Royal Hobart Hospital Mental Health Observation Unit

• Immediately halt the opening of the Mental Health Observation Unit (MHOU) at the Royal Hobart Hospital (RHH) and conduct meaningful consultation with clinical staff

as required under the awards and agreements; 

• Explain the decision making behind opening a unit that is regarded as unfit for

purpose by our Unions and organisations;

• Utilise the scarce space, on site at the RHH by opening beds that will improve patient

flow from the Emergency Department into hospital beds for unwell Tasmanians;

• Commit to opening 10 additional acute mental health beds to ensure the sickest

mentally ill patients have access to appropriate inpatient care in Southern Tasmania.

Should the MHOU proceed health Unions, organisations and their members hold grave

concerns about the ability of mental health patients to receive the quality care they

deserve.

Background

On 2 October 2017, Unions and staff Associations received a change proposal in regard to

the transit lounge at the RHH being redeveloped into a Mental Health Observation Unit

(MHOU) to accommodate mental health patients in five beds and three chairs, who were

deemed low clinical risk and had an expected length of stay of 48 hours or less. Within the

same change proposal, the planned opening date had already been set for 30 October 2017.

On 9 October 2017, Unions and staff associations attended several face to face meetings

with THS management and the Mental Health Services (MHS) management where members

overwhelmingly raised significant concerns with the proposal. Key concerns were that the

MHOU was not the most appropriate use of the space to aid in patient flow or provide

quality care to mental health clients; the lack of appropriate model of care; concern with

safely staffing the unit; concerns with work health and safety and the risk that the MHOU

would either not have a good occupancy rate due to the lack of patients meeting the

admissions guidelines, or would be used inappropriately at times of bed block placing

members and patients are risk.

Substantial submissions in reply to the change proposal were made by all Unions on behalf

of their members and correspondence upon receipt of these submissions indicated that the

MHS were considering the feedback and ‘would incorporate any changes to the unit’ on the

basis of feedback received.

However, on 23 November 2017, Unions were informed that following the consultation

period there would be no opportunity to consider whether the MHOU was the most

appropriate and meaningful use of the space at the RHH and the unit opening date was

planned for Monday 4 December 2017. Some of the concerns raised by unions were

discussed and THS and MHS management advised mitigating strategies had been put in

place, however there were still ongoing concern, particularly in regard to staffing and

quality patient care provision.

While all Unions note the absolute need to increase mental health services across the State,

both in the community and within the acute sector, the consultation process around this

change proposal is of particular concern.

At the first of the 'consultation' meetings, there were about 60 mental health staff who

expressed frustration and opposition to this idea. They had also not been involved in any of

the work that went into the proposal. Feedback is that the MHOU is a poorly thought out,

poorly consulted idea that, according to the available evidence, either won't be used

(because of the admission criteria) or will put patients at risk. By contrast, the alternative

proposal has been well researched, consulted widely, and has the support of senior staff

from ED and Medicine.

Union members and staff had asked for consideration for an alternate proposal which had

support among all members at the RHH and this was:

1) Move the Emergency Medical Unit (EMU) to the current Transit Lounge (the

proposed site for the MHOU). This would increase the EMU capacity by 7 recliner

chairs. It should be noted that EMU patients include low risk, short stay mental

health patients.

2) The move of the EMU to this new site on the below ground floor would free up the

old EMU area to allow expansion of the Assessment Planning Unit (APU) by 10 beds.

This would provide more desperately needed single and monitored beds for the

older, more complex medical patients.

Unions and staff associations along with their members has hoped that through the

consultation process that this alternate proposal could have been explored along with

discussions about other strategies to assist with improving service, care and treatment

provision to mental health patients. It is most disappointing that this did not occur and does

not comply with change consultation requirements within a number of union awards, which

implies that THS and MHS management did not intend on carrying out meaningful

consultation in the first instance.

All health Unions, specialist medical staff Association and their members furiously agree

that that mental health services need additional capacity to replace the ten beds lost during

the B Block demolition, however do not support the proposed mental health observation

unit at the RHH as the appropriate solution.

Therefore, the group call upon the Tasmanian Government, Tasmanian Health System and

Mental Health Services to:

1) Halt the opening of the proposed MHOU and consider members alternate proposal

2) Immediately identify appropriate additional space to accommodate the ten beds

that were lost during the B block demolition that can accommodate acutely unwell

mental health patients in an environment that promotes dignity and with

therapeutic spaces.