When cost-cutting hits the most vulnerable
Being the small-l liberal kind of place that it is, South Australia not only has a “thinker in residence” to help generate innovative ideas for public policy, but a kindly Catholic priest called Monsignor David Cappo who heads the Social Inclusion board to vet major government policies for their community impact.
Both of them must have been on a rostered day off when the State Government and the Health Department came up with one of the more foolish public policy ideas of recent times, which will have the effect of denying vital health care to sick young women, and forcing older women into an environment which experts believe will not help but harm their wellbeing.
SA has clocked up plenty of progressive firsts. It was the first Australian state to give women the vote, first state to recognise indigenous land rights, first state to introduce an anti-discrimination act – but now it’s about to clock up a first of a different kind as the first state to effectively shut down a cutting-edge health facility which for the past 30 years has been saving the lives of young women battling eating disorders.
It’s a facility which has a national and international reputation for treating people with anorexia and bulimia, whose medicos have been hailed as leaders in their field, and whose former patients credit their very existence with the treatment they received.
In its wisdom, the State Government has decided to close the Eating Disorders Unit at Ward 4G at Flinders Medical Centre. It quibbles with the word “close” and is upset that frontline health professionals (that is, the people who do the heavy work as opposed to those in the bureaucracy) are hailing it as a closure.
It’s as good as a closure. They are getting rid of all of the Eating Disorder Unit beds at Ward 4G. Patients over the age of 18 will now be cared for at the general mental health unit at the Margaret Tobin Centre, at the back of Flinders. Patients under the age of 18 will not be cared for at all, and no explanation has been given as to where they will find the kind of acute care they need to battle eating disorders.
As The Advertiser reported last month, 20 of the 114 patients Flinders treated in its two or six-week programs last financial year were under the age of 18.
In a perverse kind of way, some of these teenage girls might be counting themselves lucky that they didn’t wind up being cared for at Margaret Tobin, based on the assessment of health professionals I’ve spoken to about the issue this week.
These patients – almost all of them female, often in their early 20s – will now have to share a ward with general psychiatric patients who are battling myriad conditions.
Not only does this mean that women suffering acute eating disorders will no longer have access to a facility which is dedicated 100 per cent to tackling their condition. It means they will have to share a facility with older patients, many of them men, who suffer from conditions which seriously affect their behaviour towards other human beings.
This most certainly isn’t an attempt to stereotype sufferers of mental illness. But the sad reality is that there are plenty of male patients being cared for at the Margaret Tobin Centre whose conditions have left them completely unsocialised. A lot of them have probably had very limited contact with women at all.
One health professional put it this way: “If you are getting these young, thin, skinny girls who are desperately sick and then mixing them in an environment with men who are often psychotic and completely disinhibited, not only will it make it harder to treat these girls and speed their recovery, but you are placing them in an environment where there is a very real risk of sexual assault and violence.”
I mentioned Mosignor Cappo up top because Mike Rann has made much of his influence in crafting more humane and compassionate public policy. This has included the critical issue of mental health care. The Government argues that it has increased its mental health spend.
Mental health professionals see it differently. They regard whatever increases which have occurred as illusory, in that the area was so neglected for so long that any extra money has not let the sector catch up with demand.
They also question the wisdom of measures such as the Glenside sale, with the old hospital soon to be the site of a major shopping centre, with a clear gap between the amount of money the government got from the land sale and the cash it has put back into health care.
More disturbing though is the view that whizz-bang terms such as “social integration” are being used to justify kicking deeply unwell people out of fully-accommodate 24 hour medical care, and putting them on the streets where they pose a threat to themselves and potentially others.
For all his late-onset conversion to the cause of mental illness, as Premier of Victoria Jeff Kennett was hated by the medical community for championing bottom line-driven policies such as casemix which turned health care into a numbers game and drove many sick people onto the street.
There’s a strong view in SA’s medical community that what’s happening at Flinders has more to do with accounting than medicine.
It would be a tremendous pity to say the least if a purpose-built centre with a proud 30 year history of saving young womens’ lives was sacrificed through a desire to save money by filling empty beds at another centre which is totally ill-equipped to provide the care which Ward 4G has become famous for.
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