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Young women most likely to be physically restrained in mental health units

Patients in mental health units were physically restrained by staff more than 80,000 times last year, including 10,000 who were held face down or injected to subdue them, new NHS figures show.

Girls and young women under the age of 20 were the most likely to be restrained, each being subjected 30 times a year on average to techniques that can involve a group of staff combining to tackle a patient who is being aggressive or violent.

Black people were three times more likely to be restrained than white people, according to the first comprehensive NHS data on the use in England of such techniques, which have provoked controversy for many years. Mental health campaigners fear that the use of such force can cause patients physical harm or revive painful memories of the trauma that many have suffered in childhood.

The figures, published by the NHS Digital statistical agency, show that the 80,000 uses of restraint in 2016-17 included patients being subjected to “prone” restraint – being held face down – 10,000 times, and patients being controlled by “non-prone” physical force 43,000 times. Chemical restraint was used on another 8,600 occasions.

The findings have prompted fresh concern among mental health experts that too many patients are still being restrained, despite moves by the government and NHS in recent years to reduce the incidence.

“It is troubling to see how prevalent the most severe, and dangerous, kinds of restraint are in the mental health system,” said Brian Dow, director of external affairs at the charity Rethink Mental Illness. Prone restraint “can be terrifying and badly damage someone’s recovery”.

NHS Digital’s figures were published in the recent annual mental health bulletin detailing activity and treatment in NHS mental health units in England. They show that:

■ Black people were more than three times more likely to be restrained than white people.

■ Prone restraint, which guidance says should be used only in life-threatening situations, is used more often on women than men.

■ Face-down restraint is used on fewer women than men, but more often; women are physically subdued multiple times.

■ Mechanical means of restraint were used 1,200 times, seclusion on 7,700 occasions and segregation 700 times.

Katharine Sacks-Jones, the director of Agenda, an alliance of 70 organisations working with women and girls who are at risk, said: “It’s completely unacceptable that so many women and girls are being restrained over and over again.

“The picture for girls and young women is particularly alarming, with those under 20 subjected to restrictive practices nearly 30 times each on average, the majority of these being incidents of physical and face-down restraint.

“More than half of women who have mental health problems have experienced abuse, so not only is restraint frightening and humiliating, it also risks retraumatising them.”

In its annual report in July, the Care Quality Commission, which regulates NHS care in England, said its inspectors had found unwarranted and wide-ranging variation between units in terms of how often staff used restraint. Wards that had low rates had staff who had been trained to handle difficult behaviour and de-escalate challenging situations.

But, the CQC added, mental health wards dealing with acutely unwell patients are high-risk environments where patients can regularly be violent towards staff or fellow patients. The number of times restraint techniques are used has risen from 781 per 100,000 bed days in 2013-14 to 954 per 100,000 bed days last year. However, use of face-down restraint has fallen, from 231 incidents per 100,000 bed days in 2014-15 to 199 incidents per 100,000 bed days in 2015-16.

The Department of Health said that its guidance, issued in 2014, stressed that restraint should be used only if other means of dealing with difficult situations were unlikely to succeed.

“Physical restraint should only be used as a last resort and our guidance to the NHS is clear on this – anything less is unacceptable,” a spokeswoman said. “Every patient with mental health issues deserves to be treated and cared for in a safe environment. We are working actively with the CQC to ensure the use of restraint is minimised.”

The bulletin also reveals that almost one in 20 people in England received NHS help last year for mental health problems. A total of 2,637,916 people – 4.8% of the population – were in contact with secondary mental health, learning disabilities and autism services at some point. Of these, 556,790 were under 18.

In addition, 101,589 (3.9%) of those 2.6m patients ended up in hospital receiving treatment.

Young women most likely to be physically restrained in mental health units

Patients in mental health units were physically restrained by staff more than 80,000 times last year, including 10,000 who were held face down or injected to subdue them, new NHS figures show.

Girls and young women under the age of 20 were the most likely to be restrained, each being subjected 30 times a year on average to techniques that can involve a group of staff combining to tackle a patient who is being aggressive or violent.

Black people were three times more likely to be restrained than white people, according to the first comprehensive NHS data on the use in England of such techniques, which have provoked controversy for many years. Mental health campaigners fear that the use of such force can cause patients physical harm or revive painful memories of the trauma that many have suffered in childhood.

The figures, published by the NHS Digital statistical agency, show that the 80,000 uses of restraint in 2016-17 included patients being subjected to “prone” restraint – being held face down – 10,000 times, and patients being controlled by “non-prone” physical force 43,000 times. Chemical restraint was used on another 8,600 occasions.

The findings have prompted fresh concern among mental health experts that too many patients are still being restrained, despite moves by the government and NHS in recent years to reduce the incidence.

“It is troubling to see how prevalent the most severe, and dangerous, kinds of restraint are in the mental health system,” said Brian Dow, director of external affairs at the charity Rethink Mental Illness. Prone restraint “can be terrifying and badly damage someone’s recovery”.

NHS Digital’s figures were published in the recent annual mental health bulletin detailing activity and treatment in NHS mental health units in England. They show that:

■ Black people were more than three times more likely to be restrained than white people.

■ Prone restraint, which guidance says should be used only in life-threatening situations, is used more often on women than men.

■ Face-down restraint is used on fewer women than men, but more often; women are physically subdued multiple times.

■ Mechanical means of restraint were used 1,200 times, seclusion on 7,700 occasions and segregation 700 times.

Katharine Sacks-Jones, the director of Agenda, an alliance of 70 organisations working with women and girls who are at risk, said: “It’s completely unacceptable that so many women and girls are being restrained over and over again.

“The picture for girls and young women is particularly alarming, with those under 20 subjected to restrictive practices nearly 30 times each on average, the majority of these being incidents of physical and face-down restraint.

“More than half of women who have mental health problems have experienced abuse, so not only is restraint frightening and humiliating, it also risks retraumatising them.”

In its annual report in July, the Care Quality Commission, which regulates NHS care in England, said its inspectors had found unwarranted and wide-ranging variation between units in terms of how often staff used restraint. Wards that had low rates had staff who had been trained to handle difficult behaviour and de-escalate challenging situations.

But, the CQC added, mental health wards dealing with acutely unwell patients are high-risk environments where patients can regularly be violent towards staff or fellow patients. The number of times restraint techniques are used has risen from 781 per 100,000 bed days in 2013-14 to 954 per 100,000 bed days last year. However, use of face-down restraint has fallen, from 231 incidents per 100,000 bed days in 2014-15 to 199 incidents per 100,000 bed days in 2015-16.

The Department of Health said that its guidance, issued in 2014, stressed that restraint should be used only if other means of dealing with difficult situations were unlikely to succeed.

“Physical restraint should only be used as a last resort and our guidance to the NHS is clear on this – anything less is unacceptable,” a spokeswoman said. “Every patient with mental health issues deserves to be treated and cared for in a safe environment. We are working actively with the CQC to ensure the use of restraint is minimised.”

The bulletin also reveals that almost one in 20 people in England received NHS help last year for mental health problems. A total of 2,637,916 people – 4.8% of the population – were in contact with secondary mental health, learning disabilities and autism services at some point. Of these, 556,790 were under 18.

In addition, 101,589 (3.9%) of those 2.6m patients ended up in hospital receiving treatment.

Young women most likely to be physically restrained in mental health units

Patients in mental health units were physically restrained by staff more than 80,000 times last year, including 10,000 who were held face down or injected to subdue them, new NHS figures show.

Girls and young women under the age of 20 were the most likely to be restrained, each being subjected 30 times a year on average to techniques that can involve a group of staff combining to tackle a patient who is being aggressive or violent.

Black people were three times more likely to be restrained than white people, according to the first comprehensive NHS data on the use in England of such techniques, which have provoked controversy for many years. Mental health campaigners fear that the use of such force can cause patients physical harm or revive painful memories of the trauma that many have suffered in childhood.

The figures, published by the NHS Digital statistical agency, show that the 80,000 uses of restraint in 2016-17 included patients being subjected to “prone” restraint – being held face down – 10,000 times, and patients being controlled by “non-prone” physical force 43,000 times. Chemical restraint was used on another 8,600 occasions.

The findings have prompted fresh concern among mental health experts that too many patients are still being restrained, despite moves by the government and NHS in recent years to reduce the incidence.

“It is troubling to see how prevalent the most severe, and dangerous, kinds of restraint are in the mental health system,” said Brian Dow, director of external affairs at the charity Rethink Mental Illness. Prone restraint “can be terrifying and badly damage someone’s recovery”.

NHS Digital’s figures were published in the recent annual mental health bulletin detailing activity and treatment in NHS mental health units in England. They show that:

■ Black people were more than three times more likely to be restrained than white people.

■ Prone restraint, which guidance says should be used only in life-threatening situations, is used more often on women than men.

■ Face-down restraint is used on fewer women than men, but more often; women are physically subdued multiple times.

■ Mechanical means of restraint were used 1,200 times, seclusion on 7,700 occasions and segregation 700 times.

Katharine Sacks-Jones, the director of Agenda, an alliance of 70 organisations working with women and girls who are at risk, said: “It’s completely unacceptable that so many women and girls are being restrained over and over again.

“The picture for girls and young women is particularly alarming, with those under 20 subjected to restrictive practices nearly 30 times each on average, the majority of these being incidents of physical and face-down restraint.

“More than half of women who have mental health problems have experienced abuse, so not only is restraint frightening and humiliating, it also risks retraumatising them.”

In its annual report in July, the Care Quality Commission, which regulates NHS care in England, said its inspectors had found unwarranted and wide-ranging variation between units in terms of how often staff used restraint. Wards that had low rates had staff who had been trained to handle difficult behaviour and de-escalate challenging situations.

But, the CQC added, mental health wards dealing with acutely unwell patients are high-risk environments where patients can regularly be violent towards staff or fellow patients. The number of times restraint techniques are used has risen from 781 per 100,000 bed days in 2013-14 to 954 per 100,000 bed days last year. However, use of face-down restraint has fallen, from 231 incidents per 100,000 bed days in 2014-15 to 199 incidents per 100,000 bed days in 2015-16.

The Department of Health said that its guidance, issued in 2014, stressed that restraint should be used only if other means of dealing with difficult situations were unlikely to succeed.

“Physical restraint should only be used as a last resort and our guidance to the NHS is clear on this – anything less is unacceptable,” a spokeswoman said. “Every patient with mental health issues deserves to be treated and cared for in a safe environment. We are working actively with the CQC to ensure the use of restraint is minimised.”

The bulletin also reveals that almost one in 20 people in England received NHS help last year for mental health problems. A total of 2,637,916 people – 4.8% of the population – were in contact with secondary mental health, learning disabilities and autism services at some point. Of these, 556,790 were under 18.

In addition, 101,589 (3.9%) of those 2.6m patients ended up in hospital receiving treatment.

Those who need it most don’t get psychiatric care. It’s a mental health crisis | Vyom Sharma

What, precisely, is a crisis? Generally, things have to get pretty bad to be defined as one. “Housing”, “North Korean”, and ”global financial” have all seemed to earn that suffix. The problem with defining “crisis” is partly one of banality through overuse – if you believe even half of what you read, we are perpetually beset by it, in one form or another. So hearing the c-word in a context anything less than epic tends to be accompanied with a faint echo of hyperbole, and twinges of cynicism.

This cynicism can be a trap – it certainly was for me. Within the last decade of practicing medicine, I felt like if I had a dollar for every time I heard the words “mental health crisis”, I could single-handedly fund its fix. The phrase became a cliché. Over time, experience within the system bred familiarity, which spawned complacency.

Crisis is a word without a standard metric, common barometer, and sharp threshold. Its precise definition is akin to asking how long a piece of rope is. The only true answer is that it depends. But you know when you have enough to tie a noose. This week we’ve learned precisely how long that piece of rope is: a Victorian man who killed his mother amid a psychotic episode had to wait 14 months for a bed in a psychiatric hospital.

This is a new low. It’s bad enough that people die without getting adequate psychiatric help. But it turns out even killing someone else isn’t enough to qualify for psychiatric care. This is about as clear a demonstration of a “mental health crisis” as we will get.

To attribute this failure to an unfortunate lapse is to deny the very real, systemic problems that arise from mental healthcare being underfunded. This event did not occur in a vacuum. A deeper look exposes how the system, in its current state, is geared to end in such horrors.

Often the people most seriously afflicted by mental illness are the poorest, who cannot afford private psychiatric care. The problem is that publicly funded outpatient clinics are in very short supply. So often the only way to access psychiatric care out in the community is through “Catt” – Crisis Assessment and Treatment Team. That’s right, the only guaranteed way to be quickly linked in with publicly funded psychiatric care is to be in crisis. That’s how the system works.

Many patients have only this option available because they are in a strange chasm – not unwell enough to warrant a 000 call, but too unwell to wait weeks to see a private psychiatrist even if they can afford to see one. So the Catt service is often overburdened. GPs around Australia have a morose, longstanding joke about this; we say that the letters in Catt stand for “Can’t Attend Today Team”. When the “crisis” team is too busy to attend, you know there’s a problem.

This is not an indictment on the service – far from it. To say it is “overloaded” is like calling an acrobatic plate spinner “busy”. It is a job requiring a rare constitution – infinite patience, high stakes decisions, the ability to treat people who are of threat to themselves and others, and being firsthand witness to tragedy after tragedy. I’ve often seen Catt workers as patients for their own mental health. It might be a crisis in and of itself.

Depressingly, it seems the people viewing the situation with most clarity might be our youngest. Findings from Mission Australia Survey published this week show that Australians aged 15 to 19 ranked mental health as the issue of greatest national concern. Most worryingly, they identified mental health as an impediment to their future pursuits. The nurturing of at-risk adolescents through mental healthcare ought to bolster their optimism, but the failings of our system might be eroding it.

Statistics and position statements fail to capture these moments of clarity about our health system. And sometimes, reading cold statistics on per-capita funding, or wait times, without having to personally experience their impact, lulls you into the trap of confusing complaints for hyperbole.

There is another trap we can fall into. It’s one I was in for years. That trap is the belief that Australian healthcare, ranked consistently within the top-ten in the world is, overall, brilliant. That statement is undeniably true, and yet the key word here is “overall”.

If you forget those with mental illness, Indigenous Australians, LGBTIQ community, refugees and other at-risk groups, we’re doing spectacularly. The problem is that we are a country largely composed of at-risk groups. If you aren’t marginalised in this country, chances are you once were, or are descended from someone who was, or are shoulder-to-shoulder with someone who stands at the margins. And it’s at the margins where crisis thrives. That’s where we have to look to see the crisis for what it truly is.

Dr Vyom Sharma is a GP in Melbourne and a health commentator

Those who need it most don’t get psychiatric care. It’s a mental health crisis | Vyom Sharma

What, precisely, is a crisis? Generally, things have to get pretty bad to be defined as one. “Housing”, “North Korean”, and ”global financial” have all seemed to earn that suffix. The problem with defining “crisis” is partly one of banality through overuse – if you believe even half of what you read, we are perpetually beset by it, in one form or another. So hearing the c-word in a context anything less than epic tends to be accompanied with a faint echo of hyperbole, and twinges of cynicism.

This cynicism can be a trap – it certainly was for me. Within the last decade of practicing medicine, I felt like if I had a dollar for every time I heard the words “mental health crisis”, I could single-handedly fund its fix. The phrase became a cliché. Over time, experience within the system bred familiarity, which spawned complacency.

Crisis is a word without a standard metric, common barometer, and sharp threshold. Its precise definition is akin to asking how long a piece of rope is. The only true answer is that it depends. But you know when you have enough to tie a noose. This week we’ve learned precisely how long that piece of rope is: a Victorian man who killed his mother amid a psychotic episode had to wait 14 months for a bed in a psychiatric hospital.

This is a new low. It’s bad enough that people die without getting adequate psychiatric help. But it turns out even killing someone else isn’t enough to qualify for psychiatric care. This is about as clear a demonstration of a “mental health crisis” as we will get.

To attribute this failure to an unfortunate lapse is to deny the very real, systemic problems that arise from mental healthcare being underfunded. This event did not occur in a vacuum. A deeper look exposes how the system, in its current state, is geared to end in such horrors.

Often the people most seriously afflicted by mental illness are the poorest, who cannot afford private psychiatric care. The problem is that publicly funded outpatient clinics are in very short supply. So often the only way to access psychiatric care out in the community is through “Catt” – Crisis Assessment and Treatment Team. That’s right, the only guaranteed way to be quickly linked in with publicly funded psychiatric care is to be in crisis. That’s how the system works.

Many patients have only this option available because they are in a strange chasm – not unwell enough to warrant a 000 call, but too unwell to wait weeks to see a private psychiatrist even if they can afford to see one. So the Catt service is often overburdened. GPs around Australia have a morose, longstanding joke about this; we say that the letters in Catt stand for “Can’t Attend Today Team”. When the “crisis” team is too busy to attend, you know there’s a problem.

This is not an indictment on the service – far from it. To say it is “overloaded” is like calling an acrobatic plate spinner “busy”. It is a job requiring a rare constitution – infinite patience, high stakes decisions, the ability to treat people who are of threat to themselves and others, and being firsthand witness to tragedy after tragedy. I’ve often seen Catt workers as patients for their own mental health. It might be a crisis in and of itself.

Depressingly, it seems the people viewing the situation with most clarity might be our youngest. Findings from Mission Australia Survey published this week show that Australians aged 15 to 19 ranked mental health as the issue of greatest national concern. Most worryingly, they identified mental health as an impediment to their future pursuits. The nurturing of at-risk adolescents through mental healthcare ought to bolster their optimism, but the failings of our system might be eroding it.

Statistics and position statements fail to capture these moments of clarity about our health system. And sometimes, reading cold statistics on per-capita funding, or wait times, without having to personally experience their impact, lulls you into the trap of confusing complaints for hyperbole.

There is another trap we can fall into. It’s one I was in for years. That trap is the belief that Australian healthcare, ranked consistently within the top-ten in the world is, overall, brilliant. That statement is undeniably true, and yet the key word here is “overall”.

If you forget those with mental illness, Indigenous Australians, LGBTIQ community, refugees and other at-risk groups, we’re doing spectacularly. The problem is that we are a country largely composed of at-risk groups. If you aren’t marginalised in this country, chances are you once were, or are descended from someone who was, or are shoulder-to-shoulder with someone who stands at the margins. And it’s at the margins where crisis thrives. That’s where we have to look to see the crisis for what it truly is.

Dr Vyom Sharma is a GP in Melbourne and a health commentator

Those who need it most don’t get psychiatric care. It’s a mental health crisis | Vyom Sharma

What, precisely, is a crisis? Generally, things have to get pretty bad to be defined as one. “Housing”, “North Korean”, and ”global financial” have all seemed to earn that suffix. The problem with defining “crisis” is partly one of banality through overuse – if you believe even half of what you read, we are perpetually beset by it, in one form or another. So hearing the c-word in a context anything less than epic tends to be accompanied with a faint echo of hyperbole, and twinges of cynicism.

This cynicism can be a trap – it certainly was for me. Within the last decade of practicing medicine, I felt like if I had a dollar for every time I heard the words “mental health crisis”, I could single-handedly fund its fix. The phrase became a cliché. Over time, experience within the system bred familiarity, which spawned complacency.

Crisis is a word without a standard metric, common barometer, and sharp threshold. Its precise definition is akin to asking how long a piece of rope is. The only true answer is that it depends. But you know when you have enough to tie a noose. This week we’ve learned precisely how long that piece of rope is: a Victorian man who killed his mother amid a psychotic episode had to wait 14 months for a bed in a psychiatric hospital.

This is a new low. It’s bad enough that people die without getting adequate psychiatric help. But it turns out even killing someone else isn’t enough to qualify for psychiatric care. This is about as clear a demonstration of a “mental health crisis” as we will get.

To attribute this failure to an unfortunate lapse is to deny the very real, systemic problems that arise from mental healthcare being underfunded. This event did not occur in a vacuum. A deeper look exposes how the system, in its current state, is geared to end in such horrors.

Often the people most seriously afflicted by mental illness are the poorest, who cannot afford private psychiatric care. The problem is that publicly funded outpatient clinics are in very short supply. So often the only way to access psychiatric care out in the community is through “Catt” – Crisis Assessment and Treatment Team. That’s right, the only guaranteed way to be quickly linked in with publicly funded psychiatric care is to be in crisis. That’s how the system works.

Many patients have only this option available because they are in a strange chasm – not unwell enough to warrant a 000 call, but too unwell to wait weeks to see a private psychiatrist even if they can afford to see one. So the Catt service is often overburdened. GPs around Australia have a morose, longstanding joke about this; we say that the letters in Catt stand for “Can’t Attend Today Team”. When the “crisis” team is too busy to attend, you know there’s a problem.

This is not an indictment on the service – far from it. To say it is “overloaded” is like calling an acrobatic plate spinner “busy”. It is a job requiring a rare constitution – infinite patience, high stakes decisions, the ability to treat people who are of threat to themselves and others, and being firsthand witness to tragedy after tragedy. I’ve often seen Catt workers as patients for their own mental health. It might be a crisis in and of itself.

Depressingly, it seems the people viewing the situation with most clarity might be our youngest. Findings from Mission Australia Survey published this week show that Australians aged 15 to 19 ranked mental health as the issue of greatest national concern. Most worryingly, they identified mental health as an impediment to their future pursuits. The nurturing of at-risk adolescents through mental healthcare ought to bolster their optimism, but the failings of our system might be eroding it.

Statistics and position statements fail to capture these moments of clarity about our health system. And sometimes, reading cold statistics on per-capita funding, or wait times, without having to personally experience their impact, lulls you into the trap of confusing complaints for hyperbole.

There is another trap we can fall into. It’s one I was in for years. That trap is the belief that Australian healthcare, ranked consistently within the top-ten in the world is, overall, brilliant. That statement is undeniably true, and yet the key word here is “overall”.

If you forget those with mental illness, Indigenous Australians, LGBTIQ community, refugees and other at-risk groups, we’re doing spectacularly. The problem is that we are a country largely composed of at-risk groups. If you aren’t marginalised in this country, chances are you once were, or are descended from someone who was, or are shoulder-to-shoulder with someone who stands at the margins. And it’s at the margins where crisis thrives. That’s where we have to look to see the crisis for what it truly is.

Dr Vyom Sharma is a GP in Melbourne and a health commentator

Those who need it most don’t get psychiatric care. It’s a mental health crisis | Vyom Sharma

What, precisely, is a crisis? Generally, things have to get pretty bad to be defined as one. “Housing”, “North Korean”, and ”global financial” have all seemed to earn that suffix. The problem with defining “crisis” is partly one of banality through overuse – if you believe even half of what you read, we are perpetually beset by it, in one form or another. So hearing the c-word in a context anything less than epic tends to be accompanied with a faint echo of hyperbole, and twinges of cynicism.

This cynicism can be a trap – it certainly was for me. Within the last decade of practicing medicine, I felt like if I had a dollar for every time I heard the words “mental health crisis”, I could single-handedly fund its fix. The phrase became a cliché. Over time, experience within the system bred familiarity, which spawned complacency.

Crisis is a word without a standard metric, common barometer, and sharp threshold. Its precise definition is akin to asking how long a piece of rope is. The only true answer is that it depends. But you know when you have enough to tie a noose. This week we’ve learned precisely how long that piece of rope is: a Victorian man who killed his mother amid a psychotic episode had to wait 14 months for a bed in a psychiatric hospital.

This is a new low. It’s bad enough that people die without getting adequate psychiatric help. But it turns out even killing someone else isn’t enough to qualify for psychiatric care. This is about as clear a demonstration of a “mental health crisis” as we will get.

To attribute this failure to an unfortunate lapse is to deny the very real, systemic problems that arise from mental healthcare being underfunded. This event did not occur in a vacuum. A deeper look exposes how the system, in its current state, is geared to end in such horrors.

Often the people most seriously afflicted by mental illness are the poorest, who cannot afford private psychiatric care. The problem is that publicly funded outpatient clinics are in very short supply. So often the only way to access psychiatric care out in the community is through “Catt” – Crisis Assessment and Treatment Team. That’s right, the only guaranteed way to be quickly linked in with publicly funded psychiatric care is to be in crisis. That’s how the system works.

Many patients have only this option available because they are in a strange chasm – not unwell enough to warrant a 000 call, but too unwell to wait weeks to see a private psychiatrist even if they can afford to see one. So the Catt service is often overburdened. GPs around Australia have a morose, longstanding joke about this; we say that the letters in Catt stand for “Can’t Attend Today Team”. When the “crisis” team is too busy to attend, you know there’s a problem.

This is not an indictment on the service – far from it. To say it is “overloaded” is like calling an acrobatic plate spinner “busy”. It is a job requiring a rare constitution – infinite patience, high stakes decisions, the ability to treat people who are of threat to themselves and others, and being firsthand witness to tragedy after tragedy. I’ve often seen Catt workers as patients for their own mental health. It might be a crisis in and of itself.

Depressingly, it seems the people viewing the situation with most clarity might be our youngest. Findings from Mission Australia Survey published this week show that Australians aged 15 to 19 ranked mental health as the issue of greatest national concern. Most worryingly, they identified mental health as an impediment to their future pursuits. The nurturing of at-risk adolescents through mental healthcare ought to bolster their optimism, but the failings of our system might be eroding it.

Statistics and position statements fail to capture these moments of clarity about our health system. And sometimes, reading cold statistics on per-capita funding, or wait times, without having to personally experience their impact, lulls you into the trap of confusing complaints for hyperbole.

There is another trap we can fall into. It’s one I was in for years. That trap is the belief that Australian healthcare, ranked consistently within the top-ten in the world is, overall, brilliant. That statement is undeniably true, and yet the key word here is “overall”.

If you forget those with mental illness, Indigenous Australians, LGBTIQ community, refugees and other at-risk groups, we’re doing spectacularly. The problem is that we are a country largely composed of at-risk groups. If you aren’t marginalised in this country, chances are you once were, or are descended from someone who was, or are shoulder-to-shoulder with someone who stands at the margins. And it’s at the margins where crisis thrives. That’s where we have to look to see the crisis for what it truly is.

Dr Vyom Sharma is a GP in Melbourne and a health commentator

Those who need it most don’t get psychiatric care. It’s a mental health crisis | Vyom Sharma

What, precisely, is a crisis? Generally, things have to get pretty bad to be defined as one. “Housing”, “North Korean”, and ”global financial” have all seemed to earn that suffix. The problem with defining “crisis” is partly one of banality through overuse – if you believe even half of what you read, we are perpetually beset by it, in one form or another. So hearing the c-word in a context anything less than epic tends to be accompanied with a faint echo of hyperbole, and twinges of cynicism.

This cynicism can be a trap – it certainly was for me. Within the last decade of practicing medicine, I felt like if I had a dollar for every time I heard the words “mental health crisis”, I could single-handedly fund its fix. The phrase became a cliché. Over time, experience within the system bred familiarity, which spawned complacency.

Crisis is a word without a standard metric, common barometer, and sharp threshold. Its precise definition is akin to asking how long a piece of rope is. The only true answer is that it depends. But you know when you have enough to tie a noose. This week we’ve learned precisely how long that piece of rope is: a Victorian man who killed his mother amid a psychotic episode had to wait 14 months for a bed in a psychiatric hospital.

This is a new low. It’s bad enough that people die without getting adequate psychiatric help. But it turns out even killing someone else isn’t enough to qualify for psychiatric care. This is about as clear a demonstration of a “mental health crisis” as we will get.

To attribute this failure to an unfortunate lapse is to deny the very real, systemic problems that arise from mental healthcare being underfunded. This event did not occur in a vacuum. A deeper look exposes how the system, in its current state, is geared to end in such horrors.

Often the people most seriously afflicted by mental illness are the poorest, who cannot afford private psychiatric care. The problem is that publicly funded outpatient clinics are in very short supply. So often the only way to access psychiatric care out in the community is through “Catt” – Crisis Assessment and Treatment Team. That’s right, the only guaranteed way to be quickly linked in with publicly funded psychiatric care is to be in crisis. That’s how the system works.

Many patients have only this option available because they are in a strange chasm – not unwell enough to warrant a 000 call, but too unwell to wait weeks to see a private psychiatrist even if they can afford to see one. So the Catt service is often overburdened. GPs around Australia have a morose, longstanding joke about this; we say that the letters in Catt stand for “Can’t Attend Today Team”. When the “crisis” team is too busy to attend, you know there’s a problem.

This is not an indictment on the service – far from it. To say it is “overloaded” is like calling an acrobatic plate spinner “busy”. It is a job requiring a rare constitution – infinite patience, high stakes decisions, the ability to treat people who are of threat to themselves and others, and being firsthand witness to tragedy after tragedy. I’ve often seen Catt workers as patients for their own mental health. It might be a crisis in and of itself.

Depressingly, it seems the people viewing the situation with most clarity might be our youngest. Findings from Mission Australia Survey published this week show that Australians aged 15 to 19 ranked mental health as the issue of greatest national concern. Most worryingly, they identified mental health as an impediment to their future pursuits. The nurturing of at-risk adolescents through mental healthcare ought to bolster their optimism, but the failings of our system might be eroding it.

Statistics and position statements fail to capture these moments of clarity about our health system. And sometimes, reading cold statistics on per-capita funding, or wait times, without having to personally experience their impact, lulls you into the trap of confusing complaints for hyperbole.

There is another trap we can fall into. It’s one I was in for years. That trap is the belief that Australian healthcare, ranked consistently within the top-ten in the world is, overall, brilliant. That statement is undeniably true, and yet the key word here is “overall”.

If you forget those with mental illness, Indigenous Australians, LGBTIQ community, refugees and other at-risk groups, we’re doing spectacularly. The problem is that we are a country largely composed of at-risk groups. If you aren’t marginalised in this country, chances are you once were, or are descended from someone who was, or are shoulder-to-shoulder with someone who stands at the margins. And it’s at the margins where crisis thrives. That’s where we have to look to see the crisis for what it truly is.

Dr Vyom Sharma is a GP in Melbourne and a health commentator

Those who need it most don’t get psychiatric care. It’s a mental health crisis | Vyom Sharma

What, precisely, is a crisis? Generally, things have to get pretty bad to be defined as one. “Housing”, “North Korean”, and ”global financial” have all seemed to earn that suffix. The problem with defining “crisis” is partly one of banality through overuse – if you believe even half of what you read, we are perpetually beset by it, in one form or another. So hearing the c-word in a context anything less than epic tends to be accompanied with a faint echo of hyperbole, and twinges of cynicism.

This cynicism can be a trap – it certainly was for me. Within the last decade of practicing medicine, I felt like if I had a dollar for every time I heard the words “mental health crisis”, I could single-handedly fund its fix. The phrase became a cliché. Over time, experience within the system bred familiarity, which spawned complacency.

Crisis is a word without a standard metric, common barometer, and sharp threshold. Its precise definition is akin to asking how long a piece of rope is. The only true answer is that it depends. But you know when you have enough to tie a noose. This week we’ve learned precisely how long that piece of rope is: a Victorian man who killed his mother amid a psychotic episode had to wait 14 months for a bed in a psychiatric hospital.

This is a new low. It’s bad enough that people die without getting adequate psychiatric help. But it turns out even killing someone else isn’t enough to qualify for psychiatric care. This is about as clear a demonstration of a “mental health crisis” as we will get.

To attribute this failure to an unfortunate lapse is to deny the very real, systemic problems that arise from mental healthcare being underfunded. This event did not occur in a vacuum. A deeper look exposes how the system, in its current state, is geared to end in such horrors.

Often the people most seriously afflicted by mental illness are the poorest, who cannot afford private psychiatric care. The problem is that publicly funded outpatient clinics are in very short supply. So often the only way to access psychiatric care out in the community is through “Catt” – Crisis Assessment and Treatment Team. That’s right, the only guaranteed way to be quickly linked in with publicly funded psychiatric care is to be in crisis. That’s how the system works.

Many patients have only this option available because they are in a strange chasm – not unwell enough to warrant a 000 call, but too unwell to wait weeks to see a private psychiatrist even if they can afford to see one. So the Catt service is often overburdened. GPs around Australia have a morose, longstanding joke about this; we say that the letters in Catt stand for “Can’t Attend Today Team”. When the “crisis” team is too busy to attend, you know there’s a problem.

This is not an indictment on the service – far from it. To say it is “overloaded” is like calling an acrobatic plate spinner “busy”. It is a job requiring a rare constitution – infinite patience, high stakes decisions, the ability to treat people who are of threat to themselves and others, and being firsthand witness to tragedy after tragedy. I’ve often seen Catt workers as patients for their own mental health. It might be a crisis in and of itself.

Depressingly, it seems the people viewing the situation with most clarity might be our youngest. Findings from Mission Australia Survey published this week show that Australians aged 15 to 19 ranked mental health as the issue of greatest national concern. Most worryingly, they identified mental health as an impediment to their future pursuits. The nurturing of at-risk adolescents through mental healthcare ought to bolster their optimism, but the failings of our system might be eroding it.

Statistics and position statements fail to capture these moments of clarity about our health system. And sometimes, reading cold statistics on per-capita funding, or wait times, without having to personally experience their impact, lulls you into the trap of confusing complaints for hyperbole.

There is another trap we can fall into. It’s one I was in for years. That trap is the belief that Australian healthcare, ranked consistently within the top-ten in the world is, overall, brilliant. That statement is undeniably true, and yet the key word here is “overall”.

If you forget those with mental illness, Indigenous Australians, LGBTIQ community, refugees and other at-risk groups, we’re doing spectacularly. The problem is that we are a country largely composed of at-risk groups. If you aren’t marginalised in this country, chances are you once were, or are descended from someone who was, or are shoulder-to-shoulder with someone who stands at the margins. And it’s at the margins where crisis thrives. That’s where we have to look to see the crisis for what it truly is.

Dr Vyom Sharma is a GP in Melbourne and a health commentator

Those who need it most don’t get psychiatric care. It’s a mental health crisis | Vyom Sharma

What, precisely, is a crisis? Generally, things have to get pretty bad to be defined as one. “Housing”, “North Korean”, and ”global financial” have all seemed to earn that suffix. The problem with defining “crisis” is partly one of banality through overuse – if you believe even half of what you read, we are perpetually beset by it, in one form or another. So hearing the c-word in a context anything less than epic tends to be accompanied with a faint echo of hyperbole, and twinges of cynicism.

This cynicism can be a trap – it certainly was for me. Within the last decade of practicing medicine, I felt like if I had a dollar for every time I heard the words “mental health crisis”, I could single-handedly fund its fix. The phrase became a cliché. Over time, experience within the system bred familiarity, which spawned complacency.

Crisis is a word without a standard metric, common barometer, and sharp threshold. Its precise definition is akin to asking how long a piece of rope is. The only true answer is that it depends. But you know when you have enough to tie a noose. This week we’ve learned precisely how long that piece of rope is: a Victorian man who killed his mother amid a psychotic episode had to wait 14 months for a bed in a psychiatric hospital.

This is a new low. It’s bad enough that people die without getting adequate psychiatric help. But it turns out even killing someone else isn’t enough to qualify for psychiatric care. This is about as clear a demonstration of a “mental health crisis” as we will get.

To attribute this failure to an unfortunate lapse is to deny the very real, systemic problems that arise from mental healthcare being underfunded. This event did not occur in a vacuum. A deeper look exposes how the system, in its current state, is geared to end in such horrors.

Often the people most seriously afflicted by mental illness are the poorest, who cannot afford private psychiatric care. The problem is that publicly funded outpatient clinics are in very short supply. So often the only way to access psychiatric care out in the community is through “Catt” – Crisis Assessment and Treatment Team. That’s right, the only guaranteed way to be quickly linked in with publicly funded psychiatric care is to be in crisis. That’s how the system works.

Many patients have only this option available because they are in a strange chasm – not unwell enough to warrant a 000 call, but too unwell to wait weeks to see a private psychiatrist even if they can afford to see one. So the Catt service is often overburdened. GPs around Australia have a morose, longstanding joke about this; we say that the letters in Catt stand for “Can’t Attend Today Team”. When the “crisis” team is too busy to attend, you know there’s a problem.

This is not an indictment on the service – far from it. To say it is “overloaded” is like calling an acrobatic plate spinner “busy”. It is a job requiring a rare constitution – infinite patience, high stakes decisions, the ability to treat people who are of threat to themselves and others, and being firsthand witness to tragedy after tragedy. I’ve often seen Catt workers as patients for their own mental health. It might be a crisis in and of itself.

Depressingly, it seems the people viewing the situation with most clarity might be our youngest. Findings from Mission Australia Survey published this week show that Australians aged 15 to 19 ranked mental health as the issue of greatest national concern. Most worryingly, they identified mental health as an impediment to their future pursuits. The nurturing of at-risk adolescents through mental healthcare ought to bolster their optimism, but the failings of our system might be eroding it.

Statistics and position statements fail to capture these moments of clarity about our health system. And sometimes, reading cold statistics on per-capita funding, or wait times, without having to personally experience their impact, lulls you into the trap of confusing complaints for hyperbole.

There is another trap we can fall into. It’s one I was in for years. That trap is the belief that Australian healthcare, ranked consistently within the top-ten in the world is, overall, brilliant. That statement is undeniably true, and yet the key word here is “overall”.

If you forget those with mental illness, Indigenous Australians, LGBTIQ community, refugees and other at-risk groups, we’re doing spectacularly. The problem is that we are a country largely composed of at-risk groups. If you aren’t marginalised in this country, chances are you once were, or are descended from someone who was, or are shoulder-to-shoulder with someone who stands at the margins. And it’s at the margins where crisis thrives. That’s where we have to look to see the crisis for what it truly is.

Dr Vyom Sharma is a GP in Melbourne and a health commentator