The emergency department in South Australia’s largest public hospital is “not designed or resourced” to deliver effective mental health care, according to a review commissioned after a woman died in an alleged stabbing.
In December, Julie Seed died and her colleague Susan Scardigno was seriously injured at the real estate agency they worked at in Adelaide’s southern suburbs.
Shaun Michael Dunk is facing court over the alleged murder and attempted murder.
SA Health has previously said Mr Dunk was released from the Royal Adelaide Hospital (RAH) two days prior to the alleged attack, after being treated for a mental health condition.
The SA government released the findings of an independent review, led by Western Australian Mental Health Commission’s Sophie Davison and Alfred Health Associate Professor Sandra Keppich-Arnold in Victoria, which was commissioned in the days following the alleged stabbing.
The report, which cannot be released in full due to the ongoing legal proceedings, included six recommendations, which the SA government has accepted and will implement “as soon as possible”.
“The reviewers concluded that the Royal Adelaide Hospital emergency department model of care is not designed or resourced to deliver timely, effective and quality care for mental health consumers,” SA chief psychiatrist John Brayley said.
“The reviewers went on to talk about how the ED is not an appropriate environment and made particular observations about the use of security guards for mental health continuous observations in the emergency department.
“They have noted that the use of more mental health nursing would promote better quality care because the mental health nurses and clinical staff can undertake more observations and identify opportunities for early intervention.”
Dr Brayley said the reviewers identified systemic issues in the RAH ED including “the impact of prolonged waits at the RAH for a mental health bed” and “the lack of continuity of care that occurs in the emergency department by necessity as staff change for different shifts”.
“These recommendations have been put forward in the context of community safety but they will have much broader benefit to the care of many other people as well,” Dr Brayley said.
SA Health Minister Chris Picton said the review was ordered after it was publicly reported that Mr Dunk had interactions with the RAH and the Urgent Mental Health Care Centre (UMHCC) on Grenfell Street prior to the alleged attack.
“Very importantly the report makes clear on page nine, and I’d like to quote this section, ‘That there was no evidence of any individual clinician’s assessment, treatment or decisions falling below an acceptable standard or not being justifiable at that point in time with the information available to them’,” Mr Picton said.
The review also recommended more communication between the RAH and the UMHCC, such as developing a process to flag frequent attenders and a centralised record of patient contact with all mental health services.
Dr Brayley and SA Health Chief Executive Robyn Lawrence have been tasked with overseeing the implementation of all six recommendations.
“Importantly we’ll work with our healthcare leadership and mental health clinicians across our system to ensure that we share those recommendations band where they’re appropriate implement them across the board,” Dr Lawrence said.
“In particular the recommendations around frameworks and audits I think would be important for our system to review and to ensure that mental health patients where they turn up, it doesn’t matter which hospital they present to, will receive the same level of care right across our system.”
Dr Lawrence said some of the recommendations would take some time, such as recruiting mental health nurses, but the RAH would continue to provide mental health care to patients presenting to their emergency department.
“We would always need to maintain capacity for patients to attend, particularly our tertiary emergency departments, no matter what their problem,” Dr Lawrence said.
Reviewing legislation
While the review did not recommend changes to the state’s Mental Heath Act, Dr Brayley said the reviewers were concerned the legislation did not include a time limit before a required medical review for a mental health patient.
Mr Picton said the government was considering potential reforms to the legislation.
“We need to make sure the mental health care system is as safe as possible and that’s what the government is doing,” Mr Picton said.
“It is worth highlighting that the vast majority of people who have a mental health condition, of which they are hundreds of thousands in South Australia, are never a threat to violence — in fact many of them are more likely to become a victim of violence.”
Mr Picton said the government had met with the families of Ms Seed and Ms Scardigno to discuss the findings.
“Clearly there are a number of other issues in relation to this matter, and I should say particularly concern to the families as well that are of particular importance, and that includes reforms to the justice system and reforms to how we can prevent violence against women in our community,” Mr Picton said.
“They are matters in which the government is determined to take action as well and we are further considering options in relation to that.”
