Tasmanian MH system in disarray - what do we need?

[sadboyhours]

I can't believe I forgot to mention this!

A couple of years ago the Tasmanian government decided to stop paying for interstate travel via patient transport assistance (PTAS) unless to a public hospital clinic. I don't know if this was a directive from parliament or an 'operational' decision by the health service, but it seems to me that reinstating support for mental health related admissions and appointments would be a great temporary option, particularly for people getting treatments like ECT or who need medication adjustments in an inpatient setting but are not severely unwell (ie would not be able to access a public bed).

The Tasmanian government was 'renting' (contracting) 4 beds at the Hobart Clinic, which can't be cheap, plus giving them other funding - so I imagine there will be some funds freed up in the budget which could cover such a change.

[chibam]

@sadboyhours  I tried to 'support' your last couple posts, but the website seems to be having that glitch again where the support buttons don't work. So you'll just have to settle for a typed 'thumbs up', I'm afraid. 👍👍😉

My understanding is that talking about beds as a mental health statistic is a very murky subject. You can't take the figures literally, as apparently there are all sorts of other factors that play in to how the authorities count "beds".

For example, I believe that there's some rule/law that says that every facility with mental health beds must have 1 therapist on staff for every X number of beds. Sometimes, you might have 1 or 2 therapists leave the facility and suddenly you'll see that it's bed count might've decreased by 10 or so. Those 10 extra beds didn't just suddenly vanish in a puff of smoke; they've just been rendered illegal by the sudden departure of a couple of therapists, and so the hospital, ect. can't use them!

I can't help but think that maybe the issue needs a more nuanced approach then simply assuming that the government needs to buy more hospital beds, and/or build more bedrooms. Maybe a lot could be done by looking more into who is asking for these mental health beds, and whether their needs could be met in less costly manners.

[Zoe7]

@sadboyhours @tyme @RachSANECEO @Till23 @NightFury @chibam 

The closure of the Hobart Clinic means there is no private hospital option in Tasmania for MH as St Helen's closed in 2023. Beds in the public system are severely limited and people are often turned away from ED because they do not have the staff nor resources to help. GP wait times are out of control and many psychs and psychiatrists have closed their books because they are overstretched and do not have the capacity to take on any new clients.

Children's services are even worse. There are 18 month + wait times to see children and adolescents/young adults with MH issues are left in a vacuum of 'nothingness' - many having to seek help/support on the mainland because of the lack of any programs/support in Tassie.

The community MH system is a joke - you can wait days for someone to get back to you and by that time it can be too late. When they do get to you, they often say there is nothing they can do so what is the point.

The government has buried their heads in the sand for so long that the whole system is failing - and not just a little bit but on a whole-scale - so where to now .....travelling to the mainland for those lucky enough to be able to afford it or being left in the deep, dark black hole with no help at all.....

[sadboyhours]

@chibam thankyou for the thumbs up 🙂

I agree that talking about beds is a very small part of the discussion and I don't think that making more inpatient services available will fix the broader problems, but I also don't want to give the government or other parties the ability to make the general public think everything is fine because of community services that you and @Zoe7 have pointed out are often not appropriate referrals and have nowhere to put us with the previous resourcing let alone where we are at now.

I think it's also worth noting that we do not have the non-hospital resources that some regions do either, and that the areas with higher ratios of beds:population still struggle to meet demand, so we cannot simply talk about hospital admission numbers - we need to look at stepped care approaches and what best practice is across Australia and the world.

Do you think the suggestions I listed will be helpful? Do you think there are other things that could ease the strain on us and our families? (copied the list here to save scrolling)

- reinstating PTAS for private MH admissions and outpatient treatments

- step up step down units

- more Safe Haven-type drop in centres

- accelerating development of the MH precinct plans

- more inpatient beds including expanding the Hospital@Home program

- ED options that ease the strain and stress for MH and physical health staff and patients

I am really keen to see what others think, especially if people have seen these things work or not work in other areas!! 🙂

[chibam]

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@Zoe7 wrote:

The community MH system is a joke - you can wait days for someone to get back to you and by that time it can be too late. When they do get to you, they often say there is nothing they can do so what is the point.

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That's really interesting, @Zoe7 . When they say: "there is nothing they can do for you", do you think they mean that their so backlogged/tied-up that they can't get around to seeing you, or are they saying that they simply don't deliver the service your looking for?

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@sadboyhours wrote:

Do you think the suggestions I listed will be helpful? Do you think there are other things that could ease the strain on us and our families? (copied the list here to save scrolling)

- reinstating PTAS for private MH admissions and outpatient treatments

- step up step down units

- more Safe Haven-type drop in centres

- accelerating development of the MH precinct plans

- more inpatient beds including expanding the Hospital@Home program

- ED options that ease the strain and stress for MH and physical health staff and patients

I am really keen to see what others think, especially if people have seen these things work or not work in other areas!! 🙂

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TBH, @sadboyhours , I'm not really familiar with the hard-hospital side of mental healthcare, and much of the language in this area escapes me.

I focus more on developing measures to insure that patients are sent to the proper type of therapists/helpers who will give them the proper help they actually need (something that still seems to be sorely lacking in the MH system, apparently); and creating new therapist jobs that deliver practical help.

My suspicion is that a significant part of the overburdening of our existing mental health system is that measures that are essential for some members of the community (e.g. MH beds, psychiatrist appointments) are being clogged up with people who will never benefit from such measures. People who need differant types of help, but who aren't being appropriately redirected to the help they actually need, because redirection systems don't exist, are inadequate, or because the service the patient actually needs simply doesn't exist.

So, because the MH system has nowhere else to put these people, it dumps them in services they have no use for, thereby tying up said services for the patients who would actually benefit from them.

I know that on several occasions, I've had people suggest to me that I should go spend a few days in a hospital (thereby tying up a MH bed!), when this temporary solution would have no benefit for me, because when your time is up, they just send you back to the same old living arrangements. Back to square one. What I really need is a service that can permanently solve my housing problem, but apparently no such service exists.

That's just my take on how a poorly-organized mental health system can tie up precious resources (e.g. MH beds) with patients who have no use for them, thereby depriving the patients who could actually benefit from those same resources.

I think that if we did a much better job of redirecting patients to the help they actually need, it mightn't completely eliminate the shortfalls, but it would make them far less grievous.

[Zoe7]

Both @chibam I will add, it has been a long time since I even tried the community service so things may have changed but the response I received years ago was enough to never have any contact again.

[chibam]

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@Zoe7 wrote:

Both @chibam I will add, it has been a long time since I even tried the community service so things may have changed but the response I received years ago was enough to never have any contact again.

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Same, @Zoe7 .

I still need help as desparately as I ever did, but there's no way in hell I'm ever going back to a system like the one I went into 20 years ago. They had no intention of ever giving me the help I went there for, but they didn't even have the decency to tell me so. Just kept booking more and more appointments for me and taking my family's money...

I keep an eye on what's being said about the system. Checking to see if there are any reports or articles stating that the government is inventing a new type of therapist who will actually help people like me with our problems. Maybe it's not Game Over, afterall, you know?

Mostly what I hear is that I'm not unique; there are scores of people in the exact same boat as me who desparately need the exact same help! But the response to these revelations are hopelessly vague. I'm yet to see a government report come out that makes a firm, unambiguous commitment to actually create a new type of therapist who will actually help us, and to hire the necessary number of such therapists to adequately help us all.

Instead, the government and MH industry hide behind vague, nonsense jargon like "psychosocial therapist", "occupational therapist", "missing middle", "social perscribing", ect., ect. that doesn't tell you anything and is therefore beyond any scrutiny.

The sickening thing is the knowledge that many people out there, who just happen to have a supportive friend or relative, gets these sorts of problems sorted out quickly, for free, by said friend/relative. That's really all we're asking to do: to 'hire' a professional friend/relative for a few hours to sort out our everyday problems for us. It's such a simple request; to get the basic practical support that most members of the community have always enjoyed. But the government just can't be bothered setting it up for us.

I just don't understand.

[sadboyhours]

Thankyou @Zoe7 and @chibam for your insights!

I also do not trust the community MH services as far as I can throw them... I have seen 'service improvements' become the same crap by a different name too many times.

I am interested to know if you've had any experience with peer-led services? I don't know what services might be in your respective areas but in Queensland there are some places using the 'clubhouse' model and some using a 'non-clinical support' model that have apparently been positive, and the Safe Haven in Hobart is... sort of peer led, which has also been received well.

Unfortunately my experience has been that the peers are usually eventually steamrolled by clinicians who wreck it for everyone involved but if we could stop that from happening, I think it could be a good way of addressing the whole issue of going around in incomprehensible circles - trialling endless meds, calling the same hotlines over and over, not really getting anywhere because you're left with too many problems at the end of the day to even feel like you could see an end...

Of course, no pressure to share any of your journey with me 🙂

[chibam]

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@sadboyhours wrote:

Thankyou @Zoe7 and @chibam for your insights!

I am interested to know if you've had any experience with peer-led services? I don't know what services might be in your respective areas but in Queensland there are some places using the 'clubhouse' model and some using a 'non-clinical support' model that have apparently been positive, and the Safe Haven in Hobart is... sort of peer led, which has also been received well.

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No problem, @sadboyhours ! 🙂

After my horrible experiance with the traditional mental health system (which occurred years before I ever heard anyone even mentioning "peer-led/peer-support services"), I would not even think about going near any sort of help service until I knew precisely what I was letting myself in for. I was trapped in the system for 8 years, you see, with no obvious way out; and I just can't subject myself to that sort of captivity again.

Unfortunately, I'm yet to find a description of peer-led services that properly clarifies what they do exactly, in plain english. And until I can fully understand what they do, precisely, I wouldn't even think of going near them.

Unfortunately, I'm not aloud to write my opinions here about the information I've encountered about peed-led services, so I'll just have to leave it at that.

So yeah... peer-led services: haven't tried them; can't speak from personal experiance; haven't heard anything to make me think they might be worth my while.

That's all I can really say.

[Zoe7]

These forums are a wonderful example of a peer-led service @sadboyhours and a leader in that area in Australia. The Clubhouse model is an excellent example of the power of a peer led service and I know SANE have closely looked at this model and how it can be incorporated into this service. I am a big fan of this model and the massive impact it can have when people take control of their own service offering.

Unfortunately in Tassie we don't have many options for consideration 😢

@chibam I am not sure how many times we can 'tell' the government what is needed before they actually listen. So much money is wasted in setting up committees/groups etc. to 'evaluate' what is needed time after time yet nothing comes of it.