Luke Williams shares his experience of dealing with mental health units unwilling to help suicidal patients and explores reasons why this is happening.
“I FEEL LIKE if I leave I am going to kill myself,” I told the mental health nurse in a fluoro-lit bed bay at Bundaberg Base Hospital. “I’m scared about what I might do if I go.”
He shook his head, lent forward and replied, “That’s not what hospitals are for.''
I still had visible, stinging neck grazes from an attempt I’d made three hours before. I wanted to stay. I was discharged and told to go to a homeless shelter without any dedicated mental health staff.
My fifth visit to the hospital in eight months, each time telling them I’d been suicidal and each time being told to leave and to make an appointment with my GP — which, as I’d told them, would take at least ten days to see him. I was already on a waiting list to see a local psychologist. I asked for help from the hospital, but none was forthcoming.
Up to 50% of people who suicide sought help from mental health services before they died: that is 50% of the eight people per day in Australia who take their own lives. With people asking why suicide rates have steadily increased since 2006, I believe I can shed some light. I live in an area with one of the highest suicide rates in the country – Bundaberg, Queensland – a state that continues to punch above its weight for suicide numbers year after year.
My five rejections for treatment at my local mental health unit came after I had been admitted to the Royal Brisbane Hospital eight months earlier with depression.
In the months after I was discharged, the suicidal thoughts came back — daily, sometimes all day. At the Royal Brisbane, I was heavily medicated and given no strategies to deal with these thoughts. There were no follow-up services nor linked-up services after I was discharged. Through my GP, I was put on a four-month-long waiting list to see a psychologist.
This lack of post-hospital care (to be contrasted with, say, getting a knee reconstruction and seeing both a hospital physio and getting follow-up appointments with the surgeon) is a pretty common situation for mental health patients. A 2015 report showed nearly half of all patients hospitalised after a suicide attempt receive no follow-up mental health treatment.
It was in the absence of follow-up care and no short-time access to a psychologist I kept going back to my local mental health unit in Bundaberg. Each time I would be asked only about whether I was taking my medication and told I wasn’t severe enough to be hospitalised nor even be case managed as an external patient. Even after I did make an attempt on my life, the mental health unit not only declined to admit me but seemed unable to offer counselling or basic advice for dealing with suicidal ideas.
In the wake of this experience, I reached out — not to medical services, but to Facebook. I made a series of posts on local forums about my experience with the Bundaberg mental health unit. Within an hour, my inbox swelled. There were claims of judgemental and unhelpful frontline mental health staff, of feeling belittled, embarrassed and put down.
Many, including a local nurse who worked in another department at the same hospital, claimed they knew people who had gone into the ward and were turned down for help, taking their own lives a short time later. Others who messaged me provided more than a few hints of how such tragedies might unfold.
Take Matthew, a truck driver from Bundaberg, who told me he sat in emergency for seven hours waiting to see mental health staff before getting up and walking out, Or Jenny, who said she was being selfish for using up emergency department resources and was discharged despite saying she had plans to take her own life. While Brooke said she was released from the unit and on the same day she tried to make an attempt on her life, when she was brought back in, they refused to readmit her.
I’m not saying this is just a phenomenon limited to my local ward — it’s a national problem. But the lack of mental health services is compounded in regional areas because of the lack of access to psychologists, long waiting times to see a GP or external psychiatrists and no opportunity to try different hospitals.
I also ended up getting dozens of messages from people who lived across central Queensland revealing grave dissatisfaction with their local mental health units.
Daphnejean from Rockhampton – where getting an appointment to see a psychologist can take up to six months – told me she had tried to get a court order to get the Rockhampton mental health unit to treat her son — a unit that went on to deny her four times. Eventually, he broke down mentally and burned down his grandmother’s house.
Several people also told me they had gone to Maryborough Mental Health Unit asking for help and left feeling worse. In one case, a young woman went in telling them she felt suicidal only to be turned away; an hour later she made an attempt on her life and is now permanently disabled.
Both the Rockhampton and Maryborough units had already been castigated in coronial inquests for neglectful conduct, which had led to either suicides or homicides. The messages I received from people in those areas took the total complaints, including those from the Bundaberg hospital, to a staggering 87.
So where does the blame really lie? Doubtless, some of the problems with the mental health system all across Australia rests with a simple lack of funding. Mental health services in Australia received around 7.4% of the overall health spend despite comprising 12% of the total burden of disease. While by the last count, Australia had 29 fewer mental health unit beds per 100,000 people than the OECD average.
The “missing middle” is also often cited as a cause. Hospitals don’t know how to deal with suicidal patients. Mental health wards seem set-up to deal almost exclusively with psychotic or manic patients who can be managed mainly with medication, whereas suicidal patients often fall right through the centre.
A former mental health worker who saw my Facebook posts contacted me to say:
‘People who are suicidal are stigmatised within the hospital system. They take too much work. Their conditions can’t just be medicated away.’
She says staff in hospitals are under so much pressure from upper management to limit the time they have with patients and are left unable to provide basic counselling:
I would love to spend time doing therapy with someone who is suicidal, but we get pushed into rushing our time with them... hospitals aren’t therapeutic environments, they are not really structured to help someone who is suicidal like they are for people who are manic or psychotic.
There is no point in putting so much money into awareness campaigns about mental health if people aren’t getting help when they ask for it and staff aren’t allowed to use the skills they have to help.
Lifeline 13 11 14
Mensline 1300 78 99 78
Beyond Blue 1300 22 46 36
Suicide Call Back Service 1300 659 467
To make a complaint about a mental health service in Queensland you can contact the Queensland Mental Health Commission (or equivalent organisation in your state) or the Australian Health Practitioner Regulation Agency.
Luke Williams is an author and two-time Walkley finalist.
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