Lunatic Asylums !

A century ago we set aside specific institutions for the care of patients with psychiatric problems.  They were grim places, somewhere between a hospital and a gaol and anything to do with mental health brought a stigma that families dreaded.

Today those places are long gone and mental health is treated in the general hospital system.  The problem is that few hospitals have adequate facilities to deliver the restraint and seclusion that is sometimes necessary to restrain an out of control patient from self harm, or delivering injury to carers.

This came to a head when cctc footage emerged of a patient in a rural hospital naked, drugged, disoriented and covered in faeces  hours before she died of a traumatic hypoxic brain injury caused by banging her head against a hard surface wall.  Sometimes patients are isolated for long periods in seclusion rooms with no access to bathroom facilities or fresh air.  When punitive restraints are used they feel trapped and helpless.

The state health department has released an implementation plan to bring this problem under control.  Hospitals are ordered to reduce their use of seclusion to fewer than 5.1 episodes for each 1000 bed days - a twenty-five percent reduction on the present standard.  They must ensure that episodes of seclusion last less than four hours and all patients must have 24/7 supervision by managerial staff with unit visits mandatory during each shift.

All hospitals will be required to collect and publicly report seclusion and restraint data every quarter and this will form part of annual agreements with local health districts.   It seems that this problem is to be solved by diktat.

We have reached the stage where paramedics are no longer safe attending emergency calls alone because of patient irrationality and often this is caused by drugs. In particular, users of Ice are prone to highly aggressive behaviour and launching serious attacks on police and hospital staff.  Any hospital may encounter a number of people in this state when a social function is held in their area.

It is grossly unfair to expect hospitals to treat the drug deranged who the police deliver to their care simply to be relieved of the problem.  This is a temporary condition that usually abates when the effect of the drug wears off.  That can be accomplished equally well in a police cell as a hospital ward bed.

Perhaps the answer to this problem can be resolved by the decision on hospital treatment being in the hands of the attending paramedics.  Minor injuries should be treated while the patient is under police control and the drug affected exhibiting paranoia left in police custody.

There is a danger that our hospitals are being overwhelmed by the temporarily deranged drug users who need restraint, where their limited restraint facilities would be better used for those with genuine psychiatric problems.  When the numbers are fewer the limitations on the overuse of seclusion rooms and physical restraints can be better managed.