Please note: names and some details have been omitted or changed to protect the identity of those involved.
Alex, a young man, drove to a hospital emergency department experiencing suicidal thoughts. He found the response from the staff unsympathetic and unhelpful. His mother and carer, Nerida, also tried to speak to staff at the emergency department but felt that her views weren’t heard.
What Alex and Nerida told us
Alex was experiencing thoughts of self-harm and suicide and drove himself to hospital to seek help. Alex was told by staff that he could either drive himself to another part of the service to be assessed or come inside and ‘wait his turn at the emergency department like everyone else’.
Alex told staff that he had taken medication, that he needed immediate help with his suicidal thoughts and it was unsafe to drive. Alex told us that the staff member told him he seemed ‘fine’ and this felt dismissive of the severity of his distress and lacking in compassion. Alex then called his mother, Nerida, who tried to explain to the staff member that Alex was severely distressed and had a history of attempted suicide. Alex and Nerida told us that they had not been informed that the hospital had been putting plans in place to provide care and treatment to Alex within the emergency department while these discussions were occurring. Believing he would not receive the help he needed, Alex left the hospital and sustained a serious injury in an incident that occurred soon after leaving.
Nerida made a complaint to the hospital about the staff member’s lack of communication about the plans to assist Alex, and the lack of empathy she and Alex had experienced in their interactions with staff. Nerida was concerned that the lack of compassion Alex experienced was directly related to him leaving the emergency department and being seriously injured. Nerida wasn’t happy with the service’s initial response to her complaint and contacted the MHCC.
How the mental health principles applied to the complaint
The Mental Health Act 2014 (the Act) protects the rights of people receiving mental health treatment from a public mental health service. Anyone accessing care and treatment should expect the service’s approach to be guided by the mental health principles in the Act.
The principles in section 11 of the Act most relevant to Alex and Nerida’s complaint are:
c) Ensure supported decision making
Persons receiving mental health services should be involved in all decisions about their assessment, treatment and recovery and be supported to make, or participate in, those decisions, and their views and preferences should be respected.
k) Involve carers
Carers (including children) for persons receiving mental health services should be involved in decisions about assessment, treatment and recovery, whenever this is possible.
l) Recognise, respect and support carers
Carers (including children) for persons receiving mental health services should have their role recognised, respected and supported.
What do the principles mean for Alex and Nerida?
Alex had the right to have his concerns that he was suicidal and not safe to wait a long time or drive elsewhere acknowledged, and to be involved in and informed about plans for his treatment.
Nerida, as Alex’s mother and carer, had the right to be listened to and involved in decision making when she advised the staff member about Alex’s history and current need for help.
In practice, these principles mean that both Alex and Nerida were entitled to receive compassionate and responsive care when seeking help and communication with the service.
The complaint about the experiences of Alex and Nerida also raised serious questions about the apparent failure to provide mental health services to Alex in response to his expressed need for help, which can be a basis for making a complaint to the MHCC.
After hearing Nerida’s concerns, we contacted Alex with her consent. Alex consented to Nerida making the complaint on his behalf. We assessed that Alex and Nerida’s complaint raised serious issues about whether the service had adequately upheld the mental health principles to support consumers to make or participate in decisions, and to involve carers in decisions, and to provide an appropriate mental health service response.
We assessed that the consequences of Alex and Nerida’s experiences could have been even more serious and that we needed to ascertain what steps the service had put in place to ensure consumers’ and carers’ views are listened to and respected, and that services communicate clearly with consumers and carers. Following receipt of the service’s written response to these issues, we facilitated a meeting between the service, Alex and Nerida to ensure Alex and Nerida had the opportunity to explain the impact of their experiences, and to seek a further response from the service about these issues.
In the meeting, representatives from the service apologised for not seeking information from Nerida, and for not clearly explaining the plans for Alex’s treatment. They acknowledged the significant impact these experiences had had on Alex and Nerida and outlined several service improvements they were making in response to the complaint. These included:
training for all staff on being responsive to consumers’ needs, views and preferences, and to hearing carers’ views and addressing their concerns
additional training for the staff member involved in Alex’s care, including on assessing and responding to consumers’ suicide risk
planning for the short-term treatment team to move closer to the emergency department to improve ease of access to this team
creating an extra room in the emergency department for staff to speak with people in a quiet space.
After the meeting, we contacted Alex and Nerida to ask for their perspectives. Nerida told us that hearing an open acknowledgement by the service about where they could improve and understanding the steps they had put in place to improve, had addressed and resolved her concerns. We assessed that the steps the service identified were appropriate to address the concerns raised and closed it on this basis and given that Alex and Nerida were also satisfied with the outcome of the complaint. We also identified the systemic issue of people with suicidal thoughts not receiving appropriate mental health treatment when seeking help at emergency departments, along with the need for compassionate care and responses from staff. These themes from complaints have been highlighted in our submissions and consultations for the Royal Commission into Mental Health and the mental health inquiry by the Productivity Commission.