Both Australia and the United Kingdom are spending approximately 10% of their GDP on health services. In the United States this figure is nearly 18%.

Yet at the end of World War II, these countries were only paying approximately 5% of GDP on healthcare.

Healthcare costs are rising so fast in advanced economies that they will become unaffordable by mid-century without reforms, according to a new OECD report.

Unnecessary tests and treatments are estimated to consume 1/3 of the health dollar.

But this involves more than elderly people being pushed through aggressive medical treatments that they have little chance of surviving.

It also includes younger people who are not getting medical treatment they need to manage their chronic conditions, and ending up in a state of crisis.

Traumatic injury is one of the most common reasons people are admitted to an Emergency Department. And many trauma patients also have psychiatric conditions.

  • About 10% of all ED patients present with a psychiatric illness (not all are formally diagnosed)
  • 15% of patients presenting with minor injury to an Emeregency Department had a previously diagnosed psychiatric disorder
  • 45% of patients presenting with minor injury to an Emergency Department either had a history of a psychiatric disorders or a current psychiatric disorder.

Denied a psych bed, he ends up in an Intensive Care bed

The ambulance service received an urgent call from a member of the public.

A man called 'Bill' was chasing cars as they sped up and down a major city road. The person who made the call, suspected this man might have a psychiatric disorder.

The ambulance rushed to the scene. Bill had already been hit by one car, clipped by another as it swerved to avoid him. Both cars has sped off, leaving behind the broken debris of man lying on the side of the road.

The ambulance officers struggled to stabilise Bill who was still conscious, incoherent and covered in blood.

He had oxygen and cardiac monitoring attached, was lifted on to an ambulance trolly and rushed to the nearest trauma hospital, sirens screening.

An X ray revealed a fractured pelvis, fractured left thigh bone and fractured right forearm.

Bill was rushed to theatre. His thigh bone had Open Reduction Internal Fixation, his pelvis had an external fixation and his right arm was put in a plaster.

In theater a central line had been inserted to allow cardiac drugs to be given, to keep his blood pressure stable. However the line had accidentally pierced his lining of skin around his lung, causing a pneumothorax.

An Internal Costal Catheter was inserted to keep air out of the pleural spaces.

Finally, Bill was sent up to Intensive Care for monitoring.

He woke up several hours later.

“I want to go to the pub” Bill announced to his nurse.

“You are sick” she replied, “you’re in Intensive Care, recovering from a road accident”.

“I want to go to the pub, now” he repeated.

Bill tried repeatedly to climb out of the Intensive Care bed. Despite entreaties from nurses and Doctors who explained his medical condition, he refused to settle down. Eventually Bill's sedation was increased.

The following day his care worker came in to the Intensive Care Unit.

The carer explained that Bill had schizophrenia, but refused to take his medications.

These days it is almost impossible to get a community based medication order, forcing someone to take treatment against their will.

The results are that people who are delusional and incoherent are left to seriously damage themselves and others, while their families and carers are left watching, powerless to intervene.

One of Bills regular behaviours was to chase cars along a main road.

He had been involved previous traffic accidents.

No matter how many times Bills carers approached the Government, there were no long term accommodation bed for someone with a severe psychiatric disorder.

The results was an inevitable traffic accident, pain and serious injury for Bill, and thousands of dollars worth of acute hospitals beds, for a situation that could have easily been avoided.

The average cost of an acute hospital bed in a major Australian Tertiary hospital is around $4600 per day. This does not include surgeons fees, theatre use, general wards, physiotherapy and rehabilitation.

The following day Bills sister came in to Intensive Care. She brought toiletries and new clothes. When she saw her brother's condition, she cried.

“What do we do?” she asked the nurse. “There is nowhere for him to go, except the streets and hospitals”.

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