Tuesday, 7 February 2017
I rise today to read parts of a letter I recently received from a mother who lost her son to suicide following his struggle with depression. The mother wrote to me hoping to draw attention to the gaps in mental health care in this country that her son
experienced first-hand. I have her permission to read this letter but I have been asked not to identify herself or her son. She said:
My son was 28 years old, gainfully employed, living independently with strong friendships.
I am writing to you as a mother who has been alongside her son as he navigated the mental health care system. My ultimate hope would be that the number of individuals and families affected by suicide is reduced through the timely and intensive treatment management approach to individuals affected by depression and other mental health conditions across the board but particularly for our young men who statistically are one of the highest at risk groups in our community.
She then went onto say:
Age 8 he was diagnosed and treated for attention hyperactivity disorder (14% go onto develop Borderline Personality Disorder, versus 3% for general population), highlighting the need for skilled early assessment and intervention for children diagnosed with this condition.
Age 13 he experienced his first episode of depression and was treated by child and adolescent mental health services. He required a term off school and medication and short term therapy to which he responded well.
In September 2013, aged 25 my son was taken by me to a hospital after a failed suicide attempt. At that time after being assessed and deemed safe he was discharged and admission was not recommended. He commenced anti-depressants and anxiolytics and was supported by local community mental health services with follow up psychiatric appointments, which I attended with him.
But his mood continued to deteriorate and the CAT team became involved with a home supervision plan that included twice daily visits for a 2 week period. At this time he was being managed and treated for a major depressive episode. He had significant weight loss and a very strong and ruminating wish to die. This was an extremely difficult time for me as his mother to sit with and see the mental anguish of your only child and to feel powerless to affect change.
At the end of the 2 week supervision I had returned home (he was living with his father) and he attempted suicide again at his first opportunity. The CAT team were called, and he was taken again to hospital. This time, he was to be admitted under the mental health care act as an involuntary patient, at which I felt an enormous relief. Unfortunately, they had no available beds, and he was transferred to another hospital where there was a vacancy.
To my absolute disbelief, they discharged him from that facility less than 24 hours later, making their decision based primarily on his 'borderline personality diagnosis' which had not been discussed with us, his parents. I have read the health services policy guidelines re admission for patients with borderline personality and am deeply troubled. There is little accommodation for dual diagnosis. In my son's case, it was clearly evident that his depression and anxiety was an issue that needed an intensive inpatient approach, to provide close supervision, observation, medical review and access to therapeutic interventions in a safe environment. It was also apparent that the psychiatrists at the two hospitals had differing opinions re my son's primary diagnosis on admission, and so their care plans differed. When I tried to voice my concerns regarding the decision made at the second hospital, I was not able to speak with his treating doctor and was told I had no recourse. His diagnosis of borderline personality disorder, if that is what he had, should not have prevented him from receiving an admission and adequate treatment of his depressive episode. On reflection, it seems that decisions at times can be prejudicial and discriminatory when individuals with acute psychological distress present and are in desperate need of care.
He had lived with his undiagnosed mental health issue for some time, but his depressive episode was a distinctly separate issue. My son lived with ADHD disorder every day, and it presented its own unique challenges for him and his family, but this depressive episode was a distinctly different and marked episode that, in my mind, was inadequately managed and treated at this time by the second hospital.
We were not involved in the discharge planning, though we are his next of kin. Yet on admission to the first hospital the family input was highly valued and seen as an important part of my son's welfare. A referral to Spectrum was not made by the second hospital that I am aware of, as I was not involved in the discharge care planning, so services of this specialised organisation were not made available. The experience of having no voice regarding his discharge planning when he was discharged from the second hospital was gut-wrenching and completely unacceptable. It would not be an acceptable practice in any other area of medicine, and psychiatry should not be any different. This was the only period in his life that he accessed the public hospital system for mental health issues.
If my son had presented with chest pain instead, he would have been admitted and been provided with the most intensive care plan under the supervision of a cardiologist and would not have been discharged until his medical condition was assessed, investigated fully and treated. Family and or carers are involved in this process as a universally deemed mode of best practice. They would not prevent his admission based on his borderline personality disorder, and neither should psychiatry.
She then went on to say:
My son mattered, as do all those sons, daughters, brothers, sisters, mothers and fathers who now and in the future will be trying to gain access to the mental health care they deserve.
Australia ranks 26 out of 34 of our OECD countries for psychiatric beds per 100,000 population. One has to ask why that is. The National Mental Health Commission report and the recommended shift of 1 billion dollars away from public acute-care beds to expand community mental health programs is a disaster waiting to unfold. No money should be taken away until the community based sub-acute beds are in place and increased funding is needed urgently for acute inpatient beds to address the current shortages.
She then went on to say:
I believe if he had received an inpatient stay of sufficient length to monitor, medicate and engage in a therapeutic process with a well-planned and integrated discharge plan, with case managed follow up, I may not be writing this letter today. My son was denied, I believe, optimal care, and now we are left with the results of that. My son's death has impacted his immediate family, friends and wider community. To have this level of care in what is considered one of the wealthiest countries in the world is appalling and behoves change.
I know I am not alone in my perception of our current mental health service being in crisis. One only has to look at the news reports, articles and opinions of those involved directly or indirectly with the system to realise that major review and change is required urgently.
You can hear I am struggling with my voice, but I had promised this mother that I would read this letter tonight. I urge the Senate to take this on board. Our mental health system needs fixing. It needs an injection of funding. I urge everybody involved—in particular, governments allocating resources—to allocate the resources that are needed to fix our mental health system.