Response to Myles et al.: Changing the policy narrative on psychiatric inpatient care

To the Editor

We applaud Myles et al. (2021) article addressing patient’s safety on psychiatric inpatient units. They suggest, ‘instead of an admission to a common space, people should be admitted to single-person facilities with acceptable floor space, amenity, comfort and privacy’. These individualised spaces would prevent non-consensual contact between patients and are aimed at stopping the contagion of interpersonal violence and to reduce suicide rates towards zero.

These goals would be welcomed by patients, carers and staff. However, Australia needs major changes in the policy narrative to achieve them. We have ‘Adult inpatient mental health facilities that are the most difficult to staff, significantly under-resourced, and as a result manifestly unpleasant for patients, families and health workers for reasons of acuity, distress and risk of violence’ (Looi and Maguire, 2019). These risks should be more widely known, as Myles et al. assert, as well as ‘the [clinician’s] experience … in public mental health services … of ceaseless futility, which can only contribute to a sense of burnout …’ (Looi and Maguire, 2019).

While it is a broadly accepted policy goal that the Australian public mental health system should provide balanced care with maximal community support, as well as ready access to inpatient care, the parlous state of psychiatric inpatient units is directly attributable to a policy bias against spending money to provide the modern, safe and therapeutic environments that Myles et al. envisage. To illustrate, we offer two complementary policy recommendations:

1. Australia should spend more, in order to provide consumers with the best possible community treatment and social support for mental illness and psychological distress.

2. Australia should spend more on building state-of-the-art psychiatric inpatient units for consumers when they are most unwell.

Following the Productivity Commission report on Mental Health and the Royal Commission into Victoria’s Mental Health System, there is action on the first recommendation. The second is the source of a policy debate that loses track of the essential goal – ensuring the best possible inpatient experiences for patients, especially when a high proportion of psychiatric admissions are involuntary. Australian policymakers should urgently consider funding purpose-built psychiatric hospitals, with architecture conducive to person-centred care (Golembiewski, 2015), given the significant structural constraints within most acute hospital sites.