Why don't we fund affordable, long term accommodation instead of expensive 'quick fix' Emergency Departments?

Imagine if someone in your family was living with a severe mental illness.

Would you be happy for them to be left to wander the streets, end up homeless, housed in temporary accommodation then face violence from street gangs?

When health policies fail vulnerable people, lives can quickly disintegrate.






A man came to a public hospital Emergency Department. He was unshaven, wearing dirty clothes and smelt strongly of cigarettes.

He shuffled up to the triage desk and mumbled. There was bruising down the right side of his face.

The triage nurse at the front desk took one look at him.


You don't look well. Are you living on the streets? Would you like to see a social worker?


The man shrugged, mumbled something and pointed to his jaw.

The triage nurse signed, took his name, date of birth, temperature and oxygen saturation, entered the details on a computer then told him to take a seat on one of the hard, orange plastic seats against the wall.



An hour later an nurse called his name and walked him into the Emergency Department. She escorted him into a cubical, sat him on a trolly and did his blood pressure.

"Have you got pain Billy? What's that bruising on your face? Did someone hit you?"

Billy shook his shoulders in a depressed shrug. He mumbled and stared down at the floor.

The nurse put him into a hospital gown, packed his smelly clothes into a plastic bag, did a set of obs then told him to wait for the Doctor to come.






A doctor walked into to the cubical and introduced himself.


Hi I'm Doctor Rossi. What's going on Billy? I hear you've got a bruised face and are having difficulty speaking."


Billy mumbled back. The doctor asked the man to look up at him and open and close his mouth. Billy could barely open his mouth. He flinched when the Doctor tried to touch his face.

The doctor wrote a slip for radiology.


I think your jaw might be broken. We'll get an x ray and see what the results say."


The results came back that Billy had indeed got a broken jaw.

An IV line was put in to the back of his hand, bloods were taken and a 'nil orally' laminated sign was hung above his cubicle.  

His nurse came in and started to fill out a pre theatre checklist. It was difficult to get information, Billy was mumbling and evading questions.


“Where do you live Billy? We need to let people know you will be staying in hospital for a few days”.


Eventually Billy gave his home address as a temporary men’s shelter. However he insisted that nobody from the hospital should contact the management. When his nurse wanted to ring them, Billy became agitated.


“I don't want anyone to know I'm in hospital” Billy insisted. "I'll be in trouble if people at the shelter find out what happned."


Billy was wheeled off to theatre that evening. His broken jaw was reset and wired into place. He was then sent up to a general ward to recover.

His jaw was wired in place so the fracture could heal and his mouth had to be rinsed out twice daily with chlorhex mouthwash. Billy was only allowed liquids through a straw.

The ward nurses were exasperated by his smell and made him shower, shave and put on a pair of ill filling green hospital pyjamas. His smelly, torn clothes were thrown out.

They were also angry to find out that despite being the victim of a serious assault, the police had not even been contacted.

A social worker came so see Billy and spent two hours talking to him, quietly.




It turned out that Billy had been diagnosed as a schizophrenia ten years ago and had been taking regular antipsychotic medications, through a local mental health clinic.

However he had recently moved to another suburb, and instantly became ineligible to see the same clinic. No new clinic or case worker had been organised. There was no coordination of patients data between different mental health zones. No patients were tracked as they moved around the state.

The result was, many slipped through the cracks, went off their medications and ended up on the streets.

A GP was contacted who confirmed that the man was compliant with his medications and was shy and non threatening.

The problem was, the Doctor pointed out, that Billy had nowhere to live.


“I can’t find any permanent accommodation for this man. The government has closed all the psych beds. Where is he supposed to go? And what is the point of patching him up in hospital if you are going to send him back to live on the streets again?”




After making numerous phone calls, a new clinic case worker was located. She needed to see Billy in person, fill out a new set of paperwork and have him reassessed by a new Doctor, before she could restart his medications.




After a few days of regular food, warm clean clothes and people being friendly, Billy began to open up.

He admitted to nursing staff that he had been beaten up by a gang of thugs at the shelter.


"They told me they hate people with a mental illness then punched me in the face and threw me down the stairs. They also warned me not to tell, or I'd be killed."


Billy was subsequently discharged back to the same hostel where he had originally been assaulted.

There was no follow up.


Wikihospitals 2014

References

Mental health patients waiting for hours, sometimes days in emergency departments - ABC news February 2018

May Is National Mental Health Awareness Month - Mathematica, May 2017.