A requirement for Victorian emergency departments to report all use of restraints on mentally ill patients will apply to only one in four public hospitals, with the state’s mental health watchdog concerned about gaps in the new protections.
From 1 April, a series of safeguards will come into effect in certain emergency departments, including the mandatory reporting of any “restrictive interventions” on mentally ill patients – such as restraints, seclusion or forced medication – to the office of the chief psychiatrist.
Victorians who present at these emergency departments with mental ill-health or suffering from psychological distress will also be able to make complaints to the Mental Health and Wellbeing Commission (MHWC) about their treatment, in a move that has been welcomed by advocates.
The changes follow a royal commission into the state’s mental health system, which recommended ending the use of restraint altogether by 2031.
But the MHWC has warned the new oversight measures will only apply to emergency departments at hospitals defined as a “designated mental health service” under the state’s Mental Health and Wellbeing Act.
Only 19 of the state’s almost 80 public health services are a “designated mental health service”, with the vast majority located in Melbourne.
Outside the city, the only designated mental health services are located in Albury-Wodonga on the New South Wales border, Bendigo, Geelong, Shepparton and the Grampians.
Patients in emergency departments in hospitals in regional Victoria, including the Loddon Mallee and Gippsland regions, will not be covered by the new safeguards.
Guardian Australia understands the commission has repeatedly raised concerns with the Department of Health that thousands of Victorians will slip through the gaps as a result.
In November, it wrote to the head of the department, Euan Wallace, warning the safety of mentally ill Victorians was “at risk”.
The commission also warned the health department it was possible for clinicians to bypass the new reporting and accountability measures under the legislation.
This could occur if an emergency department clinician does not assess a patient as requiring mental health treatment, or if they are treated for other issues, such as intoxication or substance withdrawal.
MHWC has asked the department to consider ways to expand its oversight to all mental health matters in all emergency departments.
“At a time when the number of suicides per year is at an all-time high in Victoria, and the suicide rate is at a four-year high, every possible step should be taken to provide safe and effective emergency treatment to all Victorians,” the commission said in a statement provided to Guardian Australia.
Its chair, Treasure Jennings, added: “Given the importance placed on curbing the use of restrictive interventions by the royal commission and the devastating impact they can have on mental health consumers, carers, family and supporters, it’s vital that we continue to look at how we can better protect all people with mental health concerns.”
A spokesperson for the health department did not respond to questions from Guardian Australia, but said the Mental Health and Wellbeing Act “underpins the delivery of a transformed system”.
“Additional safeguards on the use of restrictive intervention in designated mental health services will help ensure those receiving care are doing so in a safe and supportive environment,” they said.
Alice*, a mental health advocate, has also urged the government to ensure the MHWC has oversight of all emergency departments. She described her experience at an emergency department during a mental health episode as “dehumanising” and “patronising”.
“I was treated like a child, not in a patient way but in an unkind way, as if I was an inconvenience. I was not taken seriously and I was robbed of my dignity,” she said.
“I was unable to leave and I was sedated to the point that I could not run away.”
Since then, she has not gone back to an emergency department out of fear she would be treated the same way. But she is reconsidering it after the changes.
“It would make the experience a bit easier knowing I’m protected, that I have some agency after all.”
According to the latest data from the Australian Institute of Health and Welfare, there were 58,462 mental health related presentations at Victorian emergency departments in 2021-22.
In 2023, a record number of people died by suicide in Victoria, with 801 deaths recorded across the state. This figure was up 5.3% on 2022, when there were 756 suicide deaths – then the highest number since the coroner’s court started collecting the data in 2000.
The MHWC was originally set up as the mental health complaints commissioner in 2014, to separate complaints about mental health services and clinics from those related to the broader health system.
In September 2023, legislation came into effect that turned it into a new body under its current name, with expanded powers, including the ability to conduct inquiries and report on systemic issues and make formal recommendations to the premier and mental health minister.
* Name has been changed
• This article was amended on 28 March 2024 to clarify that one regional mental health service is in Shepparton rather than “Goulburn” as a previous version stated, to avoid confusion with the NSW town of the same name. Shepparton is in the Goulburn region of Victoria.
In Australia, the crisis support service Lifeline is 13 11 14. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In the UK, Samaritans can be contacted on 116 123. Other international suicide helplines can be found at befrienders.org
