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Child and Adolescent Mental Health Services

Learning advocacy skills results in great care

Disorganised community mental health service

Lack of understanding about Autism results in poor service

Suicide of young woman receiving mental health care





Learning advocacy skills results in great care

A  family of three children with medical issues had not been well supported to access the services they needed. After one son was diagnosed with ADHD, the providers refused to listen to the parents' concerns and impeded all they were attempting to do for him. The parents felt disrespected by the social worker and paediatricians and felt there had not been a good standard of care for their son.

There were also issues about care and skill in relation to their other son who was prescribed adult depressants, who was soon to be seen by another psychiatrist.

They sought advocacy help to lodge their complaint and voice their request for a second opinion with another paediatrician who could take a fresh look, with an unbiased view. 

Another son is now under a Child Developmental Service which is difficult to get into.

The family are delighted with this. As well as having a special diet for the children, they were finally receiving good support and improvements to the services provided.  The mother said they even made home visits. Through her experience with the advocacy process, the mother felt empowered enough to take on injustices by a different organisation, concerning her children.

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Disorganised community mental health service

The mother of a consumer believed her son received poor care from the community mental health service, and contacted an advocate to complain that:

  • her son not receiving his medication from the community mental health nurse when it was due'
  • the service did not record their new address which resulted in the nurse visiting the wrong address on two occasions and going to the wrong house on the third occasion.
  • she was unable to access medication for her son from either of the two community mental health services or the mental health ward at the hospital after hours.

As a result of not receiving his medication, her son became increasingly unwell and eventually had a violent episode resulting in his admission to the mental health unit where he is still a patient.

After considering the options, and with the assistance of the advocate, the consumer's mother wrote to the manager of the mental health service outlining her concerns and requesting a meeting. This was attended by the manager and the mental health nurse who had tried to visit the consumer to administer his injection. She acknowledged that because they did not record the new address she visited the wrong address then the wrong house.

The manager said a new 0800 mental health line was in the process of being set up for all mental health calls. The manager agreed to remind the inpatient ward of processes for recording calls from consumers and those acting on their behalf. The manager also acknowledged the systemic errors that had taken place and said the community mental health service was already under review with a report due at the end of the year.

The mother of the consumer felt her concerns had been addressed and was pleased with the outcome of the meeting.

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Lack of understanding about Autism results in poor service

DHB ~ Autism ~ Nonverbal ~ Rights 1, 4, 5, & 6 ~ Respect ~ Appropriate standards ~ Effective and full communication

A mother of a nine-year-old girl who is non-verbal and has severe Autism contacted an advocate about the service her daughter received from the local hospital.

When her daughter became unwell with severe stomach pains she took her to the hospital for an assessment.  While they were waiting, the little girl displayed some challenging behaviour due to her Autism. The doctor said he couldn't examine her because she was being "badly behaved". The mother tried to explain that children who have Autism have communication difficulties (even when they are verbal) and if they are uncomfortable or in pain this will often manifest in extremely challenging behaviour. The doctor prescribed some Ibuprofen for her pain and then discharged her home. The mother felt that the doctor was dismissive of her concerns and very judgemental about her daughter's behaviour. 

With the support of the local advocate she wrote to the hospital regarding her concerns. She was upset that neither she nor her daughter had been treated with respect. She expressed her disappointment that her daughter had not been examined and went on to say she felt all staff at the hospital need to be aware of the specific needs of children with Autism Spectrum Disorder and to be respectful when they are dealing with parents. Her daughter had been discharged home without a full investigation into the cause of her stomach pains.

Although her daughter is non-verbal and was clearly in a lot of pain the discharge report stated that the primary diagnosis was "behavioural problems", which the girl's mother felt was judgemental and disrespectful to her daughter.  She said she would be willing to meet with senior staff at the children's hospital to discuss this incident in an attempt to prevent it happening again.

She received a written response from the hospital with an apology for what had occurred.  The hospital acknowledged that the communication at the time of the consumer's admission had not met expectations and that this had been discussed with staff who were involved in her daughter's care and treatment.  The hospital noted that they did not have a clinical guideline on the management of patients with Autism Spectrum Disorder and agreed to follow up with the Developmental Service to ensure that all staff are made aware of the specific characteristics and needs of this group of patients.  They also modified the electronic discharge diagnosis list to include Autism Spectrum Disorder, rather than 'behavioural problems'.

The girl's mother was happy with the outcome of her complaint and pleased to have had the support of the advocate to raise her concerns.  She was keen to have her complaint used as a case study to highlight how important it is that health professionals do not ignore health symptoms in an individual who also has a disability - particularly when they are non-verbal and can't speak up for themselves.

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Suicide of young woman receiving mental health care

Suicide ~ Mental health ~ Youth Residential Care ~ Adult Psychiatric Community Case Management ~ Root Cause Analysis (RCA) ~ Resolution meetings

The mother of an 18-year-old woman contacted the local advocate to express concern about the care her daughter had received in the months prior to her committing suicide. Her daughter had been living in Youth Residential Care and had transitioned from Youth to Adult Psychiatric Community Case Management.

Six months prior to her death the daughter had requested her mother become involved in her care, lifestyle plans and to support her at appointments.

The advocate met with the mother and heard her concerns. She wanted to know why she had not been contacted by the Adult Psychiatric Community Health team or the psychiatrist for six months before her daughter's death. She also mentioned a number of other issues about her daughter's care.

When the woman felt able to meet with the mental health service, two meetings were organised - one with the Mental Health team and the other with staff from the Youth Residential Management team. The advocate supported the mother at both meetings where she was able to voice her concerns and get some answers to her questions.

Following these very emotional meetings, a further meeting to discuss the findings from a Root Cause Analysis (RCA) investigation into the tragedy was organised. The advocate also supported the woman at this independent meeting where consulting clinicians from other services had thoroughly looked at all of the factors surrounding her daughter's death. She was told that staff training is one of the areas looked at as a part of the findings, along with policies and procedures.

The woman felt her concerns had been taken seriously and she was pleased her unanswered questions would be looked into. She was also very happy that the investigation was independent with external people looking at what had happened and she appreciated the advocate providing ongoing support at all the meetings.

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