ACEM statement – Royal Commission into Victoria’s Mental Health System

The Australasian College for Emergency Medicine (ACEM; the College) has welcomed the release of the final report of the Royal Commission into Victoria’s Mental Health System.

The College has long advocated for resourcing and systemic improvements to the care provided to people needing mental healthcare. ACEM has supported the urgent rollout of the interim measures from the Royal Commission, including additional acute mental health beds and state-wide delivery of the Hospital Outreach Post-suicidal after Engagement (HOPE) program.

ACEM commends the Royal Commission for giving a voice to people with a lived experience, their carers and families, and the wide array of people working in the mental health system. The College welcomes the acknowledgement that Victoria’s emergency departments (EDs) are being called on to provide a volume, range and complexity of mental health services without the resources, infrastructure or systemic support necessary to provide timely and appropriate care.

ACEM Victoria Faculty Chair Dr Mya Cubitt said: “There is much that is very welcome in this final report and in the Government’s commitment to implement all of its recommendations. The mental health system is broken and requires urgent reform.”

“However, the state’s mental health crisis is happening now, and the College again stresses the urgency of implementing solutions. Every day we have people experiencing serious mental health crises coming to our EDs because they have nowhere else to go for help, and then having to undergo long and stressful waits. The need is urgent.”

ACEM has previously called for whole of system solutions which include improving localised access to community care options, particularly out of hours, as well as better support and resourcing of EDs, in acknowledgement of the integral role they play in providing mental healthcare.

Emergency clinicians have sought additional mental health beds for years. While the expansion of commitments contained in the interim report, particularly the delivery of at least 100 additional beds in a range of settings is welcome, the College again stresses these are needed now, not years down the track. ACEM also supports the idea of multidisciplinary care for bed-based services, and the intention to offer these in more settings.

The College welcomes plans to establish integrated and localised initiatives including, adult and older adult mental health and wellbeing services with extended hours, as well as additional infant, child and youth area services. Fast-tracking the delivery of six mental health priority sites across the state as part of this commitment is good.

“It is also good to see plans for the creation of safe spaces and crisis respite,” said Dr Cubitt.

“The report contains some alternative options to the ED, as well as a welcome range of outreach initiatives and recommendations for additional mental health clinical support for frontline emergency responders. All contribute to a positive blueprint for a system overhaul.

“Given the scope and volume of recommendations and initiatives, it will be very important to ensure these services are properly resourced and supported, and integrate as part of a whole system, particularly where state and federal initiatives intersect and interact. Where new governance models and structures are proposed these must contribute to better outcomes for people needing mental health support, rather than duplication or additional administrative burden.”

The College notes the report’s recommendation that there be at least one highest-level ED suitable for mental health and alcohol and other drug treatment in every region. Care needs to be taken to ensure this does not result in over-centralisation, or other unintended consequences, and

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