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Australia 'She didn't want to die': Woman's pleas for help unanswered by hospitals

19:35  16 february  2020
19:35  16 february  2020 Source:   smh.com.au

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The day Tammy Peters took her own life she fought desperately to live.

On May 23 last year, the 45-year-old was in crisis. Deeply distressed and suicidal she tried to admit herself to Sutherland Hospital, but they couldn’t take her. She made nine phone calls to the hospital’s mental health acute care team that went unanswered.

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When her aunt called Prince of Wales Hospital, telling them her niece was acutely suicidal, she was told they couldn’t admit her. It had been only three days since Ms Peters was discharged from the unit, and three weeks since a suicide attempt left her in the hospital’s intensive care unit.

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[Verse] I wanted to die There ain' t no question of why haven' t I Figured a way to destroy my life I never wanted a pain so bad Living with memories that I once had Joining the voices of ones we once had Running around in a realm made of glass Into unknown territory of mass, and I look out of the.

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Hours later the much-loved daughter, mother and niece had ended her life in her home, alone.

In the months leading up to her death Ms Peters had been in regular contact with mental health services, but the day she gravely needed help – and repeatedly asked for it – she did not get it.

A spokesperson for the South East Sydney Local Health District expressed their deepest sympathy to Ms Peters' family and said the organisation was distressed about the incident.

Her death exposes the devastating consequences when acutely suicidal patients fall through the cracks of an overburdened and disjointed mental health system.

“It would be easier to come to terms with Tammy’s death if she had just given up,” said Ms Peters' aunt Kelly Brennan. “But knowing that she didn’t want to die … knowing she tried so hard to get help and didn’t get it is just devastating.

“Tammy knew she needed to get to a safe place … if one of those hospitals had taken her that day she would still be here.”

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My therapist didn ’ t agree. One missed appointment turned to severance of patient-provider relationship emails, and once again, I was alone with no Their philosophy is to listen and not to intervene. If you specifically ask for help e.g. while attempting suicide they will provide it but otherwise they are willing

"Happy" is the first word that comes to mind when Mrs Brennan thinks of Tammy before her depression.

“She was always the funniest person in any room,” she said. “She was probably the favourite among all of the aunties and uncles ... Her daughter Bree is like that now. Beautiful just like her mother.”

Bree, 14, remembers her mother’s “generous and caring heart”.

“When mum was in a good place she was the life of the party with her infectious belly laugh,” Bree said. “My mum’s final [pleas] for help on the day she ended her life were not answered by the hospitals and with that she felt like she had no other option.”

On May 23, Mrs Brennan woke up to a text message from Ms Peters saying she needed to get to Sutherland Hospital. She soon texted again saying Sutherland could not admit her.

That was despite Ms Peters being admitted to the hospital on May 3 after she had attempted suicide and was transferred to Prince of Wales.

Ms Peters' phone bill shows she placed nine calls to Sutherland’s acute care team between 9.15am and 10am that appear to have gone to a voicemail, despite its webpage stating it's a 24-hour service. She had been in regular contact with the team since her discharge.

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Mrs Brennan called Prince of Wales’ Psychiatric Emergency Care Centre, telling staff her niece was “suicidal and needed help”, but she was told Ms Peters would have to go to her local hospital – Sutherland.

“I told them Sutherland Hospital wouldn’t take her,” Ms Brennan said. “I didn’t understand why they wouldn’t help. Tammy had only been discharged ... three days earlier.”

Slater and Gordon lawyer Tim Cummings said there was a “fundamental misunderstanding of how acute the risk was”.

“How did so many telephone calls to the acute care team hotline go unanswered and unactioned?” he asked. "Why wasn’t there adequate communication between the mental health units at Prince of Wales and Sutherland Hospital?”

Mrs Brennan alerting Prince of Wales that Ms Peters was suicidal “ought to have triggered a sequence of events to ensure her safety”, Mr Cummings said. “It could have been as simple as an alert going on her electronic health record, a notification to Sutherland Hospital’s acute care team to check on her welfare or an invitation to present at Prince of Wales.”

Ms Peters was not the first mental health patient turned away from a hospital on the grounds that it was not their local area, Mr Cummings said. He was not aware of any patient with a physical medical emergency being treated in the same manner, suggesting mental health crises were not escalated with the same urgency as physical illness or injury.

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Ms Peters’s case was complicated by severe headaches that she had experienced since undergoing electroconvulsive therapy administered at a private clinic in January.

“I felt as though I was losing my mind, I felt like my brain was on fire,” Ms Peters wrote in an email she sent to her aunt. “I am now in such a state. I don't know where to turn … Please help me, I am so desperate.”

Electroconvulsive therapy is considered effective, backed by strong evidence for severe depressive disorders where other treatments have failed. Patients have credited it with saving their lives, though others have complained about neurological problems and some psychiatrists have expressed concerns that the treatment is being inappropriately administered to unsuitable patients by a minority of clinicians.

Ms Peters’ severe headaches caused some confusion among the disparate treating teams as to whether it should be treated as chronic pain or a manifestation of her psychiatric condition.

According to an internal investigation launched by South East Sydney Local Health District, Ms Peters told Sutherland Hospital she needed to be admitted for her headaches, stating “I just cannot handle it”. The report stated “denied thoughts of self-harm and suicidal ideation”.

Mrs Brennan said she did not believe her niece would not have disclosed she was suicidal.

“There is just no way she would not have told them … she wanted help,” she said.

Prince of Wales Hospital considered Ms Peters a psychiatric patient but did not communicate this to a private hospital that had initially agreed to admit her. But when she described her severe headaches they deemed her ineligible for a mental health admission on the grounds that her symptoms required medical treatment.

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“That was the final knockback,” Mrs Brennan said. “Tammy must have thought no one was going to help her.”

A spokesperson from the South East Sydney Local Health District said "senior clinicians have been in contact with the family to discuss their concerns and to offer support”.

The internal investigation identified “a number of system improvement opportunities that were not assessed as contributing to the tragic death" including a review of the Sutherland acute care team’s clinical information handover process.

The report also recommended that if a family member contacts the service, a clinician should review the patient’s medical records and relay clinical information to their treating team.

Dr Fiona Shand, a senior research fellow and head of the suicide prevention program at the Black Dog Institute, said the period immediately after a mental health discharge was a “very high-risk time” for suicide.

“There has been a lot of work done to make sure people are being followed up after discharge but if people aren’t able to access care when they reach that absolute crisis point there is a problem,” she said.

Identifying which patients are at greatest risk of suicide is notoriously unpredictable, and psychiatrists have long debated whether hospitals are the safest and most therapeutic settings for these patients.

In May, University of NSW Scientia Professor Gordon Parker warned of the “psychiatric breakdown of the public system” and mental health units constantly at capacity, where psychiatrists weighed the risks of discharging patients too early to open a bed for new patients in need of acute care.

NSW Health chief psychiatrist Dr Murray Wright said the challenge for the mental health system was to ensure services were communicating and co-ordinated so patients in crisis got the help they needed.

"It’s a really significant challenge because a person’s mental health needs can change dramatically with very little notice,” Dr Wright said.

“Everyone working in the system is distraught when something like this happens. There is a series of very significant issues being raised by the family of this poor woman.

"When things go tragically wrong we need to look at this very carefully, and what we can do locally and at a system level to learn whatever we can ... that is a responsibility we take very seriously.”

Dr Wright’s advice to anyone feeling suicidal or having a mental health crisis to go to an emergency department and seek help from the mental health services that best knows their circumstances.

“That doesn’t absolve the system from being able to cope and respond appropriately ... no matter which door they knock on," he said.

Support is available for those who may be distressed by phoning Lifeline 13 11 14; MensLine 1300 789 978; Kids Helpline 1800 551 800; beyondblue 1300 224 636. In an emergency call triple zero.

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