Mental Health Services

The Hon. T.A. FRANKS (15:15): I seek leave to make a brief explanation before addressing a question on the topic of mental health and ramping to the Minister for Health and Wellbeing.

Leave granted.

The Hon. T.A. FRANKS: Today, we have learnt that an external review into ramping at Adelaide hospitals, commissioned by the Chief Psychiatrist, found that one in three mental health patients brought to hospital by ambulance were forced to ramp. This includes more than 10 per cent of children brought to hospitals under these conditions. That report is actually dated from November 2019, but has only just been publicly released now. That report found that in 2018 a total of 10,994 mental health patients were brought by ambulance to South Australian emergency departments and that more than 34 per cent of those experienced ramping.

Those rates are well above the stated target set for ramping in the 2019-2021 service level agreement, with the actual target being that ramping should occur in less than 10 per cent of ambulance arrivals. Indeed, the Lyell McEwin had the highest rate of ramping, at nearly 60 per cent of the cases, followed by the Royal Adelaide (46 per cent), Flinders Medical Centre (35.5 per cent) and The Queen Elizabeth Hospital (32.2 per cent).

Of these ramped patients, the majority were transferred within an hour, but one in every 16 waited for more than an hour, and one in every 77 waited for more than two hours. Twenty-three patients waited more than three hours, with the longest wait being four hours and 48 minutes. That patient was a middle-aged woman with an intellectual disability and cancer, brought to the Royal Adelaide.

This report highlights a range of causes of ramping for mental health patients, including access block in emergency departments, a lack of non-ED alternatives for patients and a lack of resources right across the mental health system.

I note that, as reported in InDaily, the report detailed those 168 cases of ramping in that year a week after South Australian Health categorically denied ramping was occurring at the hospital. Can the minister explain why South Australian Health's public statements are so contradictory to the release of this report and the findings of the Chief Psychiatrist's commissioned report?

The Hon. S.G. WADE (Minister for Health and Wellbeing) (15:18): Before I go to the report more generally, I might respond, if the member permits me, to her statement about the Women's and Children's Hospital comment. I will quote it word for word:

The Women's and Children's Hospital does not ramp and there is no evidence of any occurrence of ramping in recent weeks. While the paediatric emergency department has been busy in recent weeks, all patients presenting by ambulance have been transferred in a timely manner.

There is the reference to ambulance there, and it relates to the fact that the Women's and Children's Hospital was talking about ambulance transfers. The difference with the report that the honourable member referred to is that they have used the word 'ramping' in a broader sense. They talk about external and internal; in other words, transfer of care delays within the emergency departments of hospitals are not simply transfer of care delays from an ambulance into the emergency department.

In relation to the report, there were sets of data I could see in the report that related to 2017-18. I am advised that the case studies in the report relate to cases in 2018. I would remind honourable members that this government was only elected in March 2018. In terms of the response to the report, the report itself made 24 recommendations. The local health networks and SAAS received the report in late 2019, so in other words they were aware of the recommendations.

Since then, there has been a lot of work done. There has been further work done in terms of getting feedback and providing a response to the recommendations, which has also been published on the Chief Psychiatrist's web page. I think it is important to appreciate that a number of actions consistent with the recommendations of the report have already been undertaken. For example, there has been an expansion of the Mental Health Co-responder program, and I know the honourable member, before this government even established that program, was advocating that as a sensible reform in terms of mental health.

I think it also relates to the point the Hon. Frank Pangallo was making, that often a multiagency response can be helpful. So to have a mental health clinician alongside an ambulance paramedic can provide a much more appropriate response than a paramedic alone—I should say paramedics alone—without a mental health clinician in the team.

Another action consistent with the recommendations of the report is the establishment of Hospital at Home within the Central Adelaide Local Health Network. Also, as I have had cause to mention a number of times this week, the Urgent Mental Health Care Centre is consistent with the recommendations of the report. All three of those initiatives, I think, are highlighting the value, and if you like the report highlights the value, of providing services that deliver to patients with mental health needs care outside of hospital.

Often, hospital is not the best place for a person with mental health issues to receive the care they need, but this government is also investing in hospitals. Earlier this week—I think it was last Thursday—it was my pleasure to open the Boylan Ward at the Women's and Children's Hospital, which whilst it is a hospital environment is much less clinical than the previous facility was.

We will continue to enhance mental health services in the community, and we will also continue to enhance mental health services within hospitals. There is certainly a challenge in terms of patient flow with people needing mental health care, and the Chief Psychiatrist is working actively with the mental health units, particularly in the metropolitan area, to improve that care.