I seek leave to make a brief explanation before asking the Minister for Mental Health a question about the mental health MOU.
The Hon. J.M.A. LENSINK: There is an MOU between health, the Ambulance Service, the Royal Flying Doctor Service and SAPOL which specifically relates to the transport of people with mental illness, particularly during acute episodes. On page 4 of that document it refers to transport standards and says that the least restrictive intervention will be used and that SAPOL will be used as an option of last resort, based on safety risk assessment. It also states that health workers should consider the following alternatives (that is, to transport by the police): first, private vehicle driven by family friend/carer if the individual is cooperative and prefers to have a family member accompany them; or, secondly, a taxi with a family member if the individual is voluntary and they prefer a family member to accompany them. It then runs through other options.
On 10 September I received an email from a constituent who says that on 17 August he was taken by ambulance to the Flinders Medical Centre from his home at Trott Park at the request of the police. He states:
It all started on the same day where I left a note to a friend, stating that I was going to commit suicide. She found the letter before I thought she would and she subsequently called the police.
They in turn arrived at my home before five and detained me until the ambulance arrived. However, neither the police nor the ambulance stated that I would foot the bill for the ride: if they did I would have refused. . . Since then I have spent a week in hospital. I am seeing various youth workers and my employer has been very accepting. . . The police were stationed at Sturt, just down the road, and I was willing to help and was giving no trouble. The other way would have been by taxi or public transport.
He then says that he has received a bill from the Ambulance Service. On that date he also emailed the Premier and the Minister for Health and, after I replied to him, he replied to my email of 15 September and said that I was the only one so far who had replied. Payment is due by the end of the month. This morning I was contacted by another constituent who, in slightly difficult circumstances and less able to cooperate, was transported to hospital by the South Australian Ambulance Service and has since received a bill for $683.
My questions to the minister are:
1. Has the Ambulance Service breached the memorandum of understanding by not seeking alternative options in this case as outlined?
2. Was it the intention of the memorandum of understanding to engage in cost recovery via ambulance services?
3. How much does the government expect to raise from the transport of mental health patients by ambulance services in 2006-07?
4. To which agency will that funding be provided?
5. Will the government consider revising the protocol to ensure that people who need to be transported in this way are advised that a bill will be welcoming them on their return home from hospital?
The Hon. G.E. GAGO(Minister for Mental Health and Substance Abuse): I thank the honourable member for her questions. It is important to state that this government’s approach to mental health is about affirming the rights, dignity and civil liberties of mental health consumers and their carers. We are also mindful that we need to balance these rights with the community’s legitimate expectation that they be protected from harm. I have spoken in this council before and stated that we plan to introduce legislation that will reform arrangements for the transportation of the mentally ill who are involved in an incident or disturbance.
As the honourable member noted, we have reviewed the MOU with the police and emergency services in regard to the transportation of people with mental illness, including those involved in disturbances in the community. I have to say that a lot of work went into that MOU, and those changes have resulted in far more efficient and effective use of our emergency services.
After considerable consultation, a memorandum of understanding between mental health services, SA Police, the SA Ambulance Service and the Royal Flying Doctor Service was developed and signed. Further discussion regarding the progress and content of the MOU was recommended in February this year between the Mental Health Unit and senior staff at SAPOL, and that has resulted in an agreed process regarding safety risk and safety risk assessment not only for any individual involved in an incident but also the workers involved, as well as the broader community. There is also an agreement regarding the use of standard documentation and communication processes to facilitate the transfer of care between agencies. This has resulted in far more efficient and effective use of resources and enabled those services to be far more responsive.
That MOU, which was signed on 19 June 2006, was implemented on 1 September 2006, and it is being supported by ongoing training and evaluation. If and when problems identify themselves, we will look at and evaluate the effect of this MOU, and we are certainly happy to work at improving these measures in an ongoing way. I also inform the chamber that local liaison groups have been established to assist the partners in working together to resolve issues in an efficient way. The intention behind the MOU has been communicated to key staff across mental health services, particularly team leaders and staff in emergency departments and at general hospitals. I am informed that similar communication has occurred through police and ambulance hierarchies.
In relation to specific details regarding issues of charging, I do not have that information in front of me. I am happy to take those questions on notice and bring back a reply.
The Hon. J.M.A. LENSINK: I have a supplementary question. Does the minister support mental health patients being charged for transport by ambulance to hospital?
The Hon. G.E. GAGO: The Ambulance Service of South Australia has never been a free service. To the best of my knowledge, there has always been a cost recovery component for that service, and that has been in place for a considerable period of time.
The Hon. J.M.A. LENSINK: I have a further supplementary question. Is the minister aware of whether the Ambulance Service is obliged to advise mental health patients being transported that they will be charged for the service?
The Hon. G.E. GAGO: I do not have the details around the charging of these services in front of me. As I have already indicated, I am happy to take those elements of the question on notice and bring back a reply.
Tuesday 6 February 2007
In reply to Hon. J.M.A. LENSINK (28 September 2006).
The Hon. G.E. GAGO: I have been advised that:
There is no policy or procedure in place that obliges the South Australian Ambulance Service to advise that patients will be charged for the service.
However, where a patient is not a voluntary user of the service, he or she may be eligible to recover charges from the relevant health service. To determine if they are eligible to claim a refund on fees paid, they should contact the Division of Mental Health or the hospital to which they were taken.