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Care Opinion

Re-traumatisation and enabling domestic violence

Posted By Pleasedobetter67

"Re-traumatisation and enabling domestic violence"

About: NMHS Mental Health Sir Charles Gairdner Hospital / Emergency Department

(as the patient),

I was in a long-term (15 year) domestic violence relationship.

When the abuse came to a point that it was intolerable and my ex thought they were losing control over me, they manipulated me into attending ED by saying they had chest pain.

When I didn’t know how to ask for help, I had a meltdown (ie made a scene)

Instead of asking me what was wrong, offering a quiet place to talk, or bringing some water, staff called a code black.

When my ex denied chest pain to staff at ED, staff documented I had delusional concerns about my partner's ill-health.

When I declined to engage in conversation with them because I was distracted by my ex’s chest pain and how dry my throat was, they continued to try and ask questions I had no interest in answering. They didn’t bring the water that I requested numerous times.

When I declined to take the tablets they prescribed because of a previously documented adverse effect to one of them, they gave IV sedation without my consent.

When I didn't have private insurance for the admission they organised for monitoring, they documented that I 'declined the admission'. They didn't offer a public admission or hospital in the home, as alternatives to what happened next.

I wasn't seen by a consultant psychiatrist, but my privacy was breached without my consent and without asking about my intentions re return to work. This had a significant negative impact on several important professional relationships. It made me feel uncomfortable in all interactions with my colleagues, because I was unable to ascertain what information was disclosed and the extent to which the breach had been disseminated. It likely contributed to why I lost my job and was unable to work for the next 4 months, although my inability to satisfy my employer’s reasonable expectation of a return-to-work date may have also played a role. The hospital had said I required 2 weeks off with a fitness for work assessment prior to my return. The private psychiatrist who had been treating my adhd refused to discuss the fitness for work paperwork I was meant to have completed. While their notes say I was calm, rational and would need 1-2 weeks off work, their only advice about the paperwork was to take on the sick role and see me in 2 weeks. They didn’t have any appointments for the next 2 months. They also declined to treat my adhd, presumably because their interactions with the hospital led them to distrust the initial impression they documented in their notes.

I think that the hospital's failure to consider domestic violence and their unfamiliarity with adhd and autism (ie do they know what an autistic meltdown looks like, or how sensory overwhelm contributes to escalation or de-escalation?) caused significant harm and made the abuse worse. It further eroded my confidence, leaving me more dependent on the abuser. It gave them new tactics to use in their attempts to control me and probably prolonged the time it took for me to finally leave the relationship, many months later.

I submitted a detailed complaint letter to the hospital, asking for the following: transparency and mitigation of harms related to the breach to my privacy, and amendment to my physical and PSOLIS medical record to include the additional relevant information contained in my complaint. The hospital declined both requests, questioned my credibility, and I felt they did not adequately justify the decision to breach my privacy without consultant review.

Domestic violence (sadly) and neurodiversity are extremely common conditions. Emergency Departments need to provide a safe and caring environment for domestic violence victims. State health departments need to invest in training for providers of acute care in recognising the symptoms of ADHD / Autism, especially given how the symptoms significantly overlap with those of other conditions, while the treatments do not. In the absence of significant change, I fear that another vulnerable person might not receive the care they need in a time of crisis.

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Responses

Response from Jodi Graham, Executive Director, Sir Charles Gairdner Osborne Park Health Care Group 4 months ago
Jodi Graham
Executive Director,
Sir Charles Gairdner Osborne Park Health Care Group

Submitted on 2/01/2024 at 2:22 PM
Published on Care Opinion at 2:22 PM

picture of Jodi Graham

Dear Pleasedobetter67,

Thank you for taking the time to share your experience in the Sir Charles Gairdner Hospital Emergency Department. I am sorry to read that you feel the hospital has failed to address your health concerns and is unfamiliar with neurodiversity management of conditions such as ADHS and Autism.

The management of neurodiversity is an area of which we are focusing new resourcing and services on site. We are always keen to improve services and staff knowledge and have recently commenced a new service called the Behaviour Emergency Response Team (known as BERT). The BERT team has several aims, including improving the experience for patients by enhancing access to different kinds of health practitioners, and better linking patients in with the National Disability Insurance Scheme (NDIS). Hopefully through this and other services we will be able to improve the experience for all people coming to our services in the future.

We would like to follow up with you to address any outstanding concerns. I would encourage you to contact the Consumer Liaison Service (phone: 6457 2867 or email CLS@health.wa.gov.au) to provide your personal details, which will allow the hospital to address any outstanding concerns from your previous complaint.

Once again, thank you for taking the time to share your experience of our services. It is important to us that we consistently try and improve the care we provide, and your feedback assists us with that process.

Warm regards,

Jodi Graham

Executive Director, SCGOPHCG.

  • {{helpful}} {{helpful == 1 ? "person thinks" : "people think"}} this response is helpful

Update posted by Pleasedobetter67 (the patient)

Please note that it seems autistic individuals will interact with a wide variety of staff in various roles and specialties within WA health. They might turn up to ED in crisis or meltdown during a straightforward elective admission if their autistic needs are not accommodated. And some will not yet be diagnosed or able to communicate their needs.

I feel it would be more helpful if you could widely disseminate the following resources (or similar) among clinicians providing care in your jurisdiction, because it seems that clinicians lack familiarity in autism currently, and it is an important, prevalent condition.

https://drive.google.com/file/d/1AtfbW7thIyzVqAtONnYKyXtzUPrCoOaC/view

https://www.barrierstoeducation.co.uk/meltdowns

https://www.autism.org.uk/advice-and-guidance/topics/behaviour/meltdowns/all-audiences

YouTube - excellent free talk about autism.

https://m.youtube.com/watch?v=ZQVwobHnaEc

Update posted by Pleasedobetter67 (the patient)

I’ve tried to get in touch but was told to email a different address, and didn’t hear back.

I would like to organise a meeting to discuss further. You have my details.

Update posted by Pleasedobetter67 (the patient)

This is my third time posting a response to this story because I was not aware of the hospital management structure as a layperson. I've recently learned that complaints involving some specialty consultations (within the ED) are reviewed by an entirely separate hierarchical team, and because of this I believe the response I received did not address all my concerns. The concerns not addressed are below:

1. Autistic individuals are prone to having meltdowns when overwhelmed. This is a normal autistic reaction and not a symptom of mental illness. In my case it happened outside the emergency department as part of a domestic dispute and did not cause harm or distress to other patients. I believe it necessary for staff to become informed about Autism, to improve both the quality and the cost-effectiveness of healthcare. Simple strategies and changes to existing policies might have prevented this entire ordeal.

2. When I declined to take one of the tablets they prescribed because of a previously documented adverse effect to it, I expected my decision to be respected, and for my concerns to be addressed. However, no one offered alternative oral treatment options, or discussed mitigation strategies that would be used if the adverse effect occurred. Instead, they administered IV sedation without my consent. I find this use of force and lack of consideration for alternative options to be troubling and inappropriate.

3. I disclosed the deliberate gaslighting which had led to my arrival to ED in the first place and expected that this would be met with validation and understanding. Instead, it was dismissed by a specialist team member. I believe that it was an overlooked cue for doctors to consider domestic violence.

4. My privacy was breached without my consent. This had a significant negative impact of several important relationships. It made me feel uncomfortable in all interactions with my colleagues, because I was unable to ascertain what information was disclosed and the extent to which the breach had been disseminated. I feel it contributed to why I lost my job and was without work for the next 4 months.

5. The specialist team tried to organise an admission for monitoring, however I did not have appropriate private health insurance. They documented that I 'declined the admission' without any explanation as to why (no insurance). They didn't explore the possibility of expanding my existing private coverage and they didn’t offer a public admission or hospital-in-the-home as alternatives.

6. I suspect that the psychiatrist who had been treating my adhd was informed I ‘declined the admission’ without mentioning my lack of insurance, and I feel that this detail mattered. The hospital had said I required 2 weeks off work with a fitness for work assessment. The private psychiatrist refused to discuss the fitness for work paperwork I was meant to have completed. I felt that they weren’t sure what to do with me. While their notes say I was calm, rational and would need 1-2 weeks off work, their only advice about the paperwork was to ‘take on the sick role and see me in 2 weeks’. They subsequently declined to treat my adhd and accused me of being ‘difficult’. The hospital has not taken any responsibility for the way in which their interactions impacted me, both immediately and for many months after discharge.

I feel the response to my story only sought to address concerns that were deemed as relating directly to the emergency department team, not the speciality consultant. This added significantly to the many challenges I have encountered in my attempts to advocate for better care. I have sent unanswered messages, been referred elsewhere and been told ‘I can’t help you’ several dozen times. The events, domestic violence, and surrounding circumstances were incredibly traumatic and are thus difficult to discuss. I have also had lifelong difficulties in self-expression because I am Autistic. I mention these challenges because each of them on their own are very good reasons for experiences like mine to be under-reported.

Update posted by Pleasedobetter67 (the patient)

Outcome:

1. Minister of Health WA Chief of Staff

Acknowledged a meeting that took place with hospital executive, and letter included acknowledgement the feedback from this meeting has been positive, and they were pleased to hear that there is a plan being developed to address my concerns at the local level. They thanked me for bringing this matter to the Minister's attention.

2. NMHS response

They apologised for the delay in sending a letter to me and advised they wanted to fully understand the concerns that I raised and ensure that substantive measures are being considered before responding to me. In addressing my concerns, they advised they have taken a systemic approach and focused on the two main areas of concern, as outlined in our meeting.

Experience of care within the Emergency Department (ED)

NMHS advised the ED mental health staff were not aware of my diagnosis of autism spectrum disorder (ASD) and acknowledged that I did not feel that staff adequately listened to my concerns or provided an environment in which I felt comfortable to explain my health care concerns. My suggestions to remedy this have been discussed with the clinical staff involved. Strategies that NMHS are considering include:

-Screening for ASD when patients present to the ED;

-The introduction of basic de-escalation strategies for patients with ASD including:

• reducing sensory overload by limiting the number of people involved in the assessment;

• providing a consultation room that is less overwhelming;

providing reassurance and being mindful of voice tone, volume, and body language; and

• clear communication during escalation and crisis, followed by written information post the situation.

I raised concerns about how the decision was made to advise my place of employment that I was not fit to work and the impact that this has had. NMHS have discussed this with the clinical team and has implemented a process to ensure that decisions of this magnitude are made in consultation with the patient and by a Consultant Psychiatrist, following a face-to-face assessment.

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