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How the NSW public hospital system still fails those with mental health issues

May 17, 2017 - 00:16 -- Admin

“To see a mentally ill person in 2014 at a public hospital in NSW treated in such an appalling manner is really beyond comprehension. The sight of the deceased wandering the corridor naked and covered in excrement while the senior nurse is seen to mop the floor apparently oblivious to her is horrific. While this appears not to be a system failure it is clearly a serious human failure. It is for another place to take such disciplinary proceedings as appear necessary.” [Excerpt from a NSW coronial inquest judgment delivered on 7 September 2016]ABC News, 12  May 2017:The daughter of a woman who died after she was left to wander the halls of a New South Wales hospital while naked and covered in faeces says nurses there lied to her about what happened.Miriam Merten died in 2014 from a brain injury after she fell over more than 20 times at the Mental Health Unit of Lismore Base Hospital, on the state's north coast.A coronial inquest heard she was locked in a seclusion room for hours, and when the two nurses supervising her unlocked the door they allowed her to wander around naked, covered in faeces.She continued to fall over outside the seclusion room.Coroner Jeff Linden found she died from "traumatic brain injury caused by numerous falls and the self-beating of her head on various surfaces, the latter not done with the intention of taking her life"."The sight of the deceased wandering the corridor naked and covered in excrement while the senior nurse is seen to mop the floor, apparently oblivious to her is horrific," he said.The state's chief psychiatrist Murray Wright said he was equally shocked."I can't speak for what was happening in the minds of those nurses but I think it's an absolutely appalling incident," he said.Ms Merten's daughter, Corina Leigh Merten, said she only found out exactly how her mother died when a journalist contacted her recently.She said that at the time of her mother's death, nurses gave her a different version of how her mother died."I was in school, in Year 12, my dad came and picked me up and we went straight to the hospital," she said."At the time they told me she slipped and fell in the shower."Now 20, Corina Merten said she did not know the coronial inquest was on."I'm so disappointed that it took a reporter for me to know what actually happened to my mum," she said.ABC News, 13 April 2017:The New South Wales Health Care Complaints Commission said it had found that two nurses caring for a patient who later died from a brain injury kept no record of about 20 falls captured on CCTV.The woman, known as Patient A, was filmed wandering naked and covered in faeces in Lismore's Adult Mental Health Unit in mid-2014.CCTV footage showed that in the seven hours before she was transferred to intensive care she fell 24 times.For most of that time she was alone in a locked room, but nursing records of her confinement made no mention of any falls.During a five-hour period in the seclusion room, no-one entered to check the patient's temperature, pulse, respiration or blood pressure.Patient A was not offered any food or water and had no access to a toilet.The woman died from a brain injury the following day.The HCCC found the two nurses charged with her care guilty of professional misconduct.Far too late to benefit Miriam Merten, Health Minister Brad Hazzard said the State's Chief Psychiatrist and a parliamentary committee would review whether failures in mental health care persist.See: Civil and Administrative Tribunal New South Wales, Health Care Complaints Commission v Borthistle [2017] NSWCATOD 56 decision concerning “Patient A” and Health Care Complaints Commission v Burton [2017] NSWCATOD 57 decision concerning “Patient A” .NSW Health Care Complaints Commission (HCCC), Annual Report 2015-16:Each year complaints relating to mental health make up around 12% of all complaints received by the Commission.In 2015-16, there were 759 complaints in this category.This means that over the five years from 2011 to 2015-16 the Commission has received 3,051 complaints concerning mental health….Over the last five years the Commission received:807 complaints about medical practitioners; 647 complaints about psychologists; 438 about mental health services in a public hospital and 299 about psychiatric hospitals; 302 about nurses; and, 220 about community health services.In addition to the 12% of all health complaints being listed as complaints concerning mental health providers, another 5.4% of all health complaints are complaints concerning psychiatry providers.This annual report also stated that 21% of all mental health complaints between 2011-12 to 2015-16 related to professional conduct and 31.9% related to treatment.Of the mental health complaints received in 2015-16 there were:46 referred to professional council;40 resolved during assessment;55 referred for local resolution;23 investigation conducted by the HCCC;46 referred to the HCCC's Resolution Service;12 discontinued with comments;7 referred to another body/person; and226 discontinued with no reasons stated.Case study included in HCCC Annual Report 2015-16 at page 58:The Commission investigated a complaint against a mental health inpatient unit in a regional public hospital. The key facts were that:* Patient A was scheduled under the Mental Health Act 2007 (NSW) with a dual diagnosis of schizophrenia and alcohol abuse* The patient was difficult to manage due to lack of insight, non-compliance with medication and high level aggression.* The decision to co-locate the patient in a double room with Patient B – both unpredictable and potentially violent patients – without any a risk assessment.* On a night shift, required observations either not carried out at all or were not carried out in the manner required, but staff signed off that all care level checks were completed* Overnight Patient B was killed by Patient A.The investigation found that care and treatment of Patient A was inadequate. His care plan was ineffective, rigid and failed to improve his condition. There were lost opportunities in terms of appropriate, alternative ways to manage and treat him. Furthermore, his safety and that of others was put at risk through the decision to co-locate him with patient B and because staff failed to carry out the required observations.SANE Australia 2013 report:A Mental Health Council of Australia study (2011) found that people with mental illness reported similar levels of stigma from health professionals as from the general community.Some of the study’s key findings are that: * Almost 29% reported that a health professional had ‘shunned’ them. These figures rose to over 50% for people with post-traumatic stress disorder and borderline personality disorder. * Over 34% had been advised by a health professional to lower their expectations for accomplishment in life. * Over 44% agreed that health professionals treating them for a physical disorder behaved differently when they discovered their history of a mental illness.NSW Health Care Complaints Commission decisions recorded in 2016 & 2017 re other nursing staff complaints relating to treatment of patients with a psychiatric illness:RNs Haridavan Pandya and Sumintra Prasad – Unsatisfactory professional conduct, 2 February 2017, concerning their care of a mental health patient at Bungarribee House mental health unit in Blacktown hospital on 28 February 2014.RNs Abraham Thomas and Donna Hayden, and Ms Julie Rumble – Unsatisfactory professional conduct, 11 May 2017,concerning the death of a mental health inpatient at Dubbo Mental Health Inpatient Unit on 28 February 2014.Mr Stephen Woods – disqualified from being registered as an enrolled nurse for a period of 12 months, 16 May 2016, concerning a physical and verbal attack of a patient in the Mental Health Intensive Care Unit at Hornsby Hospital on 9 April 2014.Mr Neil Mullen (RN) – Unsatisfactory professional conduct – Reprimand and conditions imposed, 18 July 2016, concerning care of care of nine patients in the Shellharbour Hospital mental health unit on 30 and 31 July 2014. Mr Mike Siebe Greive - Registered Nurse - Disqualified for 18 months, 30 March 2016, concerning a female mental health patient at the Hornsby Hospital Adult Mental Health Unit between October and December 2013. Registered Nurses Wendy Kennedy, Christopher Parker and Jisnu Dowsett cautioned and Stewart Thompson reprimanded by a Nursing and Midwifery Professional Standards Committee, 1 June 2015, concerning care of a patient at Lismore Adult Mental Health Unit’s eight bed High Dependency Unit on 19 and 20 February 2013.  The patient was found deceased in his room on the morning of 20 February 2013.Mr Ronnie Obusan - finding of unsatisfactory professional conduct – reprimand and conditions, 19 January 2016, concerning the nurse’s interactions with a patient in the mental health unit at Nepean Hospital in 2012. I'm sure NSW residents would all like to believe that each and every time they present at a public hospital they will be treated with professional care and respect.Unfortunately that is not always the case as prejudice, discrimination and racism are rarely acknowleged by government as existing within the state health care system and are therefore tolerated by default.“Stigma against people who have experienced a mental illness is deeply entrenched in our culture. It finds expression everywhere from the Parliament to the front bar. From courtrooms and pulpits to playgrounds it is possible to hear people who experience mental illness cast in an unfair light.”  [National Survey of Mental Health and Wellbeing Bulletin 6, Carr & Halpirin 2002, Stigma and discrimination]