Claims that doctors are sectioning mental health patients in order to get them access to beds on psychiatric wards amount to “more than anecdotal evidence”, according to a committee of MPs who have just published a report into the Mental Health Act.

The committee’s report makes for worrying reading for all those involved in mental health services. Pressures on community-based mental health services mean that the number of patients detained under the act are increasing and it’s clear that not everyone should be. In her evidence to the committee, Julie Chalmers, a consultant psychiatrist, said that in some areas “being detained is the ticket to getting a bed”.

Patients can voluntarily be admitted to psychiatric units but pressure on beds is high. Being sectioned puts a legal obligation under the act to get access to a facility.

When are people detained?

The compulsory treatment of people with mental health problem raises fundamental ethical and moral questions. It is one of the few areas of medicine where it is possible to ignore the expressed rejection of treatment by a patient.

The Mental Health Act sets out when someone can be detained and only applied after a certain set of conditions have been met. A person can be held against their will for up to 28 days before further assessment, and in some circumstances up to six months before a decision is made to release of extend detention.

Patients (the act always uses this term even when people are not in hospital) must be assessed by two doctors and an approved mental health professional. The legal grounds for detention are that the person is “suffering from a mental disorder of a nature or degree” that makes such an admission justified and that the admission to hospital is in the interests of the patient’s “health or safety or with a view to the protection of others”.

The guidance issued to professionals carrying out these assessments is clear: compulsory powers should only be used when all other options – including a voluntary admission to hospital – have been explored. The detention of a person is clearly a very serious matter. As well the emotional distress for the patient and their family, it can also have wider impact across individual’s lives including risk to their employment and housing – for example paying the rent. It also puts pressure on places for those who may need it more.

Detention should only be used as a last resort for those most in need.

Operating at capacity

Figures from the Care Quality Commission, which regulates health and social care in England, show that the number of detentions increased by 5% to over 48,000 in 2011-12 from the year before. There is also tremendous pressure on psychiatric inpatient beds; according to the CQC, 15% of wards were operating at a capacity of over 100% – this means that when one patient is discharged another will be admitted the same day.

While some will be desperate, an inpatient ward is not necessarily the best place to be either.

In 2011, a report by the Royal College of Psychiatrists described psychiatric wards as overcrowded and understaffed. Professor Dinesh Bhugra, the college’s outgoing chair, accepted that these failures meant that in-patient care – often imposed against an individual’s will was not of an acceptable standard.

The report showed that wards were often not a safe, let alone therapeutic environment – highlighting poor physical conditions, limited contact with staff or access to psychological therapies and a lack of constructive activity. This has echoes of a survey carried out by mental health charity Mind in London in 2000. Its conclusions paint a picture of dirty wards, poor food, lack of stimulating activities and minimal contact with staff.

The following gives a flavour of its main findings:

30% of patients found the atmosphere on the wards unsafe and frightening.

62% of patients said illegal drugs were easily available on the wards.

16% of patients said they had experienced sexual harassment on the ward, and 72% of those who had complained about this said no action was taken.

That was, of course some years ago. But it is clear that mental health services are still struggling. As Peter Beresford wrote in an article for The Conversation, mental health services are in no fit state.

It is generally accepted that there will be some circumstances in which a person’s mental health has deteriorated to such an extent that the only option will be a form of compulsory inpatient treatment. Only radical libertarians such as psychiatrist Thomas Szasz would oppose such a view. However, the use of any compulsory powers must be limited and there must also be guarantees that this treatment will take place in a safe, therapeutic environment with appropriate community support following discharge from hospital.

The Health Committee’s report outlines a vicious circle that mental health service users and campaign groups have publicised in the past: the lack of well funded community mental health services increases the pressures on inpatient services. In this pincer movement, the rights and dignity of those who need mental health services are seriously compromised.

In the current economic climate, the concern is that community mental services will be seen as soft targets and their budgets reduced significantly. Dorrell said mental health services were more in danger of local healthcare cuts because commissioners thought they were easier to cut than “more politically sensitive acute services”.

The select committee also said that the lack of hospital beds was driving an increase in the number of Community Treatment Orders, supposed to reduce hospital admissions. The whole system is clearly not working and we need to rethink how we deal with those in acute mental health distress.

In particular, community based mental services need strengthening so that hospital admission – whether as a voluntary or formal patient – is only used when all other alternatives have been exhausted.

Source: theconversation.com

Hospital Leaders: Older and Kinder?
By Bill Santamour Managing Editor
A convocation speech adds momentum to an important movement.

The novelist George Saunders delivered a convocation address in May for Syracuse University’s College of Arts and Sciences that’s become highly celebrated and widely disseminated. Saunders told the graduates that despite being poor from time to time, despite the occasional humiliation, despite the various follies he’s committed during his lifetime, “What I regret most in my life are failures of kindness. Those moments when another human being was there, in front of me, suffering, and I responded … sensibly. Reservedly. Mildly.”

The chief experience officer of a hospital out West sent me a copy of the speech after reading my blog last Tuesday about Dignity Health’s campaign promoting kindness in health care and in the world at large. “People who work in hospitals, from the top leadership on down, should read Saunders’ words,” she wrote. “Kindness isn’t a passive, smile and do-no-harm thing. It’s a hands-on, active way of life. Too many people are perfectly pleasant, but they don’t go that extra step. They don’t take the extra time to sit down next to a patient, hold her hand and really listen to what’s on her mind.”

OK, I know what you’re thinking: “Extra time? In health care? Really? There are too many patients, too much paper work, too many fires to put out every minute of every day.”

I understand, believe me. But as we all know, patient experience scores are playing a bigger role in CMS’ reimbursement formulas; hospital leaders and their staff somehow have to make improving them a priority for the good of the bottom line, if nothing else.

One assertion in Saunders’ speech is especially intriguing. “Some of this ‘becoming kinder’ happens naturally — with age,” he told the graduates. “It might be a simple matter of attrition: As we get older, we come to see how useless it is to be selfish — how illogical, really.”

If that’s true, the outlook should be bright. Baby boomers are now firmly in control of leadership and management positions in hospitals — from the board to the C-suite to patient floors. It would be terrific to believe that as they’ve gotten older, they’re being kinder — actively so, as the reader urges — not only to patients and their families, but to their staff and to each other, as well. Kindness, after all, is the cornerstone of a healing environment.

You can read George Saunders’ convocation address by clicking here.

Source: hhnmag.com

Minister for Health, Michelle O’Byrne today welcomed the Australian National Audit Office’s (ANAO) finding that Tasmania has consistently met its obligations under funding agreements for the Mersey Community Hospital.

The ANAO’s Final Report which follows a performance audit into the Mersey Community Hospital found that the Department of Health and Human Services was meeting its obligations under the 2008 and 2011 Heads of Agreement.

Ms O’Byrne said in the majority of cases clinical services are either meeting or exceeding established national targets.

“In particular, the emergency department, elective surgery, inpatient management and the High Dependency Unit are performing strongly against national benchmarks.”

Ms O’Byrne said the ANAO made five recommendations in the final report, three of which related to the Department of Health and Human Services (DHHS).

“I welcome the scrutiny applied by the ANAO and accept the three recommendations directed at the DHHS to strengthen processes to guide hospital operations and improve transparency of expenditure reporting.

“Taken together, the three recommendations will allow greater scrutiny of financial, clinical and the safety and quality of services at the Mersey.

“What this report shows is that this is a system that works well and is delivering for the local community.

“I welcome independent input as we continue to look for ways to improve services for the Mersey community,” Ms O’Byrne said.

While the Mersey Community Hospital operates as part of the Tasmanian Health system, it has been owned by the Commonwealth since November 2007 and operated and managed by the Tasmanian Government since September 2008.

In 2012, The Australian National Audit Office (ANAO) commenced an audit to look into the hospital’s management, operation and funding.

This is the first audit conducted by the ANAO using the amendments to the Auditor-General Act 1997 which allows the Auditor-General to audit Australian Government funded, state-run partnerships, such as the Mersey.

Source: ahha.asn.au

[PALU] Usai Lebaran, pasien demam berdarah dengue (DBD) memenuhi Rumah Sakit Umum Daerah (RSUD) Anutapura Palu, Sulawesi Tengah (Sulteng). Sebagian besar para penderita adalah anak-anak berumur 5-5 tahun, dan selebihnya orang dewasa berumur 20-25 tahun.

Direktur RSUD Anutapura, Dr Reny A Lamadjido mengatakan, sebanyak 31 pasien DBD dirawat di RSU Atutapura, 11 pasien di antaranya positif dan 20 pasien didiagnosa masih gejala DBD.

“Memang banyak pasien yang terkena DBD, kemungkinan karena faktor cuaca di mana saat ini musim hujan. Tetapi kami terus memaksimalkan perawatan kepada seluruh pasien. Syukurlah, beberapa pasien sudah mulai membaik,” ujar Reni, Selasa (13/8).

Sementara itu, Yanti (29), orang tua salah satu pasien yang didiagnosa positif DBD, mengaku tidak menduga anaknya terkena penyakit DBD.

“Awalnya hanya demam biasa, tapi karena panasnya tak turun-turun maka kami bawa ke rumah sakit. Ternyata setelah diperiksa positif terkena DBD,” katanya ketika ditemui Selasa sore.

Ia hanya berharap pihak rumah sakit bisa memberikan perawatan yang baik dan maksimal untuk kesembuhan anaknya.

Sumber: suarapembaruan.com

MAKASSAR – Selain diare, kasus hipertensi (tekanan darah tinggi) mendominasi keluhan pasien di Rumah Sakit Umum Daerah (RSUD) Labuang Baji Makassar, Sulawesi Selatan setelah lebaran. Konsumsi makanan yang berlebihan, menjadi salah satu faktor meningkatnya grafik penderita penyakit tersebut.

“Kunjungan pasien akhir-akhir ini didominasi gangguan pencernaan seperti diare kemudian disusul dengan hipertensi,” sebut kepala ruangan keperawatan Instalasi Rawat Inap (IRD), Muhammad Ali, Selasa (13/8).

Ali mengaku, pasca lebaran tahun ini ruangan IRD yang dimotorinya padat pasien, sebab ruangan poli yang juga menangani penyakit gejala tersebut tertutup untuk beberapa hari sebelum dan sesudah lebaran. Alasannya, karena momen libur lebaran jadi penyebabnya. Terpaksa beberapa pasien harus dibackup di ruang IRD. Tercatat 30 hingga 40-an pasien beberapa hari ini yang ditanganinya.

Menurutnya, penyebab dari kedua penyakit tersebut rata-rata disebabkan karena pola makanan yang berlemak dan lambung yang belum mampu beradaptasi dengan baik pasca puasa, sehingga memicu terjadinya kedua penyakit itu.

Lebih lanjut dia mengungkapkan, jika penyakit tersebut terindikasi parah maka disarankan untuk mendapatkan perawatan lebih lanjut alias rawat inap sementara yang bersifat ringan bisa langsung dipulangkan.

“Alhamdulillah. Beberapa pasien untuk sementara ini tidak ada yang parah,” ucap Ali bersyukur.

Dia menyarankan, jika seseorang sudah jelas-jelas memiliki riwayat penyakit tersebut, setidak-tidaknya pola makan harus terkontrol dan makanan yang berpantangan dengan tubuh sebaiknya lebih diperhatikan guna menghindari penyakit yang dapat mengancam nyawa ini. “Ini memang agak sulit dihindari tapi demi kesehatan, ya sebaiknya dibatasilah,” sarannya.

Hanya saja, kata Ali, penghambat pelayanan kesehatan di IRD adalah sulitnya mendapatkan cairan untuk pasien yang khusus menggunakan jasa Askes. Menurutnya, untuk pasien pengguna Askes ini harus membeli cairan di apotek tertentu yang berada di luar rumah sakit.

Hal sama juga terjadi di RS Ibnu Sina dan Wahidin Sudirohusodo. Di Wahidin, gangguan pencernaan mendominasi pasien, seperti muntah-muntah, diare, serta beberapa penyakit yang juga mengganggu saluran pernapasan seperti asma dan lainnya.

Menurut Kepala Triase Gawat Darurat RS Wahidin, H Mustajab SKepNs MKes, gangguan pencernaan dan pernapasan berkisar 10 pasien per hari yang dirawat di rumah sakit ini.

“Mereka masuk tanpa rujukan. Belum lagi rujukan dari daerah bisa mencapai 20 hingga 30 pasien per hari,” terang Mustajab.

Dia menyebutkan, RSU Daya selama beberapa hari trakhir menjadi rumah sakit yang paling banyak merujuk pasiennya untuk ditangani RS Wahidin Sudirohusodo.

Sementara Kepala IRD RS Ibnu Sina, A Yuliana mengatakan, usai lebaran penderita diare paling banyak dirawat di rumah sakit ini. “Berkisar 20 pasien per hari, baik pasien dewasa maupun anak-anak,” ujarnya.

Sumber: jpnn.com

Alamance Regional Medical Center has been recognized by a national healthcare alliance for the hospital’s improvement in four specific areas.

The hospital has been a member of the Premier healthcare alliance for several years, and has participated in its QUEST accountability program since 2010, said Aaron Rose, ARMC’s director of quality resources.

There are currently 333 hospitals nationwide participating in QUEST, said Public Relations Specialist Lois Myers.

“These hospitals, they voluntarily measure their performance in different areas,” she said. “It’s one way to compare yourself to other hospitals.”

According to the QUEST program website, those six areas measured for improvement are evidence-based care, cost of care, patient experience, harm, mortality and readmissions.

According to the hospital, ARMC is one of 38 Premier hospitals that received a Citation of Merit for the QUEST Award for High-Value Healthcare, specifically recognizing the hospital’s improvement in patient satisfaction scores, reduced mortality, reduced average cost of care and reduced readmissions.

Rose said reducing readmissions is a major initiative at ARMC, which has been working to reach and communicate more efficiently with providers that aren’t necessarily within the hospital’s walls, to better manage the “continuum of care” for patients and thus reduce readmissions over time.

Source: thetimesnews.com

Jakarta – Pemerintah Provinsi (Pemprov) DKI Jakarta bersedia menghibahkan Rumah Sakit (RS) Haji, di Jalan Raya Pondok Gede, Jakarta Timur, untuk menjadi RS pendidikan tenaga keperawatan dan kedokteran di bawah naungan Universitas Indonesia (UI).

Wakil Gubernur (Wagub) DKI Jakarta, Basuki Tjahaja Purnama (Ahok) mengatakan, sudah ada kesepakatan dengan Kementerian Agama (Kemag) untuk menjadikan RS Haji sebagai RS pendidikan kesehatan. Pasalnya, ada banyak permintaan dari negara-negara dari kawasan Timur Tengah terhadap tenaga kesehatan perawat dan dokter asal Indonesia.

“Kesepakatan dengan Kementerian Agama. Dia mau bikin untuk Fakultas Kedokteran. Karena kita harus akui, banyak sekali permintaan tenaga kerja kita (untuk) dikirim ke Timur Tengah. Padahal mereka itu belum terdidik dengan skala pendidikan internasional,” kata Ahok di Balai Kota DKI, Jakarta, Selasa (13/8).

Diketahui, tenaga kesehatan yang paling diminati di kawasan Timur Tengah adalah tenaga perawat. Sayangnya, kualitas tenaga perawat Indonesia, khususnya Jakarta, masih kalah bersaing dengan tenaga perawat di negara-negara di benua Asia lainnya.

“Permintaan perawat ke Timur Tengah itu tinggi sekali. (Namun) Karena kalah kualitas, itu diisi dari orang Filipina. Kan lucu,” ujar Ahok pula.

Ahok mengaku yakin, kalau ada sekolah perawat dengan pendidikan berskala internasional, maka itu akan meningkatkan kualitas perawat asal Jakarta. Oleh karena itu, Pemprov DKI pun menurutnya cenderung untuk menjadikan RS Haji sebagai rumah sakit pendidikan tenaga kesehatan, terutama perawat, di bawah naungan UI.

“Kalau ada sekolah perawat, kan jadi bagus. Kita bisa kirim tenaga perawat berkualitas internasional. Makanya, kita lebih cenderung RS Haji itu jadi RS pendidikan UI,” paparnya.

Rencana itu sendiri disebut sudah disepakati bersama Kementerian Agama. Sedangkan untuk pengganti RS Haji sebagai Rumah Sakit Umum Daerah (RSUD), Pemprov DKI menurut Ahok pula, akan menjadikan bekas kantor Jaminan Kesehatan Daerah (Jamkesda) sebagai RSUD.

“Kita mau ke arah situ. Sama-sama negara kan. UI juga milik negara. Kalau (soal) penggantinya RSUD, justru bekas kantor Jamkesda yang di Jalan Kesehatan (itu) mau kita ubah jadi RSUD,” tukasnya.

Sumber: beritasatu.com

Jakarta Provincial Government plans to grant Haji Hospital on Jl. Raya Pondok Gede, East Jakarta, to Indonesia University (UI). After being granted, the hospital would be used as health education facility for nurses and doctors.

Vice Jakarta Governor Basuki T Purnama said that Jakarta Provincial Government and Religious Ministry have agreed to transform Haji Hospital into health education facility. “Religious Ministry wants to make medical school because there are many requests for nurses and doctors to be sent to Middle East. Whereas, the nurses and doctors sent before have not been educated with international scale,” he stated, Tuesday (8/13).

According to Basuki, the most favored healthcare worker in the Middle East is nurse. However, the quality of Indonesian nurse, especially in Jakarta, is still lower than nurse from several Asian countries. “The demand for nurses to Middle East is so high. Unfortunately, our nurse’s quality is still low. So, nurses in Middle East are dominated by Filipino nurses,” he uttered.

Because of that, Basuki continued, education facility with international scale for nurse is very much needed to improve nurse quality. “If there is nurse school, that’s good because we could send internationally qualified nurses. That’s why Haji Hospital would be used as education facility for nurses and doctors, under UI’s management,” he explained.

For that, the ex Regional Healthcare Insurance (Jamkesda) office will be prepared to be used as regional hospital (RSUD) as Haji Hospital replacement. “We’re going on that direction. We’ll prepare the ex Jamkesda office on Jl. Kesehatan to be transform into a RSUD,” finished the former Regent of East Belitung.

Source: beritajakarta.com

Not many people are aware that expired medication is unsafe for consumption, so Gautam Goel and Kanupriya Goel, who are husband and wife, have come up with a way to dissuade people from taking expired pills.

Inspired after helping their grandparents get rid of expired medication, they realized that the expiration dates on these pill packets are too small to be seen by older people.

Furthermore, as their grandparents were not fluent in English, they could not even read the medical information on their meds.

After brainstorming, the doctor and designer came up with a packaging that changes color as the medicine gets closer to its expiration date.

Rows of big crosses also indicate that the medicine is not safe for consumption, which serve as better visual aids than an expiration date in fine print.

Despite coming up with this creative solution, the couple faces bureaucratic challenges which may prevent packaging like this from hitting the shelves.

Moreover, packaging like this will incur added costs, and pharmaceutical companies would have to find a way around this.

Regardless, this innovative idea could prevent complications caused by taking expired medication.

Source: designtaxi.com

Jakarta, PKMK. Badan Pengawas Rumah Sakit yang belum lama ini ditetapkan melalui Peraturan Pemerintah (PP) Nomor 49 Tahun 2013, sebaiknya mendapatkan sebuah Standar Pelayanan Medik. Dengan demikian, pengawasan yang dilakukan Badan Pengawas Rumah Sakit bisa lebih operasional karena ada rambu ataupun standar tertentu yang baku. Dr. Marius Widjajarta, pengamat kebijakan kesehatan dari Yayasan Pemberdayaan Konsumen Kesehatan Indonesia, mengatakan hal tersebut di Jakarta (13/8/2013).

Marius menambahkan, keberadaan Badan Pengawas Rumah Sakit tentu harus disambut baik. Tapi, acuan apa yang akan digunakan badan tersebut untuk mengawasi banyak rumah sakit kalau Standar Pelayanan Medik tidak ada? “Kalau Standar Operasional Prosedur (SOP), itu dimiliki tiap rumah sakit. Dan berbeda antara satu dengan yang lain. Nah, kalau Standar Pelayanan Medik, itu berlaku nasional dan sama,” kata Marius.

Lebih lanjut Marius berkata, “Tanpa Standar Pelayanan Medik, ini yang dibentuk ‘badan-badanan’ atau badan beneran? Rambunya kan tidak ada. Bagaimana mungkin rumah sakit dinyatakan melakukan malpraktek bila standar penilaiannya tidak ada?”

Standar Pelayanan Medik memang sebaiknya dibuat oleh Kementerian Kesehatan RI. Apalagi menjelang keberlangsungan Badan Pengelola Jaminan Sosial Kesehatan (BPJS Kesehatan) di tahun 2014. Perdebatan nilai premi untuk warga miskin peserta BPJS, juga diakibatkan ketiadaan sebuah standar baku yang jelas. “Kini PBI ditetapkan 19 ribu rupiah. Sebelumnya, Kementerian Kesehatan ingin 22 ribu rupiah sedangkan Dewan Jaminan Sosial Nasional berpatokan pada 27 tibu rupiah. Kesannya, penentuan PBI itu kan harga tebak manggis,” kata Marius sambil tertawa ringan.

Saat ini, ia menambahkan, Standar Pelayanan Medik baru akan diujicobakan di Pusat Pelayanan Kesehatan Masyarakat (Puskesmas) di tiga kota. Hal ini merupakan uji coba untuk pelayanan primer. Untuk pelayanan sekunder, tentu perlu standar yang sama.”Prinsipnya, Standar Pelayanan Medik itu sangat kita perlukan. Bukankah kita perlu membuat pondasi sebelum membangun rumah?” ucap Marius.