A new, private in-patient service for addictions expands WA’s capacity to deal with a mental health blow-out.
Eric Martin reports
With up to 57 West Australians hospitalised every day due to alcohol-linked conditions, last year’s opening of a private 30-bed specialised addictions inpatient service in Nedlands met a need from day one.
Patients to the Ramsay Clinic Hollywood can be admitted for a period of detoxification while engaging in therapy focusing on addictions recovery and harm minimisation.
Psychiatrist and Medical Director of Addictions, Dr Kavita Seth, who also works at Fiona Stanley Hospital, said the main drive to open this ward at Hollywood was because of the scarce number of services providing inpatient detox.
“I work with Dr Cathryn D’Cruz, who is a GP with extensive experience in addictions medicine, and we work as a team catering for both the physical and mental health needs of patients,” Dr Seth said.
“Cathryn oversees the addiction and physical side of things in both the detox space and for those with long-term addiction management needs.
“And then I explore, with the patients, why they self-medicate – and most of the time it is untreated mental health issues or past trauma – before talking to them about the suitability of medications or a combination of medication and psychology.”
Dr D’Cruz said that from a GP’s perspective, it was important that people address their addiction issues, but a GP could only do so much.
“Occasionally, patients need to come into an inpatient setting to be detoxed because for some people it is just not appropriate to detox at home,” she said.
“What I particularly like about this service is that not only do people get a safe detox, supervised by medical personnel and experienced addiction nurses, they get the benefit of a psychiatrist who is also an addiction specialist. And that is rare.
“Addiction is so tied up with mental health and that issue must be addressed as well.”
Having the detox unit located in a hospital had the added benefit that an emergency team is on hand.
“You have the backup of an ED, a functioning pharmacy, fully-trained mental health nurses and allied health as well as access to inpatient referrals for the co-morbidities that people with addiction issues often have,” Dr D’Cruz said.
Pain specialists, liver specialists or a cardiologist are a call away, Dr Seth said.
“The key thing is that the staff feel well supported and the patient feels like they are getting much more holistic treatment. They are not just coming in and getting an addiction dealt with, while the underlying issue remains unresolved.”
Dr Seth also pointed out the value of the follow-up outpatient service, with all Nickoll Ward patients discharged into one of the substance recovery programs on offer.
“Patients are encouraged to participate in support groups such as Alcoholics Anonymous, and AA is invited to come into the ward and introduce themselves, because sometimes patients are quite hesitant about attending these sort of support groups once they have left our care.
“These patients often carry stigmas about the possible exposure of their treatment and being introduced to these services in the hospital actually alleviates many of their fears and gives them access to more support on the outside.
“We even have carers’ nights where carers are welcome to ask any questions they might have, and seek advice on how to look after their loved ones after they leave hospital – to help them identify what to look out for, early warning signs and what they should avoid”
Dr Seth said that while there used to be more typical indicators associated with addiction in the past, such as a lack of social support or long-term unemployment, when COVID emerged, the prevalence of substance-use disorders went up exponentially.
The negative impact of these behaviours on people’s lives had been profound. For example, in 2020, 78% of West Australians reported being concerned about the impact of alcohol on mental health, and in 2021, WA Police attended more than 25 alcohol-related family assaults each day.
“The biggest referral we get is for alcohol dependence and one possibility as to the reason why is its ready availability,” Dr Seth said.
“We have a lot of professional people coming through – in fact, we have nearly all the professions represented in our demographic – and they feel safe and comfortable here as we maintain strict confidentiality.
“For many professionals, there can be a lot of concern about the potential to lose their registration, in addition to the sense of shame. We support them and then they go back to work functioning, it’s really rewarding.”
Dr D’Cruz said the early detection of problems was important.
“If people come in early, who are encouraged by their partner or their workplace to attend, they are still employed and have not burned any bridges yet. These are the people we love to see so that we can get them functioning back in society, in their personal lives and their occupations,” she said.
“But in the end, the most striking thing is that they want help and know that it is the right time for treatment – they have had that light bulb moment.”
Dr Seth said the usual drivers of action were partners – saying things such as, ‘if you don’t get into a hospital and address your addiction issues now, this will be the end of our marriage’, or employers saying, ‘you have to improve your performance, take the time you need just to get yourself sorted out and come back’.
However, workplaces have stepped up to improve employees’ mental health.
“Employers and managers are becoming more accommodating and accepting of mental health aspects with often underlying addiction issues and are providing that support,” she said.
“As it becomes more prevalent, it is also becoming more common in the workplace to find either someone with lived experience or someone living with a person with mental health issues, which is having a big impact destigmatising mental health and addiction issues.
“It’s not like back in the old days, when taking the time to get yourself sorted out could get you fired. Now, people are supported by being able to sit and talk with someone who has a mental health background and then a plan is made for a transition back to work.”
Dr D’Cruz said there was good capacity within the new service, so if a GP identified someone who needed help, it was available.
“It can really help GPs get effective treatment for some of those patients who can be hard to manage at times. If they do refer, the patient will be reviewed by a psychiatrist and other specialists if needed and we will always write back to the GP – the communication is there.”