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31 Aug 2015

This section of our Newsletter has been included to provide an ongoing opportunity for the State and Territory Branches of the AMA to report on any state–based issues they feel might be relevant to psychiatrists and mental health reform.  Provision of material is entirely voluntary and we very much look forward to receiving articles from AMA Branches for inclusion in subsequent Editions.  All inquiries concerning articles for inclusion in this section should be directed to the Secretary of the AMAPG, Phillip Taylor, at the Federal AMA on 02 6270 5400 or by email to:

AMA Victoria

AMA Victoria, and our Section of Psychiatry’s focus this year has been on the implementation of the new Mental Health Act which commenced on 1 July 2015 and on building better ties with General Practice and the College of Psychiatry.

AMA Victoria has been engaging with doctors across the state to ascertain the issues relating to the implementing of the new Mental Health Act. Members have consistently raised the issue of excessive paperwork, often undertaken by junior doctors at the expense of clinical training time or as unpaid overtime.

AMA Victoria has also been working with our Section of Psychiatry to improve communication and collaboration with other medical professions, in particular general practitioners. A key focus over the coming months will be finding ways to improve patient handover and collaboration and improving the physical health of mental health patients.

The Section of Psychiatry has also been seeking to strengthen the relationship with the Victorian Branch of the Royal Australian and New Zealand College of Psychiatrists and find areas for potential collaboration in the future.

AMA Western Australia (WA)

WA Mental Health Act

The AMA (WA) has been alerted to serious problems in relation to the implementation of the new Mental Health Act 2014. A range of issues has been raised in respect to the Act, specifically clinician training, systems, the mandatory notifications process, indemnity and workforce impost.

The Act is a 400 page piece of legislation that was largely driven by consumer groups. However, in spite of criticism from Psychiatrists (and others), the legislation has been passed and the Minister for Mental Health has declared that it will be enacted in November 2015. Once this is a legislated process doctors will have legal obligations to comply with the requirements of the Act.  Predominantly, this will affect Psychiatrists, ED Physicians and GPs.

The AMA (WA) and RANZCP WA Branch have suggested a staged implementation of the Act which is consistent with what has been done in other States. College representatives would guide the Minister as to the stages and the order in which they should be implemented. The stages should be comprehensively reviewed against specified KPIs throughout. However, it currently appears unlikely that the Minister will adopt the staged approach to implementation.

Some 5,000 staff need to be trained up prior to the Act’s implementation and given that there are no systems in place to do the notifications, no e-forms ready and no training ready, this will likely result in a compromised implementation. It is unlikely that the required GP interfaces will be completed at the time of implementation.

The AMA and the College are looking to develop a checklist of things that need to be addressed by the time the Act goes live. If the Minister cannot provide assurance that these things have been ticked off, there needs to be detail of the contingency plan. The Minister will be asked to provide confirmation that everything is in place prior to the proclamation of the Act. It is the view of the AMA (WA) that, if the stage is not set for the proclamation of the Act, it should not be proclaimed. There is also the question about indemnity – how are staff protected if they haven’t received the adequate training, resources, information, processes?

The Act raises new issues and amplifies those the AMA (WA) has already been raising relating to clinical governance and these are important to raise within the context of the Act.

WA Suicide Prevention Strategy

The WA Government has released its Suicide Prevention 2020 Strategy (Together We Can Save Lives: One Life) – developed by the Ministerial Council for Suicide Prevention, Chaired by Dr Neale Fong. In the current State budget, suicide prevention funding has doubled from previous levels. Whilst this is clearly welcomed by the AMA (WA), it is critical that, in the implementation of the new strategy, the serious failings of its predecessor are recognised. The previous five year strategy, established by the Liberal – National Government in 2009 was resoundingly criticised by WA’s Auditor General for poor implementation after a comprehensive review was undertaken. Initial planning was found to be inadequate and arrangements were unclear and costly in terms of time, effort and money.

The 2009 strategy came in at a cost of $18 million. Many parts of the strategy were not completed. WA's suicide rate had increased over the past decade to 36 per cent above the national rate in 2012 and the annual number of suicides rose from 194 in 2004 to 366 in 2012.

In WA on average, one person loses their life to suicide every day. The new strategy has set a high achievement target – to halve the number of suicides in WA by 2020. The WA Mental Health Commission has been tasked with developing the 2020 Strategy implementation plan (including separate Aboriginal and Youth strategies) and these are expected to be complete by mid-August. The AMA (WA) will await the details of the implementation plan as this is expected to provide important specifics that are missing from the glossy booklet released by the State Government.

The 2020 Strategy has six action areas, including public awareness, community support and prevention programs, workplace prevention programs, increased suicide prevention training, data and information improvement.

Dr Fong said the 2009-2013 strategy was heavily focused on raising awareness and reducing stigma. He claims that awareness is now better, and it is time to do more about the suicide "epidemic". The 2020 Strategy targets high-risk groups - the mentally ill, people who have previously attempted suicide, young people, Aboriginal people and drug and alcohol users.

The AMA (WA) sincerely hopes that lessons have been learned from the failure of the 2009 Strategy

– particularly in terms of improved governance, procurement and planning for implementation. Had these processes been appropriately managed, considerably more time, effort and money could have been spent on suicide prevention activities. It is hoped that that the suicide prevention activities in the 2020 Strategy will be co-ordinated with existing activities and hence will avoid duplication, increase efficiencies and be sustainable.

In August this year, the WA Coroner found that systemic problems within the State’s mental health system contributed to the suicide of a young Perth man.  The Coroner reiterated what the AMA  (WA) has been regularly and strongly communicating to the Minister – that continuing to have acute mental health patients waiting for days in Emergency Departments for acute care places is shameful. The Coroner could not have been clearer in his findings in the case of 31 year old James Anthony Stanczyk. The Coroner said that “while this situation continues, it is likely that more at-risk patients will abscond from emergency departments, with the potential for similar tragic results”.

The Coroner found that “a longer term solution to this unsatisfactory situation from a medical/mental health management perspective would be the provision of a sufficient number of places in mental health facilities where mental health patients can be managed and treated appropriately”. This will not be news to the Minister - it echoes what the AMA (WA) has been calling for over many years.

The State’s mental health system declared a “code yellow” in late July due to the acute beds crisis. In the course of one week, approximately 20 mental health patients were kept in the EDs of Royal Perth and Sir Charles Gairdner Hospitals.

With a flawed Mental Health Act due to be proclaimed in November this year and a 10 Year Mental Health Plan which appears to be unfunded at both State and Commonwealth levels, the AMA (WA) has serious concerns for patients needing acute mental health care. However, the AMA (WA) will continue to advocate vigorously for the required number of specialised emergency care facilities for acutely ill mental health patients.

WA’ s FIFO Mental Health Inquiry

The AMA (WA) provided a detailed submission to the WA Parliamentary Inquiry into the impact of Fly in Fly Out (FIFO) work practices on the mental health of employees. The Parliamentary Committee released its final report and referenced the AMA (WA) submission extensively.  As was highlighted in the AMA (WA) submission, the report found that the typical FIFO employee comes from the highest risk demographic (male aged 18 to 44) for mental illness and suicide. FIFO work puts employees in a situation of regular isolation from family, friends and other  social supports, subjects them to fatigue and controls their lives through a heavily regulated workplace and living environment whilst on-site. As was the central theme of the AMA (WA)  submission,  the Inquiry found a negative link between the structure of FIFO work and the mental health and wellbeing of employees. The Inquiry found that the incidence of mental distress in the FIFO community is significantly higher than that of the general population.

Amongst the Committee’s principal recommendations were the need for legislative change (focusing on employer duty of care and improved reporting / investigation of suicides and attempted suicides on mine sites), a new Code of Practice to be developed to protect FIFO workers from mental distress (including encouraging better rosters) and the commissioning of independent research into the mental health impacts of FIFO work on employees and their families. The new Code of Practice would address workplace fatigue, workplace bullying, the stigma of mental health within the industry and the impact of FIFO on personal relationships — including financial pressures and employment volatility.

In a letter to the Premier of Western Australia, the AMA (WA) has highlighted that, in the current environment, where the falling Iron Ore price has resulted in lack of job security and difficult roster changes for FIFO workers, the Inquiry findings in respect to even-time rosters and acknowledgement of the impact of fatigue on the mental health of FIFO workers have become even more relevant. Further, the Association has requested detail on the Government response to the recommendations and the allocation of suitable funding.

Published: 31 Aug 2015