Tag Archives: people

Social care reform ignores crisis of people stuck on mental health wards

Anyone who has spent time on an acute mental health ward will know what challenging places they can be for both patients and staff. Vulnerable people with serious mental health problems too often receive poor care in an environment that is unsafe and far from therapeutic.

You would not want to your loved one to be somewhere like that unless there were no other options. So it is scandalous that increasing numbers of people are being left on mental health wards when they are well enough to leave because of the lack of available social care.

NHS England data – obtained by the BBC – found that the rate of delayed discharges in mental health is increasing faster than in other areas of the health service. From November 2015 to October 2016, there was a 56% rise in the number of bed days lost to delayed discharges in mental health trusts. This is almost twice the rate of the increase in acute trusts. There is also a huge financial implication, with the crisis costing the NHS [pdf] more than £170m a year.

Q&A

What is the social care green paper?

The much-anticipated green paper on social care for older people is due to be published in the autumn of 2018. The government originally promised the green paper before last year’s general election, but then said it would be unveiled before MPs’ summer recess – although there were hopes it would appear much sooner. 

It was also hoped the paper would address needs across the entire adult social care sector. Instead, the paper will be limited to the government’s plans for improving care and support for older people and tackling the challenges presented by an ageing population. 

There will be a “parallel work stream” on working age disabled adults, but some are concerned this report will focus on getting more disabled people into work. 

The government has invited a number of people to advise on the paper, including Paul Burstow, chair of the Social Care Institute for Excellence; and Caroline Abrahams, charity director of Age UK. However, no user or care worker representatives have been invited. 

During a cabinet reshuffle in early January, Jeremy Hunt became secretary of state for health and social care. Despite already having social care in his mandate, the change gave Hunt lead responsibility for the green paper.

The proposals set out in the paper will build on the additional £2bn the government has provided to meet social care needs, reduce pressures on NHS services and stabilise the social care provider market over the next three years. Once published, the paper will be subject to a full public consultation. 

Delayed discharges disproportionately affect those who are already socially disadvantaged and addressing this issue should be central to Theresa May’s pledge to tackle “burning injustices”. The latest findings from the independent review of the Mental Health Act [pdf] have identified that people from black and minority ethnic (BME) communities continue to be over-represented as patients on mental health wards and are more likely to have been compulsorily detained. This reflects my own experience of working to reduce delayed discharges in a London mental health trust. The majority of patients were from BME communities and nearly all were on low incomes.

I found that delays were often the result of conflict between local authorities and clinical commissioning groups about who should pay for a person’s care. Frequently, healthcare professionals, patients and their families would push for a higher level of support while commissioners wanted evidence that a less expensive alternative had failed. This sometimes resulted in patients being discharged with an inadequate level of support – and finding themselves readmitted to hospital.


Responsibility rests with a government ​that has cut spending on services for some of the most vulnerable in our society

It is important to recognise the transformative effect that providing someone with the right care and support can have. Vea (not her real name) was a middle-aged woman of Caribbean descent who had long-standing psychosis and a lifetime spent under the care of mental health services. When I began working with her, she had recently been sectioned after becoming acutely unwell. Before this she had been turning up frequently at the hospital begging for food.

While Vea was in hospital, I visited her housing association flat. It was bare, with a broken window and toilet and no food other than a packet of cereal, which was years out of date. Months later I visited Vea in the supported accommodation I had worked with her community nurse to secure funding for. The improvement in her mental health and quality of life was immense. Without this intervention, I have no doubt she would have soon been back on the ward.

It is too easy to blame commissioners for the delayed discharge crisis in mental health. They are forced to meet increasing demand for social care when their budgets have been reduced by almost 50% [pdf] since 2010-11. Responsibility rests with a government that has cut spending on vital services for some of the most vulnerable people in our society.

The long overdue green paper could have been an opportunity to prove the government is serious about addressing the social care needs of people with severe mental health problems. The fact that it is to solely focus on the needs of older adults means this crisis will continue at the expense of both patients and the taxpayer.

  • David Stephenson is a former discharge co-ordinator at an NHS trust

Social care reform ignores crisis of people stuck on mental health wards

Anyone who has spent time on an acute mental health ward will know what challenging places they can be for both patients and staff. Vulnerable people with serious mental health problems too often receive poor care in an environment that is unsafe and far from therapeutic.

You would not want to your loved one to be somewhere like that unless there were no other options. So it is scandalous that increasing numbers of people are being left on mental health wards when they are well enough to leave because of the lack of available social care.

NHS England data – obtained by the BBC – found that the rate of delayed discharges in mental health is increasing faster than in other areas of the health service. From November 2015 to October 2016, there was a 56% rise in the number of bed days lost to delayed discharges in mental health trusts. This is almost twice the rate of the increase in acute trusts. There is also a huge financial implication, with the crisis costing the NHS [pdf] more than £170m a year.

Q&A

What is the social care green paper?

The much-anticipated green paper on social care for older people is due to be published in the autumn of 2018. The government originally promised the green paper before last year’s general election, but then said it would be unveiled before MPs’ summer recess – although there were hopes it would appear much sooner. 

It was also hoped the paper would address needs across the entire adult social care sector. Instead, the paper will be limited to the government’s plans for improving care and support for older people and tackling the challenges presented by an ageing population. 

There will be a “parallel work stream” on working age disabled adults, but some are concerned this report will focus on getting more disabled people into work. 

The government has invited a number of people to advise on the paper, including Paul Burstow, chair of the Social Care Institute for Excellence; and Caroline Abrahams, charity director of Age UK. However, no user or care worker representatives have been invited. 

During a cabinet reshuffle in early January, Jeremy Hunt became secretary of state for health and social care. Despite already having social care in his mandate, the change gave Hunt lead responsibility for the green paper.

The proposals set out in the paper will build on the additional £2bn the government has provided to meet social care needs, reduce pressures on NHS services and stabilise the social care provider market over the next three years. Once published, the paper will be subject to a full public consultation. 

Delayed discharges disproportionately affect those who are already socially disadvantaged and addressing this issue should be central to Theresa May’s pledge to tackle “burning injustices”. The latest findings from the independent review of the Mental Health Act [pdf] have identified that people from black and minority ethnic (BME) communities continue to be over-represented as patients on mental health wards and are more likely to have been compulsorily detained. This reflects my own experience of working to reduce delayed discharges in a London mental health trust. The majority of patients were from BME communities and nearly all were on low incomes.

I found that delays were often the result of conflict between local authorities and clinical commissioning groups about who should pay for a person’s care. Frequently, healthcare professionals, patients and their families would push for a higher level of support while commissioners wanted evidence that a less expensive alternative had failed. This sometimes resulted in patients being discharged with an inadequate level of support – and finding themselves readmitted to hospital.


Responsibility rests with a government ​that has cut spending on services for some of the most vulnerable in our society

It is important to recognise the transformative effect that providing someone with the right care and support can have. Vea (not her real name) was a middle-aged woman of Caribbean descent who had long-standing psychosis and a lifetime spent under the care of mental health services. When I began working with her, she had recently been sectioned after becoming acutely unwell. Before this she had been turning up frequently at the hospital begging for food.

While Vea was in hospital, I visited her housing association flat. It was bare, with a broken window and toilet and no food other than a packet of cereal, which was years out of date. Months later I visited Vea in the supported accommodation I had worked with her community nurse to secure funding for. The improvement in her mental health and quality of life was immense. Without this intervention, I have no doubt she would have soon been back on the ward.

It is too easy to blame commissioners for the delayed discharge crisis in mental health. They are forced to meet increasing demand for social care when their budgets have been reduced by almost 50% [pdf] since 2010-11. Responsibility rests with a government that has cut spending on vital services for some of the most vulnerable people in our society.

The long overdue green paper could have been an opportunity to prove the government is serious about addressing the social care needs of people with severe mental health problems. The fact that it is to solely focus on the needs of older adults means this crisis will continue at the expense of both patients and the taxpayer.

  • David Stephenson is a former discharge co-ordinator at an NHS trust

Pathologists like me save lives daily. Yet so few people know what we do

Anyone who watched BBC2’s fly-on-the-wall documentary Hospital might have heard of “the lab”. I am one of many who work there – and as a pathologist I often feel, as many of my lab colleagues do, like a forgotten or unknown entity.

There are nearly 20 disciplines of pathology – and that number is growing – and 70% of all diagnoses made in the NHS involve pathology and biomedical science. The Royal College of Pathologists’ annual report [pdf] tells us that more than a billion tests are carried out annually – and NHS England says the number of pathology tests [pdf] equates to 14 for each person in England and Wales.

Sound impressive? Then why are we seen as back office staff by other professionals, with nobody fully understanding what we do? People often assume I deal with dead bodies when I tell them I work in a pathology lab. Postmortem pathologists account for about 1% of the pathology workforce.

My colleagues in the lab issue blood products to the scene of a car accident, and carry out screening tests to make sure a newborn baby doesn’t have a condition that would otherwise not get diagnosed until it is too late. They receive tissue from colons or breasts removed during surgery to see if a surgeon has fully got rid of a tumour; they assist in postmortems so that they might answer some of the questions a family may have – and help to ease their pain.

Pathologists and biomedical scientists also see what antibiotic would work best for you to help tackle antimicrobial resistance; they investigate hereditary disease so that any future generations might avoid the same illness. This is just a small insight into what we provide as a service.

Just because we’re not patient-facing, don’t be under any illusion that we care about them any less. On a number of occasions I’ve left work in tears, trying to get it all out of my system before going home to my family. Sometimes I feel it’s unfair that we know a patient’s diagnosis before they do, because we either see the results from the analyser or produce reports and these get discussed by healthcare professionals in order to approach the patient with treatment or management options.

I know that there’s no way of fixing this. However, it still doesn’t feel just or right. Many of us in the NHS spend much of our day feeling guilty: guilty that we can’t do more, guilty that we’re healthy and the patients we care for aren’t – and guilty because in order to care for patients we miss out on our own family time.

However, we still spend more of our time helping to deliver good news rather than bad. I remember a case from when I was on rotation in a blood bank many years ago. Doctors and porters were constantly coming up to the department for blood products, because as soon as any blood went into the patient being treated, it was just as quickly coming back out because their injuries were so severe.

The patient made what can only be described as a miraculous recovery. The blood bank and Welsh Blood Service played a huge part – yet that patient, and their family, will probably be unaware of this.

Another great part of my job is when we get a request for an urgent result or report and we work hard together to deliver the results – or when we find out which specific cancer someone has, so that patient can start their treatment immediately. It’s great being part of something that can make such a big difference to people’s lives.

I’m not demoralised and fed up – quite the opposite, in fact. I just want to highlight the variety of work we do and how it impacts on patient care. We are pathologists, biomedical scientists, associate practitioners, medical lab assistants and admin and clerical staff. We play a vital role in not just assisting in diagnosis, but also advising on the treatment and management of patients.

Pathology work goes on day and night, every day of the year. I feel so fortunate to have found a career I have fallen in love with – even if bits of it are gory.

If you would like to contribute to our Blood, sweat and tears series about experiences in healthcare, read our guidelines and get in touch by emailing sarah.johnson@theguardian.com

Follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views

If you’re looking for a healthcare job or need to recruit staff, visit Guardian Jobs

Pathologists like me save lives daily. Yet so few people know what we do

Anyone who watched BBC2’s fly-on-the-wall documentary Hospital might have heard of “the lab”. I am one of many who work there – and as a pathologist I often feel, as many of my lab colleagues do, like a forgotten or unknown entity.

There are nearly 20 disciplines of pathology – and that number is growing – and 70% of all diagnoses made in the NHS involve pathology and biomedical science. The Royal College of Pathologists’ annual report [pdf] tells us that more than a billion tests are carried out annually – and NHS England says the number of pathology tests [pdf] equates to 14 for each person in England and Wales.

Sound impressive? Then why are we seen as back office staff by other professionals, with nobody fully understanding what we do? People often assume I deal with dead bodies when I tell them I work in a pathology lab. Postmortem pathologists account for about 1% of the pathology workforce.

My colleagues in the lab issue blood products to the scene of a car accident, and carry out screening tests to make sure a newborn baby doesn’t have a condition that would otherwise not get diagnosed until it is too late. They receive tissue from colons or breasts removed during surgery to see if a surgeon has fully got rid of a tumour; they assist in postmortems so that they might answer some of the questions a family may have – and help to ease their pain.

Pathologists and biomedical scientists also see what antibiotic would work best for you to help tackle antimicrobial resistance; they investigate hereditary disease so that any future generations might avoid the same illness. This is just a small insight into what we provide as a service.

Just because we’re not patient-facing, don’t be under any illusion that we care about them any less. On a number of occasions I’ve left work in tears, trying to get it all out of my system before going home to my family. Sometimes I feel it’s unfair that we know a patient’s diagnosis before they do, because we either see the results from the analyser or produce reports and these get discussed by healthcare professionals in order to approach the patient with treatment or management options.

I know that there’s no way of fixing this. However, it still doesn’t feel just or right. Many of us in the NHS spend much of our day feeling guilty: guilty that we can’t do more, guilty that we’re healthy and the patients we care for aren’t – and guilty because in order to care for patients we miss out on our own family time.

However, we still spend more of our time helping to deliver good news rather than bad. I remember a case from when I was on rotation in a blood bank many years ago. Doctors and porters were constantly coming up to the department for blood products, because as soon as any blood went into the patient being treated, it was just as quickly coming back out because their injuries were so severe.

The patient made what can only be described as a miraculous recovery. The blood bank and Welsh Blood Service played a huge part – yet that patient, and their family, will probably be unaware of this.

Another great part of my job is when we get a request for an urgent result or report and we work hard together to deliver the results – or when we find out which specific cancer someone has, so that patient can start their treatment immediately. It’s great being part of something that can make such a big difference to people’s lives.

I’m not demoralised and fed up – quite the opposite, in fact. I just want to highlight the variety of work we do and how it impacts on patient care. We are pathologists, biomedical scientists, associate practitioners, medical lab assistants and admin and clerical staff. We play a vital role in not just assisting in diagnosis, but also advising on the treatment and management of patients.

Pathology work goes on day and night, every day of the year. I feel so fortunate to have found a career I have fallen in love with – even if bits of it are gory.

If you would like to contribute to our Blood, sweat and tears series about experiences in healthcare, read our guidelines and get in touch by emailing sarah.johnson@theguardian.com

Follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views

If you’re looking for a healthcare job or need to recruit staff, visit Guardian Jobs

Pathologists like me save lives daily. Yet so few people know what we do

Anyone who watched BBC2’s fly-on-the-wall documentary Hospital might have heard of “the lab”. I am one of many who work there – and as a pathologist I often feel, as many of my lab colleagues do, like a forgotten or unknown entity.

There are nearly 20 disciplines of pathology – and that number is growing – and 70% of all diagnoses made in the NHS involve pathology and biomedical science. The Royal College of Pathologists’ annual report [pdf] tells us that more than a billion tests are carried out annually – and NHS England says the number of pathology tests [pdf] equates to 14 for each person in England and Wales.

Sound impressive? Then why are we seen as back office staff by other professionals, with nobody fully understanding what we do? People often assume I deal with dead bodies when I tell them I work in a pathology lab. Postmortem pathologists account for about 1% of the pathology workforce.

My colleagues in the lab issue blood products to the scene of a car accident, and carry out screening tests to make sure a newborn baby doesn’t have a condition that would otherwise not get diagnosed until it is too late. They receive tissue from colons or breasts removed during surgery to see if a surgeon has fully got rid of a tumour; they assist in postmortems so that they might answer some of the questions a family may have – and help to ease their pain.

Pathologists and biomedical scientists also see what antibiotic would work best for you to help tackle antimicrobial resistance; they investigate hereditary disease so that any future generations might avoid the same illness. This is just a small insight into what we provide as a service.

Just because we’re not patient-facing, don’t be under any illusion that we care about them any less. On a number of occasions I’ve left work in tears, trying to get it all out of my system before going home to my family. Sometimes I feel it’s unfair that we know a patient’s diagnosis before they do, because we either see the results from the analyser or produce reports and these get discussed by healthcare professionals in order to approach the patient with treatment or management options.

I know that there’s no way of fixing this. However, it still doesn’t feel just or right. Many of us in the NHS spend much of our day feeling guilty: guilty that we can’t do more, guilty that we’re healthy and the patients we care for aren’t – and guilty because in order to care for patients we miss out on our own family time.

However, we still spend more of our time helping to deliver good news rather than bad. I remember a case from when I was on rotation in a blood bank many years ago. Doctors and porters were constantly coming up to the department for blood products, because as soon as any blood went into the patient being treated, it was just as quickly coming back out because their injuries were so severe.

The patient made what can only be described as a miraculous recovery. The blood bank and Welsh Blood Service played a huge part – yet that patient, and their family, will probably be unaware of this.

Another great part of my job is when we get a request for an urgent result or report and we work hard together to deliver the results – or when we find out which specific cancer someone has, so that patient can start their treatment immediately. It’s great being part of something that can make such a big difference to people’s lives.

I’m not demoralised and fed up – quite the opposite, in fact. I just want to highlight the variety of work we do and how it impacts on patient care. We are pathologists, biomedical scientists, associate practitioners, medical lab assistants and admin and clerical staff. We play a vital role in not just assisting in diagnosis, but also advising on the treatment and management of patients.

Pathology work goes on day and night, every day of the year. I feel so fortunate to have found a career I have fallen in love with – even if bits of it are gory.

If you would like to contribute to our Blood, sweat and tears series about experiences in healthcare, read our guidelines and get in touch by emailing sarah.johnson@theguardian.com

Follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views

If you’re looking for a healthcare job or need to recruit staff, visit Guardian Jobs

Pathologists like me save lives daily. Yet so few people know what we do

Anyone who watched BBC2’s fly-on-the-wall documentary Hospital might have heard of “the lab”. I am one of many who work there – and as a pathologist I often feel, as many of my lab colleagues do, like a forgotten or unknown entity.

There are nearly 20 disciplines of pathology – and that number is growing – and 70% of all diagnoses made in the NHS involve pathology and biomedical science. The Royal College of Pathologists’ annual report [pdf] tells us that more than a billion tests are carried out annually – and NHS England says the number of pathology tests [pdf] equates to 14 for each person in England and Wales.

Sound impressive? Then why are we seen as back office staff by other professionals, with nobody fully understanding what we do? People often assume I deal with dead bodies when I tell them I work in a pathology lab. Postmortem pathologists account for about 1% of the pathology workforce.

My colleagues in the lab issue blood products to the scene of a car accident, and carry out screening tests to make sure a newborn baby doesn’t have a condition that would otherwise not get diagnosed until it is too late. They receive tissue from colons or breasts removed during surgery to see if a surgeon has fully got rid of a tumour; they assist in postmortems so that they might answer some of the questions a family may have – and help to ease their pain.

Pathologists and biomedical scientists also see what antibiotic would work best for you to help tackle antimicrobial resistance; they investigate hereditary disease so that any future generations might avoid the same illness. This is just a small insight into what we provide as a service.

Just because we’re not patient-facing, don’t be under any illusion that we care about them any less. On a number of occasions I’ve left work in tears, trying to get it all out of my system before going home to my family. Sometimes I feel it’s unfair that we know a patient’s diagnosis before they do, because we either see the results from the analyser or produce reports and these get discussed by healthcare professionals in order to approach the patient with treatment or management options.

I know that there’s no way of fixing this. However, it still doesn’t feel just or right. Many of us in the NHS spend much of our day feeling guilty: guilty that we can’t do more, guilty that we’re healthy and the patients we care for aren’t – and guilty because in order to care for patients we miss out on our own family time.

However, we still spend more of our time helping to deliver good news rather than bad. I remember a case from when I was on rotation in a blood bank many years ago. Doctors and porters were constantly coming up to the department for blood products, because as soon as any blood went into the patient being treated, it was just as quickly coming back out because their injuries were so severe.

The patient made what can only be described as a miraculous recovery. The blood bank and Welsh Blood Service played a huge part – yet that patient, and their family, will probably be unaware of this.

Another great part of my job is when we get a request for an urgent result or report and we work hard together to deliver the results – or when we find out which specific cancer someone has, so that patient can start their treatment immediately. It’s great being part of something that can make such a big difference to people’s lives.

I’m not demoralised and fed up – quite the opposite, in fact. I just want to highlight the variety of work we do and how it impacts on patient care. We are pathologists, biomedical scientists, associate practitioners, medical lab assistants and admin and clerical staff. We play a vital role in not just assisting in diagnosis, but also advising on the treatment and management of patients.

Pathology work goes on day and night, every day of the year. I feel so fortunate to have found a career I have fallen in love with – even if bits of it are gory.

If you would like to contribute to our Blood, sweat and tears series about experiences in healthcare, read our guidelines and get in touch by emailing sarah.johnson@theguardian.com

Follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views

If you’re looking for a healthcare job or need to recruit staff, visit Guardian Jobs

​​Want more people to get help? Make mental healthcare more affordable | Adele Perovic

The recent deaths by suicide of Kate Spade and Anthony Bourdain have caused an outpouring of shock and grief on social media, and naturally raise questions as to how we can better support people with a mental illness at risk of self-harm. While sharing advice like “reach out to your friends and family” and “seek medical help” is undoubtedly positive, actually “getting help” in the Australian healthcare system can be both difficult to achieve, and very expensive.

If you have a Medicare card, visit a GP and present with signs of a mental health condition and/or disorder, your GP can set you up with a mental healthcare plan which consists of 10 subsidised psychology sessions per year. For some people, 10 sessions a year is enough to talk through personal issues and work on developing effective coping strategies. For others with more complex or severe conditions or histories of trauma, 10 sessions barely scratch the surface. As a survivor of family violence (which we know is at epidemic proportions in this country), I have done years of work with various psychologists, and a great proportion has been paid for out of my pocket. The gap for psychology sessions tends to be anywhere from $ 40 to $ 100, depending on the charges of the psychologist or practice.

Psychiatrists, unlike psychologists, are able to prescribe psychiatric medications. An initial consultation with a psychiatrist is around $ 360, with a Medicare rebate of $ 220, which leaves a gap of around $ 140. It generally takes a psychiatrist three 45-60 minute sessions to diagnose a patient and set up a treatment plan. This means the patient will be a minimum of $ 400 out of pocket before they are able to even start medication or treatment. The gap for psychiatry varies, but is around $ 67 for a half hour appointment and $ 114 for an hour.

Once you have spent $ 460 on the gap as an individual or as a family, you reach the Medicare safety net and receive back 100% of the scheduled Medicare fee for that particular service. However, this fee doesn’t necessarily match what the medical specialist charges, and Medicare fees notoriously haven’t kept up with inflation, which has left patients increasingly out of pocket. It also has to be noted, that a patient needs to pay for the session before they get the Medicare rebate. What this means is that if you don’t have $ 360, for example, to pay the psychiatrist upfront, you can’t go to the appointment.


Steps towards making our society more equal would help to improve the mental health of those most vulnerable

If you can’t afford to access assistance in the private sector, you will have to go through the public system, which is overloaded and can barely handle those who are at crisis level, let alone provide preventative care. The tragic story of Naomi Watson-Ley exemplifies this – she took her own life only days after being discharged from the psychiatric ward of a hospital.

Seeking treatment takes time. If you need to take time off to go to the psychologist or psychiatrist (or both), that’s time that you won’t be able to work and make money. It’s not hard to see why people just try and “push through” only to end up more exhausted and sick than ever. How many employers are happy for someone to take several hours off every week or fortnight to go to medical appointments? How many employees are comfortable sharing this kind of information with employers?

Seeking treatment can also be risky, because to open up and be vulnerable in front of a stranger (even if they are a medical professional) takes an enormous amount of courage and isn’t always a safe option. Many marginalised people (such as people of colour, Aboriginal and Torres Strait Islander people, LGBTIQA+ people and sex workers) won’t know if a specialist is bigoted or holds prejudicial ideas about the group they belong to, until they have opened up to them in the session. Bad experiences beget a distrust of the system in general, and discourage individuals from seeking further assistance in the future.

It comes as no surprise that those who are the most marginalised in our society, who are the least able to afford or access expensive psychiatric treatment, are also disproportionately affected by social issues that are likely to exacerbate stress and worsen mental health. Housing instability, unemployment (or underemployment) and financial pressure all cause stress that contributes towards making people feel worse about themselves and their future. Steps towards making our society more equal would help to improve the mental health of those most vulnerable.

Telling individuals with mental health conditions and/or disorders to “get help” is easy. Changing the system to better serve the diverse Australian population is much harder.

None of the answers to these questions are easily solved, but what begs understanding is that “seeking help” is only possible when the services are available and accessible for everyone. We need to care more about mentally ill people when they are alive, and not only after they have taken their lives.

Adele Perovic is an actor and journalist based in Brisbane

In Australia, the crisis support service Lifeline is 13 11 14. In the UK, Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. Other international suicide helplines can be found at befrienders.org

Comments on this article have been pre-moderated to ensure the discussion is on the topics that have been written about in the article.

​​Want more people to get help? Make mental healthcare more affordable | Adele Perovic

The recent deaths by suicide of Kate Spade and Anthony Bourdain have caused an outpouring of shock and grief on social media, and naturally raise questions as to how we can better support people with a mental illness at risk of self-harm. While sharing advice like “reach out to your friends and family” and “seek medical help” is undoubtedly positive, actually “getting help” in the Australian healthcare system can be both difficult to achieve, and very expensive.

If you have a Medicare card, visit a GP and present with signs of a mental health condition and/or disorder, your GP can set you up with a mental healthcare plan which consists of 10 subsidised psychology sessions per year. For some people, 10 sessions a year is enough to talk through personal issues and work on developing effective coping strategies. For others with more complex or severe conditions or histories of trauma, 10 sessions barely scratch the surface. As a survivor of family violence (which we know is at epidemic proportions in this country), I have done years of work with various psychologists, and a great proportion has been paid for out of my pocket. The gap for psychology sessions tends to be anywhere from $ 40 to $ 100, depending on the charges of the psychologist or practice.

Psychiatrists, unlike psychologists, are able to prescribe psychiatric medications. An initial consultation with a psychiatrist is around $ 360, with a Medicare rebate of $ 220, which leaves a gap of around $ 140. It generally takes a psychiatrist three 45-60 minute sessions to diagnose a patient and set up a treatment plan. This means the patient will be a minimum of $ 400 out of pocket before they are able to even start medication or treatment. The gap for psychiatry varies, but is around $ 67 for a half hour appointment and $ 114 for an hour.

Once you have spent $ 460 on the gap as an individual or as a family, you reach the Medicare safety net and receive back 100% of the scheduled Medicare fee for that particular service. However, this fee doesn’t necessarily match what the medical specialist charges, and Medicare fees notoriously haven’t kept up with inflation, which has left patients increasingly out of pocket. It also has to be noted, that a patient needs to pay for the session before they get the Medicare rebate. What this means is that if you don’t have $ 360, for example, to pay the psychiatrist upfront, you can’t go to the appointment.


Steps towards making our society more equal would help to improve the mental health of those most vulnerable

If you can’t afford to access assistance in the private sector, you will have to go through the public system, which is overloaded and can barely handle those who are at crisis level, let alone provide preventative care. The tragic story of Naomi Watson-Ley exemplifies this – she took her own life only days after being discharged from the psychiatric ward of a hospital.

Seeking treatment takes time. If you need to take time off to go to the psychologist or psychiatrist (or both), that’s time that you won’t be able to work and make money. It’s not hard to see why people just try and “push through” only to end up more exhausted and sick than ever. How many employers are happy for someone to take several hours off every week or fortnight to go to medical appointments? How many employees are comfortable sharing this kind of information with employers?

Seeking treatment can also be risky, because to open up and be vulnerable in front of a stranger (even if they are a medical professional) takes an enormous amount of courage and isn’t always a safe option. Many marginalised people (such as people of colour, Aboriginal and Torres Strait Islander people, LGBTIQA+ people and sex workers) won’t know if a specialist is bigoted or holds prejudicial ideas about the group they belong to, until they have opened up to them in the session. Bad experiences beget a distrust of the system in general, and discourage individuals from seeking further assistance in the future.

It comes as no surprise that those who are the most marginalised in our society, who are the least able to afford or access expensive psychiatric treatment, are also disproportionately affected by social issues that are likely to exacerbate stress and worsen mental health. Housing instability, unemployment (or underemployment) and financial pressure all cause stress that contributes towards making people feel worse about themselves and their future. Steps towards making our society more equal would help to improve the mental health of those most vulnerable.

Telling individuals with mental health conditions and/or disorders to “get help” is easy. Changing the system to better serve the diverse Australian population is much harder.

None of the answers to these questions are easily solved, but what begs understanding is that “seeking help” is only possible when the services are available and accessible for everyone. We need to care more about mentally ill people when they are alive, and not only after they have taken their lives.

Adele Perovic is an actor and journalist based in Brisbane

In Australia, the crisis support service Lifeline is 13 11 14. In the UK, Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. Other international suicide helplines can be found at befrienders.org

Comments on this article have been pre-moderated to ensure the discussion is on the topics that have been written about in the article.

​​Want more people to get help? Make mental healthcare more affordable | Adele Perovic

The recent deaths by suicide of Kate Spade and Anthony Bourdain have caused an outpouring of shock and grief on social media, and naturally raise questions as to how we can better support people with a mental illness at risk of self-harm. While sharing advice like “reach out to your friends and family” and “seek medical help” is undoubtedly positive, actually “getting help” in the Australian healthcare system can be both difficult to achieve, and very expensive.

If you have a Medicare card, visit a GP and present with signs of a mental health condition and/or disorder, your GP can set you up with a mental healthcare plan which consists of 10 subsidised psychology sessions per year. For some people, 10 sessions a year is enough to talk through personal issues and work on developing effective coping strategies. For others with more complex or severe conditions or histories of trauma, 10 sessions barely scratch the surface. As a survivor of family violence (which we know is at epidemic proportions in this country), I have done years of work with various psychologists, and a great proportion has been paid for out of my pocket. The gap for psychology sessions tends to be anywhere from $ 40 to $ 100, depending on the charges of the psychologist or practice.

Psychiatrists, unlike psychologists, are able to prescribe psychiatric medications. An initial consultation with a psychiatrist is around $ 360, with a Medicare rebate of $ 220, which leaves a gap of around $ 140. It generally takes a psychiatrist three 45-60 minute sessions to diagnose a patient and set up a treatment plan. This means the patient will be a minimum of $ 400 out of pocket before they are able to even start medication or treatment. The gap for psychiatry varies, but is around $ 67 for a half hour appointment and $ 114 for an hour.

Once you have spent $ 460 on the gap as an individual or as a family, you reach the Medicare safety net and receive back 100% of the scheduled Medicare fee for that particular service. However, this fee doesn’t necessarily match what the medical specialist charges, and Medicare fees notoriously haven’t kept up with inflation, which has left patients increasingly out of pocket. It also has to be noted, that a patient needs to pay for the session before they get the Medicare rebate. What this means is that if you don’t have $ 360, for example, to pay the psychiatrist upfront, you can’t go to the appointment.


Steps towards making our society more equal would help to improve the mental health of those most vulnerable

If you can’t afford to access assistance in the private sector, you will have to go through the public system, which is overloaded and can barely handle those who are at crisis level, let alone provide preventative care. The tragic story of Naomi Watson-Ley exemplifies this – she took her own life only days after being discharged from the psychiatric ward of a hospital.

Seeking treatment takes time. If you need to take time off to go to the psychologist or psychiatrist (or both), that’s time that you won’t be able to work and make money. It’s not hard to see why people just try and “push through” only to end up more exhausted and sick than ever. How many employers are happy for someone to take several hours off every week or fortnight to go to medical appointments? How many employees are comfortable sharing this kind of information with employers?

Seeking treatment can also be risky, because to open up and be vulnerable in front of a stranger (even if they are a medical professional) takes an enormous amount of courage and isn’t always a safe option. Many marginalised people (such as people of colour, Aboriginal and Torres Strait Islander people, LGBTIQA+ people and sex workers) won’t know if a specialist is bigoted or holds prejudicial ideas about the group they belong to, until they have opened up to them in the session. Bad experiences beget a distrust of the system in general, and discourage individuals from seeking further assistance in the future.

It comes as no surprise that those who are the most marginalised in our society, who are the least able to afford or access expensive psychiatric treatment, are also disproportionately affected by social issues that are likely to exacerbate stress and worsen mental health. Housing instability, unemployment (or underemployment) and financial pressure all cause stress that contributes towards making people feel worse about themselves and their future. Steps towards making our society more equal would help to improve the mental health of those most vulnerable.

Telling individuals with mental health conditions and/or disorders to “get help” is easy. Changing the system to better serve the diverse Australian population is much harder.

None of the answers to these questions are easily solved, but what begs understanding is that “seeking help” is only possible when the services are available and accessible for everyone. We need to care more about mentally ill people when they are alive, and not only after they have taken their lives.

Adele Perovic is an actor and journalist based in Brisbane

In Australia, the crisis support service Lifeline is 13 11 14. In the UK, Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. Other international suicide helplines can be found at befrienders.org

Comments on this article have been pre-moderated to ensure the discussion is on the topics that have been written about in the article.

CPR rarely works – why do people have so much faith in it?

Death is the only certainty in life and most people will die in a hospital. For such an inevitability, few people consider how it will happen. Dying is a subject that carries great emotional weight, which might be why people are so reluctant to talk about it.

A hospital death is usually preceded by an illness or a decline in health. Most doctors will recognise this and try to start an often unpleasant conversation about dying and death. I’ve initiated many of these and have seen plenty end in tears.

Do not attempt resuscitation (DNAR) forms are usually mentioned at some point. A DNAR form is completed to recognise that resuscitation will likely not be successful. CPR does not work most of the time. Most efforts I have witnessed have not restarted the heart. Only 10% of patients who undergo CPR will survive until discharge. The figure drops in those above 70. It is not the miraculous laying on of hands as depicted on TV.

Still, a one in 10 survival rate is better than nothing, right? In talking to patients, I sometimes hear a variant of this. Most people imagine a cleaner, clinical vision of this facet of healthcare – and are angry that we aren’t considering it. CPR is a brutal intervention rarely fully shown on programmes like Hospital or Junior Doctors. In reality, a team of professionals pounds on the patient’s chest (often breaking their ribs) as someone charges a defibrillator to try to shock them back to life. If it works there is a great risk of brain damage and other complications. The scene is noisy and chaotic. Given that most would prefer to die in the peace of their own home, that many finish their lives in this manner seems tragic.

With this in mind, it is hard to understand why doctors meet resistance when we suggest a DNAR. When I talk about not offering CPR, people have shouted at me or stormed out of the room. In one instance, a relative tracked down my surgical team to berate the consultant while we were seeing another patient. She was furious with us over the DNAR form. Maybe for her it cemented the idea that her mother was dying; a doctor suggesting that resuscitation in the future was a strong possibility perhaps implied that the end might be near.

A decision not to resuscitate is the last port of call. A common misconception over DNARs is that they are a sign of giving up on someone – and that once the form is completed, no further treatment will be provided. Yet all it signifies is that if the heart stops beating, we won’t restart it.

Junior Doctors


‘A reluctance to linger on the subject of death and the unrealistic glamorisation of TV are responsible for a great deal of misinformation.’ Photograph: Emilie Sandy/BBC

Good practice encourages the early and sensitive introduction of this concept, if CPR is an expected part of the dying process. It is important that we have this conversation early on if we think a decline is coming so that the patient is aware of the limits of care that we can provide. After all, a DNAR is a medical decision. We are stating from our body of clinical experience that a resuscitation effort is most likely to be futile or have overwhelmingly negative consequences.

To some, this decision might appear confusing if not properly explained. I have witnessed how unpleasant and ineffectual CPR can be; most of my patients and their next of kin have not. However, as nobody likes a prolonged chat about death, these vital yet awkward conversations might be glossed over.

Once while on call, I was asked by a nurse to speak to two brothers. She told me that they were cross and didn’t understand why their comatose father wouldn’t receive CPR. Though hearing this made my heart sink, I approached the bedside and sat with them. After hearing their worries, I asked about their dad, and what he thought about a good death. I highlighted what resuscitation meant, and said I was concerned that this wouldn’t be a nice way for their father to die. They weren’t angry; rather nobody had taken the time to explain the situation properly.

It is rare that families aren’t accepting of a DNAR once the circumstances surrounding it have been properly explained. A reluctance to linger on the subject of death and the unrealistic glamorisation of a handsome TV doctor in spotless scrubs, lightly tapping on a moribund patient’s chest and effortlessly resurrecting them, are responsible for a great deal of misinformation.

There needs to be a greater national awareness and acceptance of death. We should be asking ourselves and our families how we want to die. Let’s all think about this and have the conversation while we are able.

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