when it comes to the large number of mental health patients who are being transported to the hospital by police and correctional service vehicles rather than ambulances. This is obviously on account of the poor resources for the ambulance service and the over-reliance on police and correctional officers.
They are damning figures. About half of the people who are presenting at emergency departments in Tasmania while having a mental health episode are not being seen in the required time. They are some of the most unwell members of our community—members for whom timely treatment is absolutely critical. No wonder there have been some horrid stories in Tasmania in recent times. In fact, one of the most horrid stories came out in recent weeks when the media reported that a man named Seth—I won't give you his surname—couldn't get seen at the Royal Hobart Hospital. He took the remarkable step of cutting off a finger with a pair of pruning shears so that he could go back to the hospital—minus a finger—to be seen, to simply get admitted to the emergency department.
I'm delighted to say that, in Seth's case, he was seen and did receive treatment, so hopefully the future is better for Seth, but what sort of medical system, what sort of place, forces someone to take such drastic action just to get seen in an emergency department? And Seth is just the tip of the iceberg. In the Tasmanian media in recent times, there have been more remarkable reports and even photographs in the newspaper of people sleeping on the floor of the emergency department at the Royal Hobart Hospital, staying there for two or three days or even longer. For heaven's sake, Australia is the 13th richest country in the world! We're a fabulously wealthy place. Tasmania is a fabulously wealthy place. It beggars belief that the state government thinks it's okay—or unremarkable at least—that people are forced to maim to get seen at the hospital.
Sleeping on the floor of the ED isn't an uncommon sight, believe it or not. Other stories that we've seen in the media and that I've heard about by talking to constituents—either people who suffer a mental illness or those who love them—is it is not unusual that, once someone is admitted and goes to one of the mental health wards, they are only admitted for seven days. I'm told by psychiatrists that they really need to be an inpatient for perhaps three weeks, but because of the pressure of the shortage of beds they are routinely being discharged in as little as a third of the time that is required. And then, when they're released, they're released into the community while they are still not fully well—a community where there is a chronic shortage of support for such people. In fact, in Tasmania, we used to have mobile support teams that would keep an eye on people who are mentally unwell and would support them in the community, would give them that ongoing support. Of course, like a lot of other resources in Tasmania, those mobile support teams were axed some years ago and haven't been replaced. In other words, I'm describing a mental health system in Tasmania which is chronically under-resourced, resulting in some of our most unwell members of the community not getting seen or being seen very late, or not being fully treated and not being supported in the community afterwards.
It helps to explain that, in the recent figures on suicides, Tasmania is again the worst of the states. I know this is a dreadfully painful thing to talk about. A lot of people shy away and even say to me, 'You shouldn't talk about suicide,' but we've got to talk about these sorts of things when you can so clearly see a link between under-resourcing for people with mental health and a jurisdiction with such a high rate of suicide. In fact, that's why in recent weeks I have written to the Chief Coroner in Tasmania and asked her to conduct a thematic inquiry into the connection between the under-resourcing of mental health services in Tasmania and Tasmania's very high suicide rate.
One of the main problems, of course, is that this area of medicine is nationally under-resourced, and it's even more under-resourced in Tasmania, so much so that the state government—and I would add, the state opposition too—have failed to commit to stage 2 of the Royal Hobart Hospital rebuild, which includes a dedicated mental health facility. That's the sort of forward thinking and extra resources that we really should be throwing into the sector in Tasmania. Regrettably, instead, the state government seems to be seeing for the long-term solution what others would really regard as an interim solution—squeezing mental health into two of the floors of the new K-block that is currently being built, and which I expect to open by the end of next year or thereabouts. Squeezing those two floors of mental health into K-block was always meant to be an interim solution pending completion of stage 2 of the rebuild. No-one is talking about stage 2. There's no funding for stage 2. And I'll bet that that interim solution will be the long-term solution, to the detriment, again, of all of those Tasmanians suffering a mental illness.
I'll come back to the issue of resources and money. In fact, there was a state government report which was kept under wraps for months but was released just recently. It said that public health in Tasmania is under-resourced by close to $100 million a year. I reckon that's a very conservative figure. I've heard from hospital insiders at the Royal Hobart Hospital that the forecast operating budget just for the Royal Hobart Hospital just for this financial year is already estimated to be an overspend of $100 million.
Interestingly, and very relevantly, the Commonwealth Grants Commission has already raised with the Royal Hobart Hospital and other health professionals that Tasmania is clearly not spending all of the GST it receives specifically for health care and the state is sending it elsewhere into its budget, including the fact that the state budget is now running at a surplus. That was a long-winded way of getting to the bottom line, which is: the state government at the moment is crowing about delivering a surplus at the same time that it's not spending on health all of the GST money that's coming to Tasmania for health. That is a very worrying issue. At a time when we are talking about the GST, it does give ammunition to some of Tasmania's critics: why are we getting so much GST if we're not spending it all on what it's intended for? I say again to the Tasmanian state government: 'You're getting that money for health. Spend it all for health and stop this fixation with a budget surplus.'
In closing I will offer an observation about the Tasmanian health minister, Michael Ferguson. When he took on that role some years ago I felt very optimistic about it. I think he did a good job in rescuing the rebuild of the Royal Hobart Hospital, but since then he has taken his eye off the ball and shown that he's really not up to the job. I think part of the process of fixing health care in Tasmania has got to start with getting a new health minister. The Premier, Will Hodgman, has to look at his parliamentary members and identify the very best individual to be the health minister for Tasmania. The Premier has to tell that health minister, 'We're going to give you the budget surplus and we want you to pour it all into health and to do everything you can to help health in Tasmania and, in particular, mental health in Tasmania.'
The figures that I started with from the Australasian College for Emergency Medicine showing the terrible circumstances at the emergency department at the Royal Hobart Hospital for people with mental health issues are unacceptable and the situation really must be remedied. That's the job of government. That is our job as human beings.