Psychiatric Emergencies and Suicide Prevention

The GCMA Samoa Conference 2023 brought to the forefront crucial issues in psychiatric emergencies and suicide prevention, with a particular focus on the Australian health care system and how this might inform developments in Pacific island nations. This report aims to provide an overview of the key discussions and propose potential solutions.

The Australian health care system, known for its mixed public and private model, was critically evaluated. The discussion revolved around the merits of replication by other countries, exploring aspects such as basic universal care in primary care settings and hospitals through Medicare, the role of private health insurance for non-immediate life-threatening conditions, and the potential advantages and pitfalls of fee-for-service in private practice. The tension between public and private sectors was highlighted, emphasizing the delicate balance required to ensure neither sector experiences excesses, leaving room for improvement.

A major concern identified at the conference was the state of the Australian mental health crisis. Despite national mental health plans and a decade of changes to public mental health services, there is a consensus that the care of mentally ill individuals is inadequate. The focus has traditionally been on public mental health services, but the issue is now extending into private practice, creating what is referred to as the ‘missing middle.’ The root cause was traced back to the closure of state psychiatric hospitals, which, although in need of reform, resulted in the dispossessed long-term chronic psychotic and severely mood-disordered patients being disposed of their accommodation, clinical care and rehabilitation services.

Consequences of this system failure include leading long-term patients to fill acute public hospital units. This, in turn, results in the rationing of acute beds for disturbed patients, with suicide rates peaking after non-admission of patients presenting to emergency departments because of a lack of beds or early discharge of patients due to bed pressures. The unintended consequences of new mental health acts exacerbate the problem. Inadequate, narrow focussed, and unattractive registrar training positions has led to a significant workforce shortage in psychiatry.

To avoid a national psychiatric emergency, the conference proposed the provision of adequate clinical, accommodation, and rehabilitation services tailored to the needs of the chronic and severe mentally ill population. Advocacy for parallel and integrated mental health services to replace the ‘mainstream’ model was underscored, along with strategies to make psychiatry training more attractive to address workforce shortages.

Shifting the focus to suicide prevention, the conference recognized it as a collective responsibility requiring a comprehensive and compassionate approach. Strategies include raising awareness, reducing stigma, promoting mental health, identifying warning signs, and addressing risk factors such as previous attempts, substance abuse, and providing accessible care and crisis intervention. A significant emphasis was placed on removing means of suicide, akin to gun control measures. The primary importance of making sure individuals at risk do not get isolated was emphasised as an essential task for community and clinical interventions.

The importance of raising awareness and knowledge at national, state, and local levels was stressed, drawing parallels with the reporting of national/state road tolls. Coronial inquiries into suicide clusters were proposed to understand and address factors beyond diagnosed mental illness, as more than 50% of suicides occur in individuals with no diagnosed mental illness.

In conclusion, the GCMA Samoa Conference 2023 highlighted the urgent need for comprehensive reforms in the Australian mental health system and offered valuable insights for other countries facing similar challenges. The lessons learned underscore the importance of a balanced healthcare model, the provision of adequate services, and a holistic approach to suicide prevention.

Prof Philip Morris AM