"Refusal of admission as a child"

My family member is a teenager. They have an eating disorder and were diagnosed earlier in the year at Princess Margaret Hospital following episodes of extreme distress and self-harm necessitating an admission to Bentley Adolescent Clinic. They were in their early teens at the time. Since then they have had a further three admissions to the BAU last year, and two admissions to Princess Margaret Hospital this year for medical reasons. Following discharge, they have been monitored at the eating disorder outpatient clinic on a fortnightly basis.

Recently, I brought them to the emergency room of Armadale Hospital as they had been purging and had an extremely rapid pulse and felt faint. Bloods were taken and they had a potassium count of 2.2. The doctor said it was fortunate that I had brought them in, as they could have dropped dead. Chilling words to hear.

They were admitted via emergency to an adult medical ward at Armadale Hospital where the next youngest patient was in their 50’s. They were refed and became medically stable, but the nature of their disorder saw their mental health begin to deteriorate. They became increasingly agitated and distressed, and began threatening self-harm. I believed they needed to be in the new Perth Children’s Hospital, but they were not accepted there on the basis of their age. They attend the outpatient clinic there, and historically when the clinic was at PMH, adolescents between 16 and 17 have been admitted. PMH had stated that they would not accept any ED patients over 16 at their ED during the transition to the new hospital, hence our presenting at Armadale Hospital Emergency.

On three occasions during their inpatient stay at Armadale Hospital, their agitation was so great that they had to be restrained by three security guards, and injected with a sedative. On one of those occasions they got hold of a razor and cut their arms.

They had a medical emergency on one day when their blood sugar and blood pressure dropped very low.

Although Armadale Hospital were taking advice from the consultant at PCH, as well as one of the dieticians, they were ill equipped to treat my family member. As one of the ward doctors said they may see two eating disorder patients a year, so their expertise and experience is limited.

At no time was my family member seen by a psychiatrist specialising in adolescent/child mental health. At no time were they seen by an eating disorder specialist. Adult psychiatrists saw them on a number of occasions. My family member was formed under the mental health act on the day they cut their arms.

At one point, PCH accepted them as a patient, but before transfer was arranged they rescinded the offer of a bed. I am still uncertain who made that decision and why. I believe it came from the executive level.

My family member remained in a state of limbo in an unsuitable facility and in a deteriorating state of mental health, and fluctuating physically, until recently, when the newly opened East Metropolitan Youth Unit accepted them as a patient. They had initially refused as they did not accept eating disorder patients. The only other facility which would have accepted my family member was Fiona Stanley Hospital, however they had no beds available. They were finally transferred over to the East Metropolitan Youth Unit, and this was the first time they were seen by an adolescent specialist.

They remained an inpatient for two nights and were finally discharged for care in the community, as they had been managed prior to this crisis.

I am very angry that, in my opinion, the executive of PCH discharged themselves of responsibility for my family member. The level of distress they experienced, and the length of stay they had, would have been significantly lowered, had they been in the appropriate facility. I would appreciate a review, and an explanation from the executive as to their particular rationale for their decision in this particular instance. I am appalled at the lack of compassion and appropriate response from the hospital where my family member’s treatment team practice.