Update from the Chief Psychiatrist – 20/04/2020

As Chief Psychiatrist, I am acutely aware of the incredible work being done across mental health services during this vexing interval.

The unprecedented nature of the COVID-19 pandemic has meant that this has been a constantly evolving situation. To some extent it has highlighted the relative pre-existing fragmentation of our mental health system in WA but it has also clearly shone a light on some excellent collegiality to get needed assessment and treatment for individuals when care pathways are having to be re-drawn on the run.

I know the services have all been working urgently on revamped pathways and contingencies over many weeks. I thank our colleague Dr Sophie Davison, Deputy Chief Psychiatrist, who has been the WA COVID-19 Mental Health Stream Clinical Lead. She has been working tirelessly to seek legal clarity, bring stakeholders together, develop cohesive planning across agencies, and facilitate the dissemination of what is necessarily incomplete information at this stage. She has been involved in the discussions around this update.

The Office of the Chief Psychiatrist during COVID-19

The Office of the Chief Psychiatrist continues to function robustly during this period. Our values and principles have not changed at all – and will not change – during this challenging period, notwithstanding we are all being prevented from practicing to the full extent of our best practice by circumstances outside our control.  Therefore, we seek alternate means to maintain standards during this time. The Chief Psychiatrist has diverted activity to the issues at hand and has been actively involved in mental health system COVID-19 planning and troubleshooting.

Helpdesk

The Chief Psychiatrist’s Clinical Helpdesk remains open Monday-Friday 8:30am to 4:30pm on 08 6553 0000 to assist clinicians who may need advice during this period.

 Authorisations and Approvals

The Chief Psychiatrist continues to track and oversight changes to service function during this period, including, eg Electroconvulsive Therapy.

Authorised Mental Health Practitioners

AMHPs are encouraged to continue their yearly Continuing Professional Development (5 hours) and Clinical Supervision (6 hours), but in line with the COVID-19 directions for maintaining safe practice. However, AMHPs will not be unduly penalised if they have not been able to complete all of these requirements for the reporting period 01 July 2019 – 30 June 2020.

Monitoring

While the Chief Psychiatrist is unable to conduct full face-to-face Clinical Reviews currently, clinical monitoring continues, and feedback to services will continue during this period.   The OCP is continuing to consider alternative monitoring strategies and is well-prepared to quickly escalate review processes again as the opportunity arises.   

The OCP continues to track clinical incidents and the follow up to these. Seclusion and Restraint monitoring remains critically important at this time, and the Chief Psychiatrist encourages all staff to actively report, and to continue to work towards eliminating restrictive practice in mental health settings.

We have been a part of an extensive collaborative picture to assist the Private Psychiatric Hostels, as they house many vulnerable individuals and are non-clinical settings in the face of COVID-19. I strongly encourage every Health Service Provider to take extra proactive steps to ensure hostels within your catchment are well-linked with your clinical services and have local contingency planning agreed and documented.

Strategy and Research

The Challenging Behaviours Review is nearing completion and will be released soon after the COVID-19 situation begins to ameliorate, likewise with the Review into homicides allegedly committed by people in contact with mental health services during 2018. Following a recent Coroner’s recommendation on confidentiality and carers, a brief paper has been distributed to HSPs for comment to inform a meeting of clinical leads which had to be cancelled earlier this month because of the COVID-19 crisis. It will be re-scheduled after the end of May. Work actively continues on building partnerships across States and Territories to strengthen Quality Improvement initiatives in mental health.

Other Special Projects

Work is actively progressing with the Chief Psychiatrist’s Sexual Safety Guidelines and notwithstanding delays due to COVID-19, these will be released in due course.

Interface between the MHA 2014 and other Public Health and Emergency Legislation

It is not my role to speak on behalf of Public Health or the COVID-19 MH Stream, but there are some key principles and information I think it’s critical to clarify for psychiatrists and College Associates. I note again that this is a rapidly evolving situation and any information provided here may be potentially superceded at any time. This update is not a substitute for legal advice.

A few key points:

  • The Mental Health Act (MHA) 2014 remains very much active- there is still a clear requirement to comply with the MHA 2014.
  • The Public Health Act 2016 and the Emergency Management Act 2005 have been brought into play (ie to enforce quarantine).
  • Currently each region is developing patient pathways as to where to manage any mental health inpatients who may have COVID or be suspected of having COVID. There is a need to keep patient transfers to other health services to a minimum to control spread. If you are seeking information regarding COVID-19 pathways, please discuss with your Health Service.
  • Reduce risk when you are assessing or treating an individual or group who may be at risk for COVID-19.
    • For general clinical work, use of a range of strategies such as telephone, audiovisual (AV), online are already being appropriately used.
    • Barriers (eg assessment through a door or behind another appropriate barrier) or at a distance may be necessary at times.
    • Personal Protective Equipment (PPE) is not always easily available in general mental health settings but there may be some occasions when (with appropriate advice from Public Health or your service) you may undertake care using PPE.
  • Please note that the Deputy Chief Health Officer, Dr Robyn Lawrence, has released a Public Health Act (PHA) 2016 Direction on 07/04/2020 (superseded version released 14/04/2020) relating to the use of MHA 2014 audiovisual assessments and examinations or individuals who meet certain criteria relating to COVID-19.  Please read this Direction and Communique.
  • The MHA 2014 should not be used simply to keep individuals quarantined or isolated – if someone meets the established MHA 2014 criteria for an involuntary inpatient treatment order, then  MHA 2014 is relevant; if someone is being held  on hospital to be quarantined because of COVID- 19, this is a matter for PHA 2016.
    • Seclusion and restraint as defined by the MHA 2014  relate to the MHA 2014 purposes, not the PHA 2016
    • Do not use the MHA 2014 forms for forced quarantine or isolation (relating to COVID-19 only)
    • Mentally unwell individuals kept in forced quarantine or isolation (relating to COVID-19 only) is not done through the MHA 2014- this is a PHA 2016 matter
    • Mentally unwell individuals kept in forced quarantine or isolation (relating to COVID-19 only) require good mental and physical health care – please take steps to ensure this.
  • There is pressure to use Electroconvulsive Therapy (ECT) resources for COVID-19- I am aware many of our colleagues, including Dr Davison and myself, have been working hard to advocate and ensure the availability of ECT during the pandemic period.
  • Visitors to all hospitals have been restricted across WA.
    • The Mental Health Advocacy Service don’t count as visitors-  they have a clear statutory role.  Much MHAS work is being done via telephone, but if there is any uncertainty as to whether an Advocate should enter a ward do not enter into a dispute, but escalate the matter to service Executive to resolve.

Remember the 13COVID hotline (13 26 843). As well as hearing important COVID-19 prevention tips, callers are given a range of options directing them to the relevant sources of information for their needs. The hotline will operate seven days a week, from 7am to 10pm.

Again, my thanks to all staff – clinical and non-clinical – and the service leaders who have shown great flexibility, courage and resourcefulness during this challenging time.

This is a changeable situation – please be aware that the comments in this update may be superceded at any time.

Dr Nathan Gibson
Chief Psychiatrist

Updated Communique: COVID-19 Alert: Mental Health Infection Control Directions

WA’s Deputy Chief Medical Officer, Dr Robyn Lawrence, issued a formal Direction under the Public Health Act 2016 specifically dealing with mental health infection control which came into effect on 7 April 2020.

There is now a revised Communique regarding the Mental Health Infection Control Direction as confirmed by the Department of Health COVID-19 Mental Health Stream. The revision has only been made to the Communique only and not the Direction (the Direction remains unchanged).  The Communique has been update to be more explicit in instruction to practitioners. 

COVID-19 ALERT: Mental Health Infection Control Directions
Effective date – 14/04/2020

Please note this Communique supersedes the original sent out on 7 April.

Medical Practitioners and Authorised Mental Health Practitioners (AMHPS)

It is essential that all doctors and AMHPs read the attached Public Health Act 2016 Direction and associated Communique which talks about precautions to take when assessing or treating patients who have risk factors for COVID-19, or have confirmed COVID-19, as well as advice around isolation and when it is necessary.

The Direction enables Audio Visual Assessment to be added to the assessment criteria considered under the Mental Health Act 2014 in specified situations.

Should you have any queries, please discuss with your service Clinical Lead in the first instance.  The Chief Psychiatrist’s Clinical Helpdesk, as always, remains available to assist where required.