KeepHealthCare.ORG – ACT mental health faces staff departure and ‘chronic skills shortage’, review finds
July 12, 2018 08:53:06
A chronic skills shortage in Canberra’s mental health facilities could, along with budget pressures and increased demand, form a perfect storm, putting patients at risk, according to an external review.
But the report, commissioned as part of the recent re-accreditation of the Canberra Hospital, found the facilities were safe and overseen by experienced managers.
The report was sparked after “extreme risks” were identified during the accreditation process, due to delayed investigations and actions after five suicides over 18 months on ACT Health units.
Four of the suicides are currently being investigated by the coroner.
The review concluded those incidents, while deeply regrettable and tragic for the families, did not represent an unsafe system and should be taken in the context of 13 years without any other unexpected fatalities.
Mental health units lost one third of senior mental health staff within one year. (ABC News: Elise Scott)
“The reviewers consider the bed-based mental health and drug withdrawal programs [of ACT Health] to be safe and very competently managed by a skilled and experienced senior management team,” the report said.
But it did note mental health services had trouble attracting and retaining qualified senior medical staff.
In one year, ACT mental health inpatient services lost 12 senior medical staff from a workforce of 33.
Executive director of ACT Mental Health Katrina Bracher acknowledged a chronic skills shortage but said there had been recent recruitment of some permanent staff.
Accepted recommendations:Develop sustained national and/or international recruitment programIncrease the percentage of nurses with specialist mental health qualificationsParticipate in current ACT Health governance reviewReviews for suicides or other such incidents should be undertaken within 60 daysConsider embedding quality improvement staffInvestigate installing CCTV in the adult mental health unit
“We do fill those roster shortfalls using agency staff, which is not ideal, but certainly we have enough staff on the floor at any given time,” she said.
“Mental health is a hard place to work, we try very hard to support our staff, the culture inside our service is good.
“There is a lot of pressure on staff. It’s the clinical work we do and having new staff and agency staff adds extra pressure onto staff absolutely.”
Some staff had left due to contract expiry while some international employees had moved to other cities, Ms Bracher said.
The report found the shortages, coupled with other factors like budget efficiencies, could contribute to organisational risk and a decrease in patient safety if not addressed.
Those factors include a 9 per cent budget savings target over two years, increasing demand on mental health services from the emergency department and occupancy rates above 100 per cent in the acute mental health unit.
“There is an acknowledgement that we do need to look at our budget profile where there are pressures, clinical pressures,” Ms Bracher said.
“That is being addressed within ACT Health.”
ACT Health has accepted all 11 recommendations of the review, including that it consider a national or international recruitment program and hire nurses with specialist mental health qualifications.
“These are medium to longer-term solutions, so we do need to be mindful of that,” Ms Bracher said.
“We have good supports in place, we have nurse educators on the ward, they are really there around supporting new and more junior staff to have the skills that they need.”
Suicide investigations ‘unreasonably long’
The review, undertaken by NorthWestern Mental Health based in Victoria, noted the timeframes for completing investigations of the suicides were “unreasonably long”, with two of the five taking more than 200 days.
It said prolonged investigation times represent a lost opportunity to quickly identify factors that could be changed, like improving infrastructure or staff training.
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Ms Bracher agreed there could have been missed opportunities.
“It is true to say there was a delay and we do have to accept that that’s not OK,” she said.
A recommendation of investigation timeframes of under 60 days had been proposed to the ACT Health Quality and Safety Unit, she said.
The accreditation process in March also found actioning an engineer’s report to fix high-risk areas of the unit had been delayed by more than a year.
Ms Bracher said that was in part because the mental health ward had to remain open while that took place.
“The complicated nature of retrofitting very sophisticated electronic monitoring systems into a unit does take time to work through,” she said.
“It’s not a cheap process so that did take ACT Health some time to work through how that was going to be funded.”
Work to remove those areas was expected to be completed in August or September, Ms Bracher said.
The review also found a lack of clarity in lines of accountability between clinicians and executives and unclear decision-making processes.
“The review has been a very positive process and the report will give us some great focus for what we need to do over the next few months to further improve our service,” Ms Bracher said.
‘Excellent’ infrastructure and staff engagement
The report noted the quality of infrastructure across all facilities, except the 30-year-old Brian Hennessey Rehabilitation Centre, provided high levels of consumer and staff amenity.
The facilities were clean, well-maintained, well-designed and had good access to natural light, it found.
Patients at Brian Hennessy Rehabilitation Centre, which will be refurbished, will soon be transferred to the new University of Canberra Hospital.
Reviewers also observed clinical staff interactions with mental health short stay unit patients to be respectful, engaging and non-threatening, and said there was good cooperation with emergency department staff.
July 12, 2018 07:31:10