Shining a light into a dark corner of Victoria’s health system

by Stephen Duckett

Published by The Age, Tuesday 19 December

The tragic stories of patients being abused in mental health hospitals, recently reported by The Age’s Farrah Tomazin, should concern us all. They shine light into a dark corner of Victoria’s health system.

For too long, mental health care has been a Cinderella – unloved and neglected. We as a community have been willing to turn a blind eye to the problems, probably because we thought people with mental illness are not like us. The reality is they are. Mental illness is still stigmatised, allowing this political neglect.

The overcrowding in Victoria’s mental health services is shocking, a contributing factor to the problems occurring.

In our review of safety in Victorian hospitals for the state government released last year, we discussed access problems in one area only – mental health care. Why? Because the overcrowding we found in mental health care was so bad that it was clearly affecting the quality of care provided to these vulnerable Victorians.

For too long, the mental health community has been content to accept whatever crumbs have been thrown to it, including cheap, symbolic changes – a national plan here, a designated minister for mental health there – rather than demanding real change in resources and systems.

Regardless of the competence of a minister for mental health, appointing a designated minister is mere window dressing. A minister for mental health cannot reallocate funds from general services – the preserve of the separate and invariably more senior minister for health – to mental health care. A mental health minister cannot guarantee that all hospitals will give appropriate priority to their mental health services. This ghettoisation is exacerbated when, as was the case until recently in Victoria, mental health and general health care were separated bureaucratically in the health department.

Unfortunately, the responses to the safety issues identified in The Age give me no confidence that the mental health system has learnt the lessons that the general health system learnt from the tragic cluster of potentially preventable baby deaths at Bacchus Marsh Hospital in 2013 and 2014. Is there no mechanism to ensure hospitals learn from what happens in other mental health units in other hospitals?

The quality and safety of mental health care is an important national issue in Australia. Yet, inexcusably, the Commonwealth and state health ministers have decided to sweep the safety issues in mental health care under the carpet. They recently endorsed a set of “Hospital Acquired Conditions” as a way of measuring the safety of hospital care. This list includes complications such as infections, medication complications and pressure injuries. Changes in the rate of these Hospital Acquired Complications affects the total amount of money the Commonwealth pays the states for health care.

But in a bizarre decision, the official Hospital Acquired Complications list excludes any complications which occur in patients admitted for mental health conditions (and those admitted for alcohol and drug-related conditions as well). This is blatant discrimination. It cannot be justified. It sends a terrible signal that infections in people with mental illness don’t count and so don’t matter.

Government needs to monitor and publish the rate of all complications in mental health units, so that all Australians can gain some knowledge about what is going on in these units.

It’s time all Australians took a stand against the abuse and neglect. We should demand that our political leaders make real and urgent improvements to the safety and quality of care for people with mental illness.