Acute mental health assessment and treatment services are an invaluable part of our mental health system in SA. Ward 18 at the Repat Hospital (soon to be moved to Flinders Medical Centre) services the eastern/southern area of Adelaide, Ward SE based at the Queen Elizabeth Hospital covers western suburbs with Ward 1H at Lyell McEwin Hospital covering the north. When patients display violent or extreme/difficult behaviours this ward is the next option after hospital. The public hospitals do their best to control the behaviours but cannot sustain it long term, as the busy hospital environment is not really conducive to people with late stage dementia.
Essentially the public hospitals become temporary ‘holding bays’ and may administer medications to control the behaviours, whilst ensuring the person is medically sound. An ambulance transfer is required to the acute wards and then an interview with staff is had on arrival. This next hour is very important as it is your chance to chat with the senior doctor and nursing staff to discuss the best ways to handle the upcoming care for the patient. Behaviours, triggers and ways to de-escalate situations are all discussed in great detail. You are also given a document called an ‘Inpatient Treatment Order’ (under the Mental Heath Act 2009) refer links below for more information:
The difference with this ward is that there are less beds (approx 8-12), the patients are locked out of their rooms (for safety reasons) and any items that can be considered dangerous are ether confiscated or asked to be removed. This may include electrical items, dressing gown cords, shoe laces and sharp instruments. Bathrooms are locked and patients reside in a main common area with staff based behind a central glassed office area . There is very little stimuli in the ward and is extremely quiet, a welcome change from the very noisy public hospitals (which is better for people with dementia).The wards are very different to hospitals and may appear ‘prison like’ at first due to heavy lockable doors, heavy furniture and a barren environment. The heavy chairs have wheels on them to allow you to move them, televisions are installed behind strong perspex plastic and most doors and cupboards are locked. There are very few items for the patients to be in contact with. They include a handful of magazines, newspapers and their plastic cups, saucers and plates.Quiet activities are locked away in a cupboard to be brought out as required. These measures are to ensure the safety of both the patient and the staff.
There is a nurse allocated to every 1-2 patients and their role is to observe and document the movements and behaviours. The nurses are at risk of being hit at times and it can happen without warning. Patients may sit in silence or cry & shout uncontrollably,push furniture around or may display manic behaviour including pacing and speech issues, which is all part of a day in an acute ward . The patient is rarely out of the gaze of a staff member and they are observed across every 15 minutes (this includes overnight). These wards are a vital part of our health system and need to be in place to ensure people with dementia and others with mental health issues are cared for properly.