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< In effect a manual split from an unsplittable thread. I won't try to quote absolutely everything and will do this in stages. Hence "under construction" for now. [Update: the split is now complete.]>
watt price tully wrote:Funny to be posting this here but it relates to the jobs theme. In the last 5 years and more our workload has increased exponentially, through the roof.
ED used to get say 140-150 presentations and that was considered a lot.
Now we're getting 200-280 per day.
Mental health presentations have gone through the roof
The number of staff employed has not been commensurate but some of the supports have improved and become more streamlined.
The EFT has increased but we can't get staff to fill the positions.
In the last 2 years about 6 more staff have been employed and only one remains of those 6.
Having said that we recently got a young guy who has some good expernece & he seems the goods. We also have 2 young women on our bank staff who are also very good.
The workload is just so full on and we have had too much micro management as the reasons for people leaving.
I've been at this workplace for 18 years. I don't need the promtions now as I've worked in senrior management and policy and enjoy what Im doing most of the time (the politics) like any job is the hard part
K wrote:...
Why have these presentations gone through the roof? Are these voluntary presentations or involuntary?
watt price tully wrote:...
ICE, Police, Overseas students, police, ambulance, alcohol, both voluntary and involuntary (in Vic sinc 2014 in the new Mental health Act called Compulsory Patients, lack of Crisis Teams (CATT services), inceased population, increased homelessness, cutting goverment housing, better reporting, more people being banged up then released throuugh the magistrates courts on orders, police etc. Mental Health Triage being more defensive, GP's not bulk billing, GP's panicking.... off the top of my head. Some GP's find it quicker and easier to send people to the ED for an assessment whether they are acute or not rather than call the mental health triage number: one classic is you have a person who reports they have been feeling suicidal for years. They have no plan or intent. The GP still sends them in rather than call the triage number where a person can be assessed and if required a crisis team can see them the next day, the day after etc. depending on what the triage clincian ascetains on assessment.
To the list add:
* Less skilled and less staff in care facilities
* DHS disability not giving a phuk and bad behaviour being referred to mental health: eg. there is a Cummunity REsidential UNit nearby.One male resident was given two eggs for breakfast while the person in question only got one. Thy get pissed off & state they want to kill themselves and run onto the street. Police are called, then ambulance, the person may or not be restrained, the person may or not be be injected by the paramedics. Paramedics then look at the psrons medication box and a GP has prescibed a low dose anto psycotic. The person is then tken to the ED. The paremedic then makes a huge asumption: necause the person has been prescribed an anti-psychotic they handover to the ED triage nurse the prson is suicidal and has schziophrenia. The Traige nurse duly writes this down. it is now documented that the situational crisis that it was has become 34 year old male history of schizophrenia tries to suiciee after running into traffic. WE then either see it on the system ot get a referral through pager or telephone. Do out checks & not no sych hx of schizophrenia.
Yes years of training!- refer back to the ED Dr & say this is not acute psychiatry there's a problem we need to fix the problem but this is Social work not acute psychiatry. In the language "the person has learned maladaptive ways to communicate their distress". Mind you what do you do when the person or place refuses to go back or refuses to have them back? These type of issues I handball back to the Dr to sort & suggest options. What do you do when the person say assaults their parents or care providers?
TBC
Last edited by K on Thu Aug 23, 2018 12:05 am, edited 1 time in total.
K wrote:...
What has changed in this new 2014 Mental Health Act? ...
stui magpie wrote:the 2014 mental health act, when combined with the updated charter of human rights makes dealing with people who present with potential mental illness problematic.
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K wrote:...
I wasn't intending to do this, but I've now found the Charter of Human Rights and Responsibilities Act 2006, " incorporating amendments as at 1 July 2014". It surely can only strengthen patient/victim rights, though, not hand more power to (e.g.) police...
stui magpie wrote:They very much strengthen the rights of the person over the authorities and clinicians.
K wrote:...
Well, the Charter of Human Rights and Responsibilities Act basically does not mention health and literally does not mention mental health. It does seem, though, that police would struggle legally to force people to do anything just for appearing to have a mental illness, let alone actually having one, a judgement police have no authority (or skills) to make whatsoever. (The Mental Health Act, which I'll comment on in a later post, does not address police; it addresses registered "health professionals".) Unless the victim has actually committed some offence, I really do not know on what basis they can cart someone off to the ER involuntarily, as WPT's post suggests they may be doing. (The same applies for ambos.) I'm wondering if they are bending the laws (or worse) here.
What the Charter does mention is stuff related to criminality:
e.g. "21... (2) A person must not be subjected to arbitrary arrest or detention.
(3) A person must not be deprived of his or her liberty except on grounds, and in accordance with procedures, established by law.
(4) A person who is arrested or detained must be informed at the time of arrest or detention of the reason for the arrest or detention and must be promptly informed about any proceedings to be brought against him or her."
I don't see anything in Section 21 addressing whether a person arrested or detained must be read their rights... I kind of hope this is stated somewhere else, i.e. that they have the right to know their rights.
[Footnote: Rules do vary by state and country, of course, but that variation is presumably in their equivalent Mental Health Act, not in their equivalent Charter of Human Rights.]
stui magpie wrote:being detained or deprived of liberty doesn't just mean gaol, it also covers involuntary admission to a psych ward. There's all sorts of hoops you have to jump through and i's and t's to be dotted and crossed, all of which is designed to protect the individual but also serves to make it more difficult for clinicians and cops dealing with people who show signs of psychosis.
Cops can't tell if someone is off their nut on drugs or just off their nut, so they drag them to an ED for a mental health assessment.
K wrote:...
I'm wondering if the cops actually know the law. If they do, another possibility is that they bend it by verbally persuading people who are probably scared and don't know the law to "accompany them voluntarily" to the psych ward. I find this all rather disturbing.
...
stui magpie wrote:...
I think it's perfectly legal in the majority of cases. The cops get called to an incident where someone is acting up, potentially posing a threat to themselves or others. Under the mental health act (IIRC) that's grounds for an involuntary admit to a pysch ward, if that is supported by a Psych assessment.
So the cops have a choice. They can leave the person alone and they may suicide or harm others, they can take them to the watch house and lock em up for 4 hours, putting resources into watching them, or take them to an ED for a mental health assessment which, as WPT has indicated previously, takes time and skill. You can't just plug em into machine or run a scan.
Health services operate within the law and the charter but sometimes it's necessary to push the boundaries to ensure the safety of staff and other patients.
It's a classic case for mine of the people who framed the legislation and charter not giving due consideration to the unintended consequences.
K wrote:...
The "posing a threat" part is very iffy. I mean, if the patient has actually e.g. assaulted someone, then it seems clear there's ground to act, so we're not talking about that sort of thing.
... An assessment order can only be given by a registered health professional. Let's concentrate for the moment on well-intentioned cops. It may be the cop's intention to take the person to a place where there is a registered health professional who can legally make an assessment order, but this means the cop has had to restrict the person's freedom before a health professional has had a chance to make an assessment that could possibly justify such a later action. Not kosher, as far as I can see.
stui magpie wrote:...
Now you need to check the Crimes act. Both the Crimes act and mental Health act would over rule the charter to the extent of any inconsistency and the Police have the right to detain you by placing you under arrest.
...
Thanks for your note, WPT... (Actually, the police aspect was just one thing and perhaps not the main thing that caught my eye from WPT's initial comments. ...)
Mugwump (in a different thread) wrote:... Judges are not trained psychiatrists. And trained psychiatrists are not very far above medieval plague doctors. ...
This, I think, makes getting the legislation right even more important.
I don't see it specified what the police must (e.g.) tell the person apprehended, so I assume it's the same as for an arrest in a criminal setting. [Jumping ahead a bit, I'm concerned about whether people under these laws can be treated no better than, and maybe much worse than, alleged criminals. (e.g. This is a serious issue for sentencing of people convicted of murder.)]
