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Psychiatric wards at Melbourne’s major hospitals are being forced to close beds and specialist 24-hour teams for mental health emergencies are struggling to respond to the rising wave of callouts amid crippling staff shortages caused by the Omicron wave.
Days after a statewide code brown emergency was declared to relieve the health system struggling under the pressure of COVID-19, mental health clinicians said they were being crushed by demand as staff in hospitals worked double shifts with no breaks to cover high absenteeism.
Emergency departments are more crowded than ever.Credit:Damian Shaw
Health services are also struggling to fill rosters for 24-hour specialist teams, which are the crucial front line for the most severely mentally unwell people in the state.
The Age has been told a psychiatric phone triage service for people in the grips of a mental health crisis operating out of Monash Health in Melbourne’s southeast has been unable to function several times in recent weeks due to staffing shortages.
One mental health clinician, who works in Melbourne’s outer west, said the situation had become so dire that peer support workers, who were not clinically trained, had driven a suicidal man to hospital because all available ambulances were attending to “lights and sirens emergencies”.
“It should never, ever, come to that but it has become so desperate,” said the senior healthcare worker, who is not authorised by his employer to speak publicly. “Our biggest concern is that we just can’t get to everyone in time, and we are worried somebody will die while waiting for help.”
Eastern Health’s crisis assessment and treatment team had to temporarily halt home callouts due to high numbers of staff absences as outbreaks in mental health units plunged two-thirds of specialist staff into isolation and forced psychiatric wards to temporarily shut or wind back their services – a situation one senior psychiatrist said was “unheard of” pre-pandemic.
Describing the situation as “extremely parlous”, Health and Community Services Union state secretary Paul Healey said some mental health units in hospitals were operating with just two staff members per shift instead of the usual seven, meaning there was no choice but to close beds.
“It’s getting very desperate,” Mr Healey said.
Among the worst hit in Melbourne is Monash Health, which has been forced to close at least six mental health beds – roughly 20 per cent of capacity – at its Clayton hospital this week due to staffing shortages. Mr Healey said 400 nurses were in isolation.
Ambulances were diverted this week from all three of Monash Health’s emergency departments with the hospitals unable to accept patients except those arriving with life-threatening conditions.
The Mercy Hospital’s psychiatric unit in Werribee also closed 16 of its 66 mental health beds due to furloughing of staff last week, while the Footscray Hospital’s Orygen youth mental health unit closed temporarily due to a coronavirus outbreak.
Killian Ashe, a consultant psychiatrist at the Royal Melbourne Hospital’s acute psychiatric unit, said patients were finding it increasingly difficult to secure a bed in his ward – where 10 per cent of staff have been absent in recent weeks – and were in some cases spending long stretches of time in emergency departments as a result.
Once these patients were discharged they faced months-long waiting lists to secure appointments with general practitioners or private psychiatric and psychological services.
“In real terms … there’s much less availability of face-to-face care for people who are having mental health issues and then inevitably small problems go into big problems, treatable symptoms become wildly out of control, which leads to more and more hospitalisations.”
Dr Ashe said three of the ward’s nine consultants and registrars were absent two weeks ago and staff had to work long, double shifts and forgo their leave to make up for the shortfall, which could lead to burnout and possible resignations.
The ward came close to closing some beds in December, but this did not eventuate.
“It’s just unheard of that such conversations would even occur,” Dr Ashe said.
Before the COVID-19 pandemic, Victoria was roughly 450 mental health nurses short, but Mr Healey said this number was probably far higher now as workers left the sector due to burnout.
Four mental health clinicians, who work across Melbourne, told The Age there had been a troubling spike in drug use and self-harm cases across the state coinciding with a surge of more than 1000 hospitalisations linked to the Omicron outbreak.
“A lot of people are having very serious suicide attempts and because of the sheer number of people affected by COVID, our workforce has taken a huge hit,” one senior mental health clinician who works at a major metropolitan hospital in Melbourne said. ”We have been left with a third of the workforce or two staff for an entire mental health unit.”
The healthcare worker, who cannot be identified as she was not authorised to speak publicly, said that on top of an increase in self-harm presentations, she had also observed a rise in people with psychosis seeking help.
“We are seeing psychotic symptoms emerging in people that have never had psychosis before,” she said. “We’ve also seen a massive increase in drug and alcohol presentations as well.”
Another senior mental health clinician, who works in the western suburbs, said he would often call ambulances for patients needing to be admitted to hospital because they were at risk of harming themselves but they would be left waiting hours for an ambulance that never arrived.
The clinician, also not authorised to speak publicly, said staffing shortages due to coronavirus exposures had meant teams of specialist police, ambulance and mental health clinicians which attend acute mental health callouts were unable to operate or attend every callout in recent weeks.
“The police will always do their best to still attend the cases, but the ambulances just don’t have the manpower at the moment or they are being tied up in EDs for hours and hours,” he said.
Doctors say some Victorians with severe mental illness are spending days in emergency departments as they wait for a bed.
Emergency physician Stephen Parnis, who works across several Melbourne hospitals, said there had been a steady rise in people arriving at hospitals acutely unwell with complex mental health issues, since the end of last year.
“You’ve got a situation where distressed staff are looking after very distressed people,” Dr Parnis said. “Everybody is doing their best, but it’s a combination of ongoing heightened triggers for mental illness and a significantly reduced capacity to respond.”
“We’ve got an entire population in Victoria who are traumatised by this pandemic.”
Eastern Health’s program director of mental health Lisa Shaw-Stuart said despite the staffing challenges, the service had continued to provide emergency crisis assessment and treatment services, face to face where possible, or via telehealth.
“This is a really challenging time for many in our community and I encourage all those who need help to please speak up,” she said.
The state government spokeswoman said Monash Health’s psychiatric triage phone service was unable to be staffed for a full shift on a small number of occasions and people were redirected to alternative supports.
The spokeswoman said prior to the code brown, steps to protect the mental health system had been taken, including adding 104 new mental health beds and 23 new community mental health hubs across Victoria
The government has also implemented its Hospital Outreach Post-suicidal Engagement services, with seven out of the nine new sites up and running.
If you are troubled by this report or experiencing a personal crisis, you can call Lifeline on 131 114 or Beyond Blue on 1300 224 636. Beyond Blue’s coronavirus mental wellbeing support service can also be contacted on 1800 512 348.
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