The Australasian College for Emergency Medicine (ACEM; the College) has welcomed the release of the final report of the Royal Commission into Victoria’s Mental Health System.
The College has long advocated for resourcing and systemic improvements to the care provided to people needing mental healthcare. ACEM has supported the urgent rollout of the interim measures from the Royal Commission, including additional acute mental health beds and state-wide delivery of the Hospital Outreach Post-suicidal after Engagement (HOPE) program.
ACEM commends the Royal Commission for giving a voice to people with a lived experience, their carers and families, and the wide array of people working in the mental health system. The College welcomes the acknowledgement that Victoria’s emergency departments (EDs) are being called on to provide a volume, range and complexity of mental health services without the resources, infrastructure or systemic support necessary to provide timely and appropriate care.
ACEM Victoria Faculty Chair Dr Mya Cubitt said: “There is much that is very welcome in this final report and in the Government’s commitment to implement all of its recommendations. The mental health system is broken and requires urgent reform.”
“However, the state’s mental health crisis is happening now, and the College again stresses the urgency of implementing solutions. Every day we have people experiencing serious mental health crises coming to our EDs because they have nowhere else to go for help, and then having to undergo long and stressful waits. The need is urgent.”
ACEM has previously called for whole of system solutions which include improving localised access to community care options, particularly out of hours, as well as better support and resourcing of EDs, in acknowledgement of the integral role they play in providing mental healthcare.
Emergency clinicians have sought additional mental health beds for years. While the expansion of commitments contained in the interim report, particularly the delivery of at least 100 additional beds in a range of settings is welcome, the College again stresses these are needed now, not years down the track. ACEM also supports the idea of multidisciplinary care for bed-based services, and the intention to offer these in more settings.
The College welcomes plans to establish integrated and localised initiatives including, adult and older adult mental health and wellbeing services with extended hours, as well as additional infant, child and youth area services. Fast-tracking the delivery of six mental health priority sites across the state as part of this commitment is good.
“It is also good to see plans for the creation of safe spaces and crisis respite,” said Dr Cubitt.
“The report contains some alternative options to the ED, as well as a welcome range of outreach initiatives and recommendations for additional mental health clinical support for frontline emergency responders. All contribute to a positive blueprint for a system overhaul.
“Given the scope and volume of recommendations and initiatives, it will be very important to ensure these services are properly resourced and supported, and integrate as part of a whole system, particularly where state and federal initiatives intersect and interact. Where new governance models and structures are proposed these must contribute to better outcomes for people needing mental health support, rather than duplication or additional administrative burden.”
The College notes the report’s recommendation that there be at least one highest-level ED suitable for mental health and alcohol and other drug treatment in every region. Care needs to be taken to ensure this does not result in over-centralisation, or other unintended consequences, and more information, as well the evidence-base behind this initiative, is needed.
“EDs must be properly resourced to perform their roles as part of regional networks, and all new initiatives must be properly established and supported, to acknowledge the many complexities often associated with mental health presentations, including alcohol and other drug issues, chronic health and social situations,” said Dr Cubitt.
“There is also a need to recognise and address the significant workforce and resourcing challenges which already exist.
“Over the medium term we look forward to working with other stakeholders, including the proposed Victorian Mental Health and Wellbeing Commission, to implement these reforms. However, we also need to see measurable improvements within the next six months. It is not fair to expect Victorians in distress to wait any longer for quality care.”
ACEM President-Elect Dr Clare Skinner said: “The problems facing Victoria’s mental healthcare system have been well-documented and examined by this Royal Commission, with similar issues being experienced in every jurisdiction across Australia and New Zealand.”
“The issues have been established time and time again. Now we must act to ensure everyone has access to the mental health support they need, when and where they need it.
“We need to address the socio-economic drivers of mental health, while also ensuring all systems, levels of government, clinicians, community providers – everybody involved in mental healthcare – are working together for consumers.
“Within the implementation, there must also be clear metrics for measuring success, including who will be accountable for ongoing failure. This should include mandatory reporting of 12 and 24 hour ED stays for people in need of mental healthcare to the hospital executive and minister, respectively.
“It is well past time to address these issues. Genuine solutions must be the ultimate outcome of this Royal Commission.”
Background:
ACEM is the peak body for emergency medicine in Australia and New Zealand, responsible for training emergency physicians and advancement of professional standards. www.acem.org.au
In 2020 the College released the Nowhere else to go report which examines the factors contributing to Australia’s mental healthcare crisis. It contains a comprehensive set of recommendations to help improve care for members of the community seeking mental health support, and address unsustainable pressures on hospital emergency departments.