Case Studies
Some complaints and enquiries received by the Community Visitor Program are easily resolved. Others are less so. In this section of the website, complaints and enquiries, with actions taken by community visitors and their outcomes are described. In all cases, details are sufficiently changed or blurred to ensure the confidentiality of all people, staff, consumers and carers involved.
Police Transport to Hospital
In its past three Annual Reports, the CVP has commented on Police transport of consumers to hospital. A consumer transported in a police vehicle is almost always transported in the cage of the vehicle. Sometimes this may be necessary to protect the safety of all involved, however if alternative, safe transport to hospital is possible, the CVP sees transport in the cage of a police vehicle as a breach of a person’s right to be treated with dignity.
The CVP has argued that use of Police for transport appeared to be routine practice throughout the Territory, accepted as the norm by all players; staff, Police and consumers and carers.
The CVP has received many complaints from consumers transported to hospital this way. A few such complaints are detailed below:
- A consumer complained to the CVP that he had been transported to hospital in the cage of a police vehicle. When queried about the inappropriateness of transporting the consumer this way, the Psychiatric Registrar said he was not exactly sure who had organised it but that he thought it was the mental health service’s protocol. He said that someone at risk of suicide could not be transported in a car.
- A service provider contacted mental health staff concerned about the wellbeing of a consumer who had recently been discharged from hospital. There were no apparent safety issues, yet the service provider was counselled to contact Police. A few days later, when they had assessed the consumer as requiring further involuntary admission, mental health staff transported the consumer to hospital.
- A case manager arranged to transport a consumer to hospital, however the consumer’s family had already contacted Police. The case manager stated that when the consumer knew she was to be transported by Police, she resisted, saying over and over "Not in the cage".
- The mental health of an elderly consumer with a number of serious physical health issues (so much so that he could not walk ten metres without support) deteriorated, and a family member brought him to the Emergency Department for assessment. The consumer left the Emergency Department before he was admitted to the psychiatric inpatient unit. Police were contacted, and he was transported back to the ward in the cage of the police vehicle.
The CVP has received and investigated a number of similar complaints. Complaints have also been received from consumers who could not be transported safely to hospital by any means other than Police, and the Police role in managing these situations is acknowledged.
This issue was referred to the Darwin community visitors panel for investigation during their visit to the TEMHS Inpatient Unit in November 2007. As part of their report to the Principal Community Visitor, the panel wrote a letter requesting that the Principal Community Visitor write to the CEO of the Department of Health and Families and the Commissioner of Police requesting that action be taken to ensure that consumers were no longer routinely transported to hospital by Police.
The CVP is aware that these complaints and CVP follow up is all happening at the same time as the development of National Principles for Safe Transport of consumers to hospital and the review and development of a Memorandum of Understanding between NT Mental Health Services and NT Police. There appears to be a commitment to a change in practice and the CVP looks forward to increased use of Ambulance and better coordination between mental health, police and ambulance services to ensure safe and respectful transport to hospital.
Timely Review of Involuntary Admission
A person admitted to hospital involuntarily on the grounds of mental illness must be reviewed by an Authorised Psychiatric Practitioner (APP) within 24 hours to determine whether the person still meets the criteria for involuntary admission, and then by the Mental Health Review Tribunal (Tribunal) within a time specified by the Mental Health and Related Services Act If the person is admitted involuntarily on the grounds of mental disturbance, the admission must be reviewed by an APP within 72 hours.
At times the mental health service has assessed that the person’s health will improve before the expiration of the time before which the admission must be reviewed by the Tribunal and so has not notified the Tribunal of the involuntary admission. On more than one occasion the person has not recovered as quickly as anticipated, and the service has been faced with the choice of changing the person’s status to voluntary when this would place him or her at risk, or detaining the person out of time.
- The community visitor became aware of a situation where the service elected to change the person’s status to voluntary after the detention was 48 hours out of time. The person was involuntarily admitted to the facility on a Sunday and should have appeared before the Tribunal within 7 days. The mental health service, believing the consumer was improving, decided not to notify the Tribunal of the need for the consumer to appear before it on the Wednesday that the hearing would have been conducted. The person’s mental health deteriorated, and when the order expired the following Sunday, he was still receiving involuntary treatment in the locked unit. Two days later, his status was changed to voluntary. He left the Unit, and on return was involuntarily admitted. The community visitor was of the view that the consumer suffered a financial detriment as a result of the service’s actions, and requested compensation for him. The service agreed.
- A consumer had been admitted involuntarily to the Joan Ridley Unit pursuant to section 42 of the Act which requires that the admission be reviewed by an APP within 72 hours. The consumer contacted the CVP complaining that the admission had not been reviewed in time. On investigation, the community visitor found that the APP review had been out of time. The mental health service issued a formal apology to the consumer.
Liaison with Family
The CVP occasionally receives complaints from family members experiencing difficulty liaising with the doctor responsible for treating their relative (with the consent of the person receiving treatment).
- One such complaint was received from a parent whose adolescent child (over 18 years) was experiencing an episode of psychosis. The parent wanted to speak to the doctor about why his son had become unwell, and to express concerns about involuntary treatment in the Joan Ridley Unit. The complaint was resolved when a meeting was organised between the doctor and the family member.
- It is particularly difficult when the person has been admitted to an inpatient unit in the Northern Territory when family lives interstate. One family contacted the CVP after unsuccessfully trying to contact the doctor over two days. The complaint was resolved after the Community Visitor contacted the doctor concerned to find that attempts had already been made to contact family. In the meantime, the Community Visitor visited the consumer in hospital and with the consumer’s permission phoned the family member to reassure her that the person was coping well with the admission
- A family who had a close family member admitted to the TEMHS Inpatient Unit suffering first episode psychosis had not met with the doctor or staff from the Unit in the first two days after the admission. The Community Visitor, while on a visit to the facility, met the family and asked them how they were coping with the person’s illness and admission to hospital. They had little knowledge or understanding of mental illness and appeared quite bewildered by their experience. The Community Visitor spoke to the family about supports available in the community and about the social work service now offered through the ward. The family stated that they would find it helpful to speak to the social worker and agreed for the Community Visitor to contact the social worker to arrange a meeting. The social worker followed up immediately and met with the family the next working day.
Advocacy
The CVP sees advocacy as one of its most important functions.
- A consumer contacted the CVP because he was unhappy with ongoing contact with his case manager. He was on a Community Management Order for the first time, and had a number of personal issues which he felt were not being addressed by the service. The consumer asked the community visitor to attend a meeting with his case manager so that he could talk to the case manager about his expectations of case management. He did not believe he could do so without advocacy support. The meeting was arranged, and the consumer and case manager were able to address the consumer’s issues as well as resolve how the case management relationship would operate into the future.
- During a visit to the inpatient facility, a community visitor approached a consumer sitting quietly in the dining area. The consumer had been admitted to the Unit that morning, and was waiting to see her nurse. She said that not eaten for the last 24 hours, and while she had been there for lunch, she did not eat the food that was served (she preferred Asian food). The community visitor spoke to the nurse and arranged for food to be brought to her.
- On another occasion, a consumer approached a community visitor with concerns about her diet. The consumer has diabetes, is on a special diet and was concerned with the fat content of the food being served. The community visitor informed her that she could ask for a salad meal, and asked whether she would like the visitor to speak to staff. The consumer was happy to follow up herself with the community visitor present.
- A consumer admitted involuntarily to the inpatient unit for the first time was frightened by the experience of a brief admission to the secure unit and involuntary administration of medication which he said made him feel sedated and physically unwell. The community visitor informed the consumer of his right to ask for a second opinion. The community visitor also attended a meeting with the consumer and his doctor so that the consumer could ask questions about his admission and treatment.
