EATING DISORDER UNIT

Mrs REDMOND (Heysen—Leader of the Opposition) (14:17): Can I encourage anyone who is going to the Fringe to at least see The Importance of Being Earnest. My question is to the Minister for Health. Is the minister aware that the number of deaths due to eating disorders, which has the highest mortality rate of any mental health illness, will likely increase with the closure of Ward 4G? On my visit to Ward 4G on 25 January 2011, a senior medical practitioner stated that he expected an increase in mortality resulting from the closure of this dangerous disorders unit.

The Hon. J.D. HILL (Kaurna—Minister for Health, Minister for Mental Health and Substance Abuse, Minister for the Southern Suburbs, Minister Assisting the Premier in the Arts) (14:18): I have great sympathy for those who have eating disorders and who treat people with eating disorders. By way of background, I have some personal interest in this. My late sister was a psychiatric nurse. She died when she was still associated with a private hospital in Sydney where she was the matron of an eating disorders clinic. I spent many hours talking to her about the issues associated with eating disorders and, from my own family circle, we have friends who have had children with eating disorders. So, I am very well aware of the issues faced by both the children or patients, generally, and their families and what a terrible illness this can be; how devastating it can be for families trying—

Mr Williams interjecting:

The Hon. J.D. HILL: Look, this is a sensitive and important issue and it would be very nice if the opposition would let me actually say what I think and what I am doing about it before they have their interjections to make smart alec remarks.

The effects on families are quite traumatic and the health effects on a young person, or any person for that matter but typically young people who do have these eating disorders, can be life-threatening, as the member mentioned, and, if they do survive, it can have all sorts of serious health consequences for the rest of their life.

I want to explain very clearly to the house, to the media and to some of the people who represent various associations associated with eating disorders how strongly I understand this issue. It is my earnest intention that we, as a state, provide the best possible service that we can for people in our community who have eating disorders.

There are no funding cuts at all in association with this. Whatever people might be suggesting, there is no intention to reduce funding to services for people with eating disorders at all. In fact, if anything, I think we probably need to put additional resources into this area.

What we are trying to do is make sure that we actually have a service that can provide help for patients right across our state. One of the things that health professionals tell me—the chief medical officers of the department—is that there has been a change in the nature of the patients who have eating disorders that has been identified over recent years. This unit at 4G was set up at a particular time but, over time, there has been a change in the nature of people who have the disorder.

We are now seeing younger people, children as young as nine or 10, who are suffering from some of these severe disorders. It used to be—say, 20 or 30 years ago—people typically in their late teens or 20s, and the age has been coming down. It is not to say that people in their late teens or 20s still do not suffer from this disorder, but the onset is happening earlier. One can think about why that might be so.

The images in the media and the kind of messages that young people are having pushed at them on a continuing basis, about what is right and what is the best way of looking, the best way of eating and the best way of behaving, is creating a very stressful environment for people. I just want to put that on the record.

At the moment, 4G is part of the Flinders Medical Centre, and the patients who are associated with an eating disorder are part of a ward which has four other mental health beds which cater to a mix of patients who have gambling, anxiety and general mental health issues. So, they are not in a discrete or separate ward at the moment. That is something that I think people need to understand, because the argument which always gets around in headlines would suggest that 4G is a discrete eating disorders unit. It is not. There are other patients with mental health issues there and, on occasions, patients with eating disorders have to share rooms with patients who have other problems.

There are also general surgical beds in that ward as well, as I understand it. The mixed ward environment, I am told, does not provide a setting conducive to recovery, and that is what ward staff have acknowledged. I think if the leader was being honest, when she attended, that is one of the things they would have said to her.

Mrs Redmond interjecting:

The SPEAKER: Order, leader!

The Hon. J.D. HILL: There have also been issues, I am told, on Ward 4G about inappropriate behaviour. I will give you an example. I know this will be sensationalised, but you need to understand what is being said and what has happened there. An example is when a male patient—one of the general mental health (anxiety, gambling) beds—received the wrong message when he saw a young girl with a top unbuttoned and thought that she meant she was interested in him. That is part of the environment that is there. It is not an ideal environment to look after particularly young women who have these eating disorders.

Ms Chapman interjecting:

The SPEAKER: Order, member for Bragg!

The Hon. J.D. HILL: Madam Speaker, if the member for Bragg has other questions she would like to ask me, would she please give the house the courtesy of asking them after I have completed this question. When asked by the member for Heysen's adviser about negative aspects of the eating disorder unit in the current setting, a nurse during her recent visit there indicated that the current environment of the ward is not as good, as the surgical area and the traffic going past the eating disorder rooms creates a lot of noise, which is distracting for the girls who need a calmer environment to concentrate on getting better. That is what a nurse who works there said. So, I think we can understand that this is not an ideal setting for these patients.

Currently, there are some people aged under 18 years with eating disorders who are admitted to the Flinders Medical Centre and also to the Women's and Children's Hospital, so we are looking at how we can best deal with paediatric patients as compared to adult patients. When we made the announcement that we were going to move the patients and the services from 4G into the areas that we talked about, there was a reaction, I think it would be reasonable to say, from some of the patients, some of the staff and some of the—

Mrs Redmond interjecting:

The SPEAKER: Order! The Leader of the Opposition will be quiet.

The Hon. J.D. HILL: It's like a bubbling brook; it's always there in the background. It would send you to sleep, I suppose.

The SPEAKER: Minister!

Members interjecting:

The Hon. J.D. HILL: That is a sort of Tony Abbott kind of comment, isn't it? 'Get on with it.' Here I am trying to—

Members interjecting:

The SPEAKER: Order!

The Hon. J.D. HILL: Here I am trying to deal with an issue which is sensitive and is of absolute—

Members interjecting:

The SPEAKER: Order! This is an issue that I am very interested in and I would like to hear the minister's reply.

The Hon. J.D. HILL: Madam Speaker, I have not tried to make this political, I am just going through the issues and it does take a bit of time to actually explain what we are doing. There were concerns raised by the eating disorder community, I think it would be fair to say (if I can describe them in that way) and, as a result of that, we said, 'Okay, we will work with you to try and come up with something which is better,' and that is what we are doing. We have established a working group which has a representative of consumers, a representative of the two units—the Women's and Children's and Flinders—the clinical staff and a range of other experts, and we have an independent expert as well, Ms Deidre Mulligan, to work through the issues so that we can come up with a statewide plan. At the moment—

Members interjecting:

The SPEAKER: Order!

The Hon. J.D. HILL: I will answer the interjection from the member in a minute.

Dr McFetridge interjecting:

The SPEAKER: Order! Who is answering the question, the minister or the opposition health spokesperson?

The Hon. J.D. HILL: He wishes! What we have said we would do is to come up with a statewide plan. At the moment we do have these two services but if you are in the northern suburbs, where is the service for you? If you are in the country, where are the services for you? In addition, we want to look at the—

An honourable member interjecting:

The SPEAKER: Order!

The Hon. J.D. HILL: We also want to look very closely at the balance between in-hospital services and out of hospital services. For example, a lot of our services are in hospitals but, in other jurisdictions, many of those services are now placed in the community. For example, a community house which has clinical support has been established in some other jurisdictions where patients with eating disorders can live together in a more normalised environment and undertake cooking, food preparation and eating activities. That is very difficult to do in—

Mrs REDMOND: Point of order, Madam Speaker.

The SPEAKER: Point of order, the Leader of the Opposition.

Mrs REDMOND: The point of order is relevance. The minister's explanation is very much on the eating disorders unit—accepted. However, the point of the question was about how he explains the fact that a doctor working in that unit says that there are going to be more deaths resulting from this disorder if they close the unit. That is what we want to know. What is his answer to that question?

The SPEAKER: Minister, I am very interested in your answer and I think what you are saying is covering the answer to the question. I do not think it is just specific to that. I think it is a bigger picture.

The Hon. J.D. HILL: Of course it is, Madam Speaker. The question is based on an assumption that somehow we are cutting the service—but we are not. What we are doing is looking at how we can deliver a better service and looking at where that service can be delivered from. I am saying that Ward 4G is not an ideal location for it to be delivered from. If it were to be kept together as a discrete service, as it is now, where else could we put it which would be better for the patients and better for the staff? If that is not the best arrangement to have, what would be the best arrangement? There will be full consultation, discussion and involvement with the clinicians and those who represent the users of the service. I am just letting people know that that is the case. The reference group is established and we expect, in answer to the member for Norwood's interjection, the work to be completed by the end of April this year.