Response to acute care needs of patients

The Bowral Mental Health Service, as does any such similar service in any part of the country, responds to the urgency of the cases presented to it. Not unlike the Emergency Department of any hospital, the person presenting has to be triaged according to the guidelines established by NSW Health, and best clinical practice. This means that the most urgent cases must be given priority by the clinical staff. However, in all instances, this triage process recognises how stressful any level of mental illness can be to both the patient and those in their immediate family and social networks. Following triage by the intake worker, or by the admission staff at the local hospital, the mental health team are advised of the presentation of the patient. Generally, the hospital mental health consultation liaison staff are the first to respond. They can also be assisted by the remainder of the Adult Mental Health team. A preliminary assessment is conducted during which details of present circumstances and past history are recorded. The documentation used by the staff is a generic form used by all NSW mental health services. This means that if the patient's care is transferred to another mental health service the information can travel with the patient to the new public health facility or service.The outcome of the assessment is generally a streaming of the patient to the most appropriate service for their needs. The NSW Mental Health Act 2007 requires any mental health service to engage the patient in a treatment care plan the offers the least harmful outcome for them. Obviously people's needs differ so it may be that the patient is offered voluntary admission to a sub-acute health service for stabilisation, treatment, or even respite from their emerging illness. In other cases, particularly where the patient may lack insight into their mental state, the service may be required to detain the patient under the Mental Health Act and arrange transport for them to a mental health inpatient facility. Nowadays, for the local area, this usually means the facilities located at the Campbelltown Hospital. The Southern Highlands is fortunate to have five staff of the Bowral mental health service trained and authorised as "Accredited Persons" (APs). This means they have been trained to undertake preliminary but detailed assessments, in the absence of a medical practitioner, and schedule an acutely unwell mental health patient under Section 19 of the NSW Mental Health Act 2007. A safeguard for the patient is that the view of the Accredited Person must be upheld by a medical practitioner located at the inpatient mental health facility to which they are transferred. There are a number of other legal processes that must be followed in order to ensure that the rights of the patient (even though detained) are maintained. It is not the role of the Accredited Person (or indeed any non-medical staff) to make a formal diagnosis of the patient. That diagnosis will generally be made after a significant period of observation and the patient's response to treatment. The AP or any other clinical staff could make a provisional diagnosis based on their knowledge, training and skills which, in the end, could be quite accurate. Diagnosis in mental illness is based on sets of world-wide criteria established collaboratively by clinicians around the world. As such, diagnosis can be open to interpretation differently, by different clinicians. Psychiatry is not an exact science. Often, because the behaviour of patients change (sometimes rapidly) it becomes increasingly difficult to determine a clear diagnosis. Often this is due to the fact that treating psychiatrists are often only seeing brief images of the patient during the course of their hospital stay, or during the course of their therapeutic sessions. Clearly, it would be comforting for patients and their families to know what particular mental illness they suffer from and, thereby, what treatment is likely to bring about a good outcome. Ideally, it would be best, particularly in the early phases of diagnosis, to make allowance for the possibility of the diagnosis to change in later days - or even years. Diagnosis is often helped by referring the patient to one of the VMO psychiatrists or the psychiatric Registrar of the Bowral Mental Health Service. Should there be a need to maintain the involvement of the Bowral mental health service and/ the VMO psychiatrist this is advocated and implemented. It remains a free service provided to the local community.Alternatively, patients have the right to choose to access psychiatrists and psychologists in the private health sector. The Bowral Mental Health Service encourages this involvement of patients with their general practitioners and private psychiatrists and psychologists as a means of enhancing care of the mental health needs of the community.