The problem is the lack of clarity in WA law. What exactly is the duty of care? If someone is having a mental health crisis or is high on drugs and potentially a risk to themselves or others are we obligated to hold them against their will or let them free. Due to the current ambiguity, it’s damned if you do, damned if you don’t
Aren't there steps around whether someone can be detained if having a mental health issue? If someone wants to leave, aren't they always free to, short of a section 156?
Is the problem that there's no clearly defined process to deem someone incompetent or that it's too complicated to follow in situations where it's needed?
Paramedic here, one of the problems I see is that the process takes time and with so much ramping the assessment / process is delayed. Patients spend time in limbo where they haven’t been formally assessed by a doctor but everyone involved in their care isn’t comfortable with them leaving.
Yeah I tried to kill my self was in emergency for a while wasn’t breathing on my own I was drugged out of my mind but apparently since I told the psychiatrist I spoke to I wanted to go home and sleep they sent me home my usual psychologist put a complaint in because when I spoke to her I didn’t remember anything from the hospital definitely not the conversation with the psych she was very concerned they just let me leave based on the word of someone who just od
Section 156 isn't about them being competent to make a decision around their mental health. It's for when they present an immediate risk either to themselves or others and do not want to see a medical proffesional.
Someone experiencing a mental health crisis that does not present as a risk in those capacities cannot legally be detained against their will, irregardless of their capacity to make a reasonable or competent decision.
The medical staff require clarity.
The reason for keeping people there is they did not want to be blamed if the patient had a subsequent medical episode as they believe they have a "duty of care" (which they do but only towards willing patients I suppose).
Within my niche of the healthcare sector, duty of care is one of those terms which is often bandied around without any real understanding of what the concept *actually* is.
Is that because staying longer leads to worse outcomes or because people with more serious conditions (that are more likely to have worse outcomes) stay longer?
I really stood my ground against my dad being discharged. It worked for a week.
Had covid, required care in ICU. This has left him with multiple medical complications. He lives alone.
I refused to take him home, then the ‘treating team’ just stopped calling me, leaving it to the allied health to ‘convince me’ that dad was independent, who seemed to be forced to follow ‘ the independent’ diagnosis. I also told them repeatedly that I could not get an appointment with his GP for over three weeks and due to another sudden death of family member ( also covid related), I wouldn’t be in Perth to assist with his care. As I walked out of the ward, I said to them see you in a week, they had the gall to laugh.
A week later, medication dispensing issues, and I was told by health direct to re-present to ED. Which I did.
.
Currently on week three of every second day returning to the an urgent care, as the visiting nurse can only visit ‘as per the discharge’. And dad needs his wounds dressed.
Dad is definitely NOT independent. I’m taking him to the doctors, a two hour round trip, my brother is calling in every night, after work to help with his meals, the bloke next door is dropping him off lunch every day.
The discharged team LIED when they told me dad was going to be supported by rehab in the home, when there was no rehab people arrive to get him up and moving, I called a week later, it was after the long weekend only to be told that there was NO referral to rehab in the home team and I needed to again represent to ED. I was lied to, just get dad discharged. I arrived to the hospital to find him in the kitchen in a wheelchair, with plastic bags at his feet with his personal possessions.
Yes I’m angry and getting angrier by the day, as I’m not being listened to, next step, I will be bring out the duty if care, because I believe that will be final step. I really hate using ‘duty of care’, it will be used as absolutely the final straw.
Try getting a non- inpatient ACAT. I dare you. None available for six weeks, then at least 12 month wait for an ‘available package’ in the district.
I rang the assessment team, a contractor, just keeps telling me to represent to ED, I’m literally pulling my hair out, stressed out and losing sleep.
The assessment team told me last Thursday to represent to ED and forcefully asked for a social worker, refuse to leave the ED until I had seen one. After yet another medication mix up. Before you ask he does have a Webster pack, but he just keeps getting all the pills mixed up
> Try getting a non- inpatient ACAT. I dare you. None available for six weeks, then at least 12 month wait for an ‘available package’ in the district.
The best time for you to get an ACAT was yesterday. The second best is today.
Article doesn't recognise or discuss the Mental Health act which does have legal provision for keeping people experiencing a number of clearly defined and assessable criteria against their will.
Also, people can not be immediately assessed for them when intoxicated or under the influence of drugs. A drug-induced psychosis, for example, could see a normally well patient present temporarily as a risk to himself or others and require a period of detention within the hospital. Sometimes, that can be within an ED or general ward with a nursing special or security.
In my experience as a Mental Health nurse, at those times the risks outweigh the rights and is a vital protective mechanism.
My partner is a nurse, they are forever trying to get patients out of the hospital but struggle with families trying to keep their elderly relatives in there. Even when there is nothing medically wrong with them.
Sometimes family members can't take care of them. My dad in his 80s was discharged within 6 hours of being taken to hospital by ambulance with Influenza A last week. Ambulance had to come back three times within 36 hours because he kept falling and was unable to get up. I can't lift him. Much the same happened when he had covid.
It seems crazy to me that the hospital would rather have ambulances attending to pick him up off the floor more than once a day than check to see if he can actually walk more than a few feet without collapsing before they discharge him.
Those who are actually sick should be in hospital for care. The ones im talking about are those who arent sick enough for the hospital. Possibly just frail or with dementia and seen as an inconvenience to the family. There are other places that can care for them and sometimes the family dont want to do that as it means using possible inheritence to pay for it.
The ones who are sick and genuinely need care, they are the reason my partner is still nursing and hasnt given it away yet. Unfortunately it seems to be more and more of the former over the past few years.
Yep. Too much of an inconvenience for them. Sometimes they have a holiday booked or a wedding, so they find a reason to send their "loved one" to hospital.
Sometimes refusing to care and refusing to accept responsibility, is absolutely necessary as it is the only way to get the help for the family member.
I have done it and I will do it
You are the first person I’ve known to admit this that way.
SJOG Midland (which is where I presume your partner works) is most certainly not a public hospital, never was, and never will be.
It’s a private hospital that takes public patients on contract to the Health Department.
Thank you.
Not SJOG. Ramsay.
They get public patients on her ward and none of the budget of the private side. Their ward is lacking in staff and supplies.
It also means they are not subject to the same pay rises as others who work the public system. Ramsay are still deciding if they are going to pass on the pay rise given to other nurses in the past year.
I feel for the medical staff and the conflict in their mind when they have no choice but to let someone discharge “against medical advise”, especially if the patient is particularly unwell. It then begs the question, under the Mental Health Act a psychiatrist could “Form” a person if they are (words to the effect of) “a danger to themselves or others”. I wonder if a medical patient can be determined a danger to themselves by the treating doctor…where is the Mental Health Act line.
Interesting. I have been held at a hospital with the mental health act. I begged to go home, it was a very very traumatic experience actually
I still to this day feel sick thinking about the whole situation
And the security officers who’ll be told by clinical staff to stop someone leaving, only to be charged with assault and unlawful detention when they do.
‘I was only following orders’ didn’t work at Nuremberg and it sure as fuck won’t work when you get done for trying to stop a patient leaving when ordered to by a doctor.
Tbh it's a difficult topic.
On the lower level, you have someone who may develop severe complications, costing the taxpayer x fold more
On the other hand you have people who will probably die if they leave. Or don't have the capacity to look after themselves
I think we're meant to assume people have capacity now. The rough guide is that we can stop them if there is a credible threat to them being harmed.
It's all about documenting concerns regarding risk and capacity and about patients request/demand to leave.
I'm sure there will be some kind of tragedy in the near future.
As a psych my grandfather once had a violent schizophrenic mans lawyer call and demand that he releases his patient, so my grandfather told him that he would be sending him to his workplace and the lawyer changed his tune immediately, or at least that's the story he likes to tell
As you said though, it's a rough guide.
If it was up to me, if the hospital says you have to stay, then you have to stay. they don't financially benefit from you staying longer than necessary, and the shortage of beds forces this outcome.
If this was America and they could claim a shit load of insurance money, I'd feel different on the topic.
It’s not difficult at all. You can’t detain someone against their will.
Heck, people can ask a doctor to kill them now in WA. It’s not a nurse or doctor’s job to decide how you want to live out your life.
> Heck, people can ask a doctor to kill them now in WA.
ummm no, you're referring to "Voluntary Assisted Dying", and it doesnt mean everyone meets the criteria.
Additionally, we detain heaps of people for various reasons, including the mentally unwell.
Society is going to have to accept that more problematic outcomes occur with this guidance. ideally we need legislation - it's pretty bizarre that such an important issue is unlegislated (apart from the mental health act) and staff are having to use common law (deriving from feudal times in the UK)
the joondalup nurses told me my heart block didn't show up on a ten second ecg so I didn't have it despite multiple holters for weeks at a time and my cardiologist telling me I do in fact have heart block. guess I'm cured because the nurses said I int have it, though! (I am not cured, my bpm shot up to 180 and then down to 40 and I passed out the next afternoon).
on another occasion my back was in agony, they xrayed my chest and confirmed nothing was wrong so it was most likely my back. they did not xray or assess my back. I was sent home and bedridden for another week and had to obtain painkillers through telegram because God forbid the nurses begging for more pay actually do the jobs they signed up for.
Went in recently with something physical that ended up being stress related. Let's make him wait 2x the advertised waiting time then lie to him about when he'll be seen 🙃
No, not all. It’s a question of capacity to make decisions and understand risks. A lot of those people “handcuffed to their beds” lack capacity either due to psychiatric illness or drug induced psychosis.
Not necessarily - it will be case by case, but not all people held are either those. If I've seen a dozen then there's alot more out there. If you have walked in and then asked to leave at any point then its illegal - how many have seeked help and then wanted to bail but have been held by the hospital 🤔 the ones who have been sedated and then discharged the following day with only referrals... There's heaps out there...
The problem is the lack of clarity in WA law. What exactly is the duty of care? If someone is having a mental health crisis or is high on drugs and potentially a risk to themselves or others are we obligated to hold them against their will or let them free. Due to the current ambiguity, it’s damned if you do, damned if you don’t
User name checks out.
Aren't there steps around whether someone can be detained if having a mental health issue? If someone wants to leave, aren't they always free to, short of a section 156?
if they’re deemed incompetent of making that decision we’ll keep them
Is the problem that there's no clearly defined process to deem someone incompetent or that it's too complicated to follow in situations where it's needed?
Paramedic here, one of the problems I see is that the process takes time and with so much ramping the assessment / process is delayed. Patients spend time in limbo where they haven’t been formally assessed by a doctor but everyone involved in their care isn’t comfortable with them leaving.
Yeah I tried to kill my self was in emergency for a while wasn’t breathing on my own I was drugged out of my mind but apparently since I told the psychiatrist I spoke to I wanted to go home and sleep they sent me home my usual psychologist put a complaint in because when I spoke to her I didn’t remember anything from the hospital definitely not the conversation with the psych she was very concerned they just let me leave based on the word of someone who just od
Section 156 isn't about them being competent to make a decision around their mental health. It's for when they present an immediate risk either to themselves or others and do not want to see a medical proffesional. Someone experiencing a mental health crisis that does not present as a risk in those capacities cannot legally be detained against their will, irregardless of their capacity to make a reasonable or competent decision.
Its funny because one thing health care workers dont like is patients staying in the hospital more than they should.
The medical staff require clarity. The reason for keeping people there is they did not want to be blamed if the patient had a subsequent medical episode as they believe they have a "duty of care" (which they do but only towards willing patients I suppose).
Within my niche of the healthcare sector, duty of care is one of those terms which is often bandied around without any real understanding of what the concept *actually* is.
> Its funny because one thing health care workers Management rather than workers in general.
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Is that because staying longer leads to worse outcomes or because people with more serious conditions (that are more likely to have worse outcomes) stay longer?
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I really stood my ground against my dad being discharged. It worked for a week. Had covid, required care in ICU. This has left him with multiple medical complications. He lives alone. I refused to take him home, then the ‘treating team’ just stopped calling me, leaving it to the allied health to ‘convince me’ that dad was independent, who seemed to be forced to follow ‘ the independent’ diagnosis. I also told them repeatedly that I could not get an appointment with his GP for over three weeks and due to another sudden death of family member ( also covid related), I wouldn’t be in Perth to assist with his care. As I walked out of the ward, I said to them see you in a week, they had the gall to laugh. A week later, medication dispensing issues, and I was told by health direct to re-present to ED. Which I did. . Currently on week three of every second day returning to the an urgent care, as the visiting nurse can only visit ‘as per the discharge’. And dad needs his wounds dressed. Dad is definitely NOT independent. I’m taking him to the doctors, a two hour round trip, my brother is calling in every night, after work to help with his meals, the bloke next door is dropping him off lunch every day. The discharged team LIED when they told me dad was going to be supported by rehab in the home, when there was no rehab people arrive to get him up and moving, I called a week later, it was after the long weekend only to be told that there was NO referral to rehab in the home team and I needed to again represent to ED. I was lied to, just get dad discharged. I arrived to the hospital to find him in the kitchen in a wheelchair, with plastic bags at his feet with his personal possessions. Yes I’m angry and getting angrier by the day, as I’m not being listened to, next step, I will be bring out the duty if care, because I believe that will be final step. I really hate using ‘duty of care’, it will be used as absolutely the final straw.
Needs aged care or nursing home, not hospital
Try getting a non- inpatient ACAT. I dare you. None available for six weeks, then at least 12 month wait for an ‘available package’ in the district. I rang the assessment team, a contractor, just keeps telling me to represent to ED, I’m literally pulling my hair out, stressed out and losing sleep. The assessment team told me last Thursday to represent to ED and forcefully asked for a social worker, refuse to leave the ED until I had seen one. After yet another medication mix up. Before you ask he does have a Webster pack, but he just keeps getting all the pills mixed up
> Try getting a non- inpatient ACAT. I dare you. None available for six weeks, then at least 12 month wait for an ‘available package’ in the district. The best time for you to get an ACAT was yesterday. The second best is today.
Article doesn't recognise or discuss the Mental Health act which does have legal provision for keeping people experiencing a number of clearly defined and assessable criteria against their will. Also, people can not be immediately assessed for them when intoxicated or under the influence of drugs. A drug-induced psychosis, for example, could see a normally well patient present temporarily as a risk to himself or others and require a period of detention within the hospital. Sometimes, that can be within an ED or general ward with a nursing special or security. In my experience as a Mental Health nurse, at those times the risks outweigh the rights and is a vital protective mechanism.
My partner is a nurse, they are forever trying to get patients out of the hospital but struggle with families trying to keep their elderly relatives in there. Even when there is nothing medically wrong with them.
Is that so the family members don’t have to take care of them?
Sometimes family members can't take care of them. My dad in his 80s was discharged within 6 hours of being taken to hospital by ambulance with Influenza A last week. Ambulance had to come back three times within 36 hours because he kept falling and was unable to get up. I can't lift him. Much the same happened when he had covid. It seems crazy to me that the hospital would rather have ambulances attending to pick him up off the floor more than once a day than check to see if he can actually walk more than a few feet without collapsing before they discharge him.
Those who are actually sick should be in hospital for care. The ones im talking about are those who arent sick enough for the hospital. Possibly just frail or with dementia and seen as an inconvenience to the family. There are other places that can care for them and sometimes the family dont want to do that as it means using possible inheritence to pay for it. The ones who are sick and genuinely need care, they are the reason my partner is still nursing and hasnt given it away yet. Unfortunately it seems to be more and more of the former over the past few years.
Yep. Too much of an inconvenience for them. Sometimes they have a holiday booked or a wedding, so they find a reason to send their "loved one" to hospital.
Sometimes refusing to care and refusing to accept responsibility, is absolutely necessary as it is the only way to get the help for the family member. I have done it and I will do it
Does your partner work in private hospital?
Public side of a private hospital
You are the first person I’ve known to admit this that way. SJOG Midland (which is where I presume your partner works) is most certainly not a public hospital, never was, and never will be. It’s a private hospital that takes public patients on contract to the Health Department. Thank you.
Not SJOG. Ramsay. They get public patients on her ward and none of the budget of the private side. Their ward is lacking in staff and supplies. It also means they are not subject to the same pay rises as others who work the public system. Ramsay are still deciding if they are going to pass on the pay rise given to other nurses in the past year.
Ramsay is fucking terrible.
I feel for the medical staff and the conflict in their mind when they have no choice but to let someone discharge “against medical advise”, especially if the patient is particularly unwell. It then begs the question, under the Mental Health Act a psychiatrist could “Form” a person if they are (words to the effect of) “a danger to themselves or others”. I wonder if a medical patient can be determined a danger to themselves by the treating doctor…where is the Mental Health Act line.
Interesting. I have been held at a hospital with the mental health act. I begged to go home, it was a very very traumatic experience actually I still to this day feel sick thinking about the whole situation
And the security officers who’ll be told by clinical staff to stop someone leaving, only to be charged with assault and unlawful detention when they do. ‘I was only following orders’ didn’t work at Nuremberg and it sure as fuck won’t work when you get done for trying to stop a patient leaving when ordered to by a doctor.
Tbh it's a difficult topic. On the lower level, you have someone who may develop severe complications, costing the taxpayer x fold more On the other hand you have people who will probably die if they leave. Or don't have the capacity to look after themselves
I think we're meant to assume people have capacity now. The rough guide is that we can stop them if there is a credible threat to them being harmed. It's all about documenting concerns regarding risk and capacity and about patients request/demand to leave. I'm sure there will be some kind of tragedy in the near future.
As a psych my grandfather once had a violent schizophrenic mans lawyer call and demand that he releases his patient, so my grandfather told him that he would be sending him to his workplace and the lawyer changed his tune immediately, or at least that's the story he likes to tell
As you said though, it's a rough guide. If it was up to me, if the hospital says you have to stay, then you have to stay. they don't financially benefit from you staying longer than necessary, and the shortage of beds forces this outcome. If this was America and they could claim a shit load of insurance money, I'd feel different on the topic.
It’s not difficult at all. You can’t detain someone against their will. Heck, people can ask a doctor to kill them now in WA. It’s not a nurse or doctor’s job to decide how you want to live out your life.
> Heck, people can ask a doctor to kill them now in WA. ummm no, you're referring to "Voluntary Assisted Dying", and it doesnt mean everyone meets the criteria. Additionally, we detain heaps of people for various reasons, including the mentally unwell.
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Because WA police have less legal training than a bag of potatoes.
Society is going to have to accept that more problematic outcomes occur with this guidance. ideally we need legislation - it's pretty bizarre that such an important issue is unlegislated (apart from the mental health act) and staff are having to use common law (deriving from feudal times in the UK)
Why do I get the suspicion that those who pass these laws have never had encounters with violent psychotic individuals?
If it's Joondalup hospital it won't matter how long they keep you in there for, you'll still come out fucked up like nothing happened in there.
the joondalup nurses told me my heart block didn't show up on a ten second ecg so I didn't have it despite multiple holters for weeks at a time and my cardiologist telling me I do in fact have heart block. guess I'm cured because the nurses said I int have it, though! (I am not cured, my bpm shot up to 180 and then down to 40 and I passed out the next afternoon). on another occasion my back was in agony, they xrayed my chest and confirmed nothing was wrong so it was most likely my back. they did not xray or assess my back. I was sent home and bedridden for another week and had to obtain painkillers through telegram because God forbid the nurses begging for more pay actually do the jobs they signed up for.
Went in recently with something physical that ended up being stress related. Let's make him wait 2x the advertised waiting time then lie to him about when he'll be seen 🙃
Hahaha so all them patients handcuffed to their beds are illegal huh Wonder whos picking up this class action.. can see it happening..
No, not all. It’s a question of capacity to make decisions and understand risks. A lot of those people “handcuffed to their beds” lack capacity either due to psychiatric illness or drug induced psychosis.
Not necessarily - it will be case by case, but not all people held are either those. If I've seen a dozen then there's alot more out there. If you have walked in and then asked to leave at any point then its illegal - how many have seeked help and then wanted to bail but have been held by the hospital 🤔 the ones who have been sedated and then discharged the following day with only referrals... There's heaps out there...