“Adequate” transitions?

A BLOG POST

The families of the young people transitioned from the Barrett Centre to facilitate its closure are understandably disturbed by the finding of the Commission of Inquiry that “Overall, the Commission has determined that the transition arrangements for the 17 transition clients were adequate.” That is one sentence in a report of which the first volume alone is 665 pages. But it means a lot when you have lived with the regression, deterioration, and most tragically, the death of the young person you love following that transition. However, the hundreds of pages of definitions, constraints and considerations that surround that sentence show that it might not be exactly what it appears to be when extracted and interpreted in isolation.

Firstly, it should be noted that the finding of ‘adequate transitions’ clearly state that it is “overall. So it’s very possible that within the specifics of decisions made and actions taken, that there were steps that weren’t adequate. Volume 2 of the report is, rightly, restricted but individual families should be able to discuss their particular situation with government representatives in the near future.

The report also states that “The Commission finds that the care, support and services provided to several transition clients were not ideal” and “that systemic problems affected the transition arrangements for and the care, support and services available to some of the transition clients.” So ‘overall … adequate’ is far from perfect. Or even ‘good’.

It’s important, too, to note that the report is based on information provided that falls within the parameters of the Commission’s Terms of Reference – anything outside those Terms was not considered. In addition, the report indicates that not all former patients provided evidence – for so many, to relive their trauma would have been too detrimental to their health and it’s totally understandable that they had to do what was right for their personal health and safety. (I think everyone is glad that they took the right steps to ensure stability in their health and fully supports them in doing so.)

We should also probably consider that the Commission of Inquiry wasn’t looking at the full picture that families can see. They can’t see a young person now isolating themselves when in visits home during their time at Barrett they had begun to socially engage. The Commission didn’t hear anything of the personal circumstances of young people’s day-to-day existence as weeks passed and fresh challenges were presented in the adult services they were transitioned to. They learnt nothing of how it felt once all the logistical things were settled and a teenager was left to deal with a new environment, new people, new responsibilities … and then, if they managed to navigate the first few months, reacting to the suicides of three friends. Three people who were more like them than anyone else in this new world they’d been pushed into. Because the Commission of Inquiry had clear, legal parameters. It had time constraints and theoretical definitions that restricted its examinations. So what it views as “transition” and “adequateonly applies to a very specific time period and a very specific set of circumstances.

ADEQUATE IN THE CONTEXT OF A TIGHT TIMEFRAME AND THE LACK OF APPROPRIATE ALTERNATIVE SERVICES

After multiple submissions from the legal representatives of various parties, the Commission concluded that “‘adequate’ in this term of reference means ‘sufficient’ or ‘satisfactory’ in the circumstances of the impending closure.” So … bearing in mind that they were operating in an environment where an artificial deadline forced the transfer of patients from a closing facility that was the only one of its kind in the state TO services that did not match the need of the patient, the Commission has concluded that those responsible for the transitions did what was ‘sufficient’. Viewed in that light, it’s not a glowing assessment.

PARAMETERS – ONE MONTH POST-CLOSURE AND NO ASSESSMENT OF RECEIVING SERVICE ONCE TRANSITION WAS COMPLETE

The Commission also had to restrict its investigations to within a limited time period – with having only a certain number of weeks to complete its work, it couldn’t look at what happened with Barrett patients over months and years. So it had to define what was meant by “transition” in relation to the Inquiry. So –

“the Commission determined that generally a transition in association with the closure ended about a month after the transition client’s discharge from the BAC. This temporal limitation meant that the Commission’s factual inquiry started at the beginning of the transition and ended around one month after the transition client’s discharge from the BAC. The Commission’s terms of reference, and its factual inquiry, do not extend to a consideration of the following matters:

  • the immediate cause or root causes of the deaths of the three young people who died in 2014 who had formerly been patients of the BAC
  • whether those deaths were caused by or contributed to or affected by the closure of the BAC in early 2014
  • whether those deaths were caused by or contributed to or affected by the transition arrangements or the adequacy of care provided by the various receiving services.

Those are matters for the Coroner.”      (p 398)

So an ‘adequate transition’ was, we hope, never intended to describe the circumstances surrounding the tragic loss of three young people. Nor even the ongoing outcomes of the post-Barrett treatment and accommodation for any of the former patients.

“Under term of reference 3(d)(i), the Commission is required to make a factual inquiry as to the transition arrangements for each of the transition clients. This means examining how the care, how the support, how the service quality and how the safety risks were identified, assessed, planned for, managed and implemented for each of the transition clients before and after the closure. This inquiry focuses on the process underlying each transition client’s movement to alternative care. It includes consideration of the transition plan prepared for that transition client and how a receiving service was identified, both as the type of service and as having the capacity required for that transition client. It does not extend to the clinical outcomes, quality or efficacy of the treatment at the alternative care service once the transition process was complete.(p343)

So, not vastly different from the “Report: Transitional Care for Adolescent Patients of the Barrett Adolescent Centre” under former Health Director-General Ian Maynard, this was an examination where much of the focus was on how those planning for the transition of patients went about their duties. And it took into account the environment they were doing so in i.e. one where “by November 2013, it was unanimously understood that none of the replacement services would be available when the BAC closed.” And where some questioned whether that full suite of services did, in fact, cater for those young people for whom Barrett had been a ‘last resort’.

A Commission of Inquiry is probably rarely able to achieve everything that those so seriously affected by the issue under investigation would want. There are costs and time constraints and legal considerations. But it’s hoped that the people – the human beings – whose lives have been irreparably damaged might come through the Inquiry experience with some kind of foundation on which to seek the outcomes they need. There will be a Coroner’s Inquest into the deaths of Talieha Nebauer, William Fowell and Caitlin Wilkinson-Whiticker.
The government has indicated a commitment to meet with families of former Barrett patients to discuss their personal circumstances and to collaborate on developing a new facility.
And, the silence that represented the ignorance of most of us to the plight of these families, these young people whose bravery and strength and loyalty is unmatched, which was replaced by a consistent murmur and than some determined calls for understanding and compassion and support has ultimately grown in some to a contained inner roar. That reminds us that will we do whatever we can to make the real voices heard. And to make the right people listen.

So it isn’t over. And it certainly isn’t adequate. And while we can move forward in many ways, we are always with those who won’t be able to forget the Barrett closure. So neither will we.

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