The potholed road to care for people with mental illness in regional NSW

Gary Shallala-Hudson, who lives with post-traumatic stress disorder, was relaxing at his NSW North Coast home the day before New Year’s Eve 2010 when there was loud knocking at the door.

“I had no idea what was going on. Turned out someone had called the police to tell them I was going to try to suicide,” said Gary.

Gary is one of thousands of people each year across NSW who are taken, under legislation, for a psychiatric assessment, usually by the police. In rural and regional areas, this can involve long trips in the back of a paddy wagon to a major hospital in a distant town.

Yet legal changes to the Mental Health Act, designed to reduce police transport of people with mental health challenges, were not having the desired effect in regional and rural areas, a group of researchers led by Dr Joanne Bradbury, a postdoctoral fellow at Southern Cross University in Lismore, has found.

In the paper ‘Mental health emergency transport; the pot-holed road to care’, published today in The Medical Journal of Australia, Dr Bradbury and her co-authors investigate the reasons for ongoing police involvement in emergency mental health interventions.

“Police have historically had state powers to apprehend and transport a person suspected of having a mental illness to a psychiatric facility and this practice continues to the present time,” she said.

“In response to community concerns about the widespread practice of transporting people with mental health challenges in police vehicles, changes to the Mental Health Act in 2007 gave ambulance officers and other NSW Health practitioners more powers and responsibility for intervening in mental health disorders”

However, Dr Bradbury said while ambulance paramedics were now also involved in mental health transports, the changes to the law did not seem to have substantially reduced police involvement, particularly for people in rural and remote areas where mental health intervention teams were stretched, and particularly so afterhours.

“Apart from resourcing issues, perhaps the major reason that police are often called in is that the situation has escalated to a high risk emergency,” she said.

“The Mental Health Act is worded in such a way that carers and health practitioners are powerless to intervene until the person is a risk of serious harm themselves or others. By this stage, the police are usually required to attend because of the serious risk involved. It’s a catch-22 situation.”

Gary Shallala-Hudson recounted his experience of when the police turned up to his front door.

“I was put into the back of a paddy wagon and bounced around the pot-holed streets of Lismore,” he said.

“It was degrading, stigmatising, and embarrassing. I felt like I was being treated like a criminal.”

Dr Bradbury said there were ethical concerns with waiting until the person became so unwell that they were a serious risk of harm to themselves or others.

“The person’s capacity to make their own decisions is not properly taken into account under the current legislation.

“When a person loses the capacity to look after themselves medically, this is a crucial point when carers should be able step in to help them, out of benevolence.

“Of course, earlier intervention strategies need to be strengthened with a view to creating empowerment beyond the health system, and mental health care units need to be transformed into attractive, healing places of respite and growth.

Dr Bradbury said although the question of when to intervene was not an easy one, it needed to be widely discussed and debated by people living with mental health challenges, carers, health practitioners, police and paramedics and the wider community.

“Earlier interventions in mental illness could be a more compassionate state and community response and may reduce the need for police involvement,” she said.

The National Mental Health Commission is calling for submissions from the public to inform mental health services and programs. Submissions are open until 11.59pm AEST Monday 14 April 2014. Go to www.mentalhealthcommission.gov.au and click on the '2014 Review of Mental Health Services and Programs’ link.

If you find the content of this article is distressing for you, please contact Lifeline on 13 1114.

Photo: Dr Joanne Bradbury.