Inquest into deaths of Barrett Centre young people begins

Today was the first day of the inquest into the tragic deaths of Talieha Nebauer, Will Fowell and Caitlin Wilkinson Whiticker.

Being overseen by Deputy State Coroner John Lock, the entire process is scheduled to run across a number of weeks, with a number of the parties (i.e. individuals, groups, government bodies etc.) directly involved in the Barrett Adolescent Centre Commission of Inquiry (BACCOI) also represented at these proceedings (in some cases by the same legal counsel). Each young person’s situation will be scrutinised over several days before a final procedure where the collective issues will be examined so as to address the need to consider “opportunities to improve management of the risk of suicide“, as noted in the prioritised issues listed on the Inquest Schedule.

It has been a long and difficult wait for the families who lost young people more than four years ago. Many of the others involved – politicians, those involved in professional roles etc. – have been able to go on with their lives since the days in 2014 when those close to Talieha, Will and Caitlin were forced to face an existence without those they loved. And then again then since the procedure and conclusion of the BACCOI. But since the COI took a clear position to not encroach on any areas that could relate to an inquest – those being in the Coroner’s jurisdiction – Justice Margaret Wilson was not in a position to provide families with the answers they have needed. In fact, due to the time constraints of the COI, it was deemed necessary to ‘draw a line in the sand’ as regards a timeframe for consideration of consequences of the closure:

“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.”

Barrett Adolescent Centre Commission of Inquiry Report
p 385 of printed document, p 398 of pdf (
Click here to access)

This earlier post may provide more clarity on the relation of the findings of the COI to the coronial inquest. But it is clear that the Coroner’s office, in holding a combined inquest procedure for the three young people, has determined that the closure of the Barrett Centre must be examined as a factor in the deaths as, tragically, that is the key event that links all three.

This will be an extremely challenging process for those who have been emotionally affected by the losses of Talieha, Will and Caitlin and by the closure of the Barrett Centre. To relive trauma numerous times is a debilitating experience and to have to do so in a formal legal arena where events, accounts and perspectives will be questioned by those defending the positions of other individuals and groups will be gruelling.

It is rare to find anyone in our communities these days who has not been impacted by mental health issues in some way so we know that many people will be feeling for those whose lives have been changed dramatically because of severe and complex mental health issues in adolesence. And particularly now for those who lost three treasured young people. So perhaps, as the news reports are filed and the lawyers quoted, we should all keep in mind that this inquest is about 

TALIEHA

WILL

and 

CAITLIN

There are many people who have never, and will never, forget them.

So may this process provide the answers that these three deserve.


Note: Coverage by the ABC Radio’s ‘The World Today’ program can be listened to by clicking here.

All reporting on this and on other issues related to severe and complex mental youth health can be found on our In the Media‘ page.

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Progress Report – June 2017

A summary on the progress of the implementation of the recommendations to improve mental health services for those affected by severe and complex adolescent mental health issues in Queensland is now on the DEVELOPMENTS page at severeyouthmentalhealth.org. This includes links to more detail via the Queensland Health Communiqués released following each Steering Committee meeting as well as  other recently tabled reports.

A couple of documents that are likely to be of particular interest are those relating to RECOMMENDATION #4 – THE DEVELOPMENT OF A NEW ADOLESCENT EXTENDED TREATMENT FACILITY (AETF). The Thematic Analysis Report summarises the web feedback provided on the draft Model of Service for the AETF so whether or not you were in a position to complete the online survey, the feedback from that makes for interesting reading. In addition, there is an External Review of the Model of Service by Dr Paul Robertson, a Victorian based child and adolescent psychiatrist of 25 years experience, who undertook consultations with a number of groups and individuals as well as being given access to relevant documentation. His insights will undoubtedly also play in a role in the development of not only the new facility but will encourage a strong focus on the full continuum of care for young people with mental health issues in Queensland (the child and youth mental health services continuum ie. CYMHSC, as Dr Robertson refers to it) and the ongoing co-design process i.e. “A structure to support ongoing consumer and carer participation in the broader CYMHSC system is recommended“.

So a complete and integrated CYMHSC system that will allow access across the state for all young people with mental health issues to a full range of treatment and other service options will be a key issue in the future. This will not only ensure stable and informed transitions from one care/education/support service to another but will hopefully mean that some young people who might otherwise have needed extended inpatient care could achieve recovery without that. For, although the clinical experts who gave evidence at the Barrett Inquiry made clear that there will always be a group of young people whose conditions and individual circumstances are so severe and complex that community-based care will not adequately support their progress, the objective is always to facilitate recovery in the least restrictive environment possible. Queensland needs a statewide service like the AETF but it also needs a complete system within which collaboration and communication are the foundation of operations. Mental health issues impact all aspects of people’s lives and when the individual needs and situations of those suffering are acknowledged, understood and met as effectively and immediately as possible, all our communities will benefit. So Dr Robertson’s urging that collaborative planning does not begin and end with a new facility is extremely pertinent.

He also stresses the need for RESEARCH to be a key component of the new AETF i.e.

Reference is made to the AETF undertaking research. It should be obliged to collect sufficient data to allow appropriate review of its functioning. Adequate resources, funding and time should be allocated for this to occur. Research will not occur without appropriate funding and partnerships with universities or other research organisations. Both appropriate data collection and analysis and research would require an active and resourced plan.

Existing and developing technologies should ensure that research extends beyond the new facility and across all the components of the CYMHSC. Collecting data on the services that precede and follow a young AETF patient’s inpatient treatment – will provide insights into this cohort of young people that is currently lacking across the globe. AND compiling extensive evidence on all youth mental health issues must be seen as a priority in a country where available data states that one in four young Australians currently has a mental health condition [ABS National Survey of Mental Health and Wellbeing: Summary of Results 2007 (2008), p 9] and we are regularly made aware that the risk in our youth population only continues to grow. So methods of gathering and collating information on the challenges faced by our young people that not only avoid any negative impact on the vulnerable but may, in fact, have potential for therapeutic benefit require prioritised consideration.

The STATEWIDE FORUMS facilitated by the Health and Education Departments along with Health Consumers Queensland have now concluded and summary information from those should soon become available. Consumers and carer representatives attended these with the support of HCQ and, with a number of factors influencing the ability of local consumers and carers to attend, it has also been invaluable to have Leonie Sanderson, the dedicated HCQ Engagement Advisor, continually open to accepting input via a range of communication avenues (surveys, emails, teleconferences and meetings for specific subgroups) to ensure that anyone in Queensland with insights into service provision in this area have had – and will continue to have – their voices heard.

THE ROLE OF HEALTH CONSUMERS QUEENSLAND has been extremely important in the process so far – supporting and facilitating the active involvement of consumers and carers. And HCQ’s enthusiasm for the project was highlighted when they made it the theme of the Plenary Session at their annual forum (video and written info on that session is available here), with Katherine Moodie and Jeannine Kimber – two of the consumer/carer representatives on the Steering Committee – on the panel alongside John Allan, Executive Director, MHAODB, Queensland Health; Gunther De Graeve, the Managing Director of the consulting firm undertaking the design of the new AETF; and Stacie Hansel, Executive Director, Dept Education & Training. The discussion highlighted the great potential of this project to not only produce innovative and more effective outcomes but to influence the way that future service planning should proceed. Participants significantly endorsed the tangible value of consumer/carer input as Gunther De Graeve stated:

There has been an enormous change in our design development, actually, through this process. … This co-design process really allowed us to reach very deep into the operational requirements, into the therapeutic requirements, the day-to-day requirements and then safety overlays etc. of this facility and it gave us a very wide platform. Traditionally, this engagement goes to clinicians and nursing staff and therapeutic staff and very little with the consumers. … It was a genuine process of actually trying to understand what the needs were and, to date, I still say that if we didn’t do that process we would have designed a very different facility and it probably wouldn’t have been – definitely not – as therapeutic as that facility could be for the patients.

So, as progress goes, it would seem that in many ways we are at the beginning of something bigger than a response to the Inquiry recommendations. Although the planning for the new AETF is well underway and the examination of transition procedures, service agreements and other vital elements that underlay the provision of services has been undertaken, the potential of this project to have an effect on other aspects of service delivery (education, vocational training, support for carers and families, justice and legal issues, housing and accommodation etc.), of approaches and attitudes to mental health and to ALL those affected by these issues must make this project only the start. People with lived experience must have a permanent seat at the table – not just on listening tours and wider consultation but at levels of decision-making and influence. And that includes not only consumers of services and their carers and families but those professionals who have dedicated years of clinical, educational and other practice to these consumers and carers. Those who work daily to improve the lives of others by being part of the reality, by knowing the individuals and supporting them in their journey must always be encouraged to give insights on the practicalities, the impediments, the successes.

Only through true collaboration will success be achieved. And if there is any area in which we must achieve, it is in keeping our young people alive and giving them hope for a better life.

A reminder of INADEQUATE TRANSITIONS

A BLOG POST

10 months ago, I posted on the BLOG page of severeyouthmentalhealth.org – where pieces that have personal perspective, analysis or opinions appear (other posts are News and aim to focus on facts and information about developments etc.). I had been compelled to write about the findings of the Barrett Commission of Inquiry in relation to the transitions of patients.

As independent reviewers undertake a look at the transitions from adolescent to adult mental health services, particularly in relation to those suffering severe and complex mental health issues, I would urge anyone who is unsure of what they can contribute to read that July 2016 post which reflects on how the Barrett families felt in relation to the findings of the BACCOI on transitions.

These families know what needed to be done and what was overlooked and I am confident that they are not the only Queenslanders with this kind of insight.

So now is the time to do whatever you can to share your knowledge and experiences – or encourage others to do so – so that the young people who need the best support, the most carefully planned and gradual transitions and our best efforts in all the services they require in order to finally see a light at the end of the tunnel have access to what will not just improve their lives but, in some cases, save them. NOW IS THE TIME TO SAY WHAT NEEDS TO BE SAID. Through processes that ensure confidentiality but that also will mean that the input given IS ON RECORD and MUST BE TAKEN INTO CONSIDERATION.

If you have an opinion following experience in this area or know someone who has, since the HOI reviewers’ survey is no longer accepting entries, please do the following yourself or encourage those who have important insights to:

The next few weeks provide key opportunities for those who understand what’s needed to contribute to providing those very things.

On behalf of all Queenslanders who are affected by severe and complex youth mental health issues – now and in the generations to come – I implore you all to give your expert input. From those who have seen the reality to those who can shape the future – the vital passage of ideas is the only way we can get closer to the right support for those who need it the most.

*

Have your say ~ Transitions between Adolescent and Adult Mental Health Services

NEWS

The Inquiry into the closure of the Barrett Adolescent Centre brought many issues to light in relation to mental health services for young people that need to be addressed.

In chronological and legal terms, an adolescent becomes an adult at 18 years old. But when that adolescent has been enduring severe and complex mental health issues for years, adult services are too often totally inappropriate for his/her needs and transition to those purely because they’ve passed their 18th birthday can frequently be more harmful than helpful. The process of transition (when a young adult does actually reach a stage where they have the reasoning capacities, lifeskills and emotional/social development of an adult – ensuring access to adult services will facilitate ongoing progress) is also obviously vital. Trauma is likely to have already been a significant experience in the lives of these young people and all efforts to support them must ensure that no therapeutic process or mechanism between processes contributes to that in any way. Individual readiness and gradual and appropriate transitions must not be an aspiration but a BASIC REQUIREMENT of their mental healthcare.

Justice Wilson’s Recommendations from the BACCOI included:
REC 5: Improve transitions for adolescents moving into adult mental health services
and the government’s action on this has been to assemble a working group to outline the terms of reference for the engagement of an organisation to undertake an independent review of the current situation as regards the alignment and transition arrangements between Queensland’s adolescent and adult services.

Health Outcomes International (HOI) and Synergy Nursing and Midwifery Research Institute are, as a result of their appointment, undertaking a range of consultations – from focus groups, discussions with key stakeholders and an online survey to gather information on issues including the following:

  • Mental Health Program/Services that currently exist throughout Queensland
  • Capacity/ resourcing issues
  • Processes for the transition of adolescents and young people to the adult mental health system
  • Collaborative working arrangements and communication between services
  • Service Innovations
Many young Queenslanders and their families will have valuable information based on their own experiences and it is only through sharing those experiences that access to the appropriate services and transition methods can be developed. The problems Queenslanders have personally experienced or witnessed cannot continue but any shortcomings or mismanagement can’t be addressed if they are not communicated to the independent reviewers. Please be assured that any contributor’s personal identity WILL BE PROTECTED.

CONFIDENTIALITY
HOI states clearly that the information collected by the survey is for statistical purposes only and won’t be used to identify survey respondents, mental health service users or their families/carers. If you have any questions or concerns, you can contact Andrew McAlindon, Senior Manager at HOI (AndrewM@hoi.com.au)
and/orLeonie Sanderson
please note that Leonie Sanderson at Health Consumers
Queensland is an ADVOCATE and ADVISOR for the needs of CONSUMERS and CARERS, specifically in relation to the government response to the Inquiry’s recommendations.

As the HCQ website states:

Health Consumers Queensland is a not-for-profit organisation and a registered health promotion charity and we believe in improving health outcomes for people in Queensland. One way we do this is through enabling consumers to be an effective voice in how health services are designed and delivered.

So you can contact Leonie at leonie.sanderson@hcq.org.au to clarify anything or provide anonymous information should you have any concerns about sharing information related to your mental health service experiences in a more public forum.

Those who were/are unable to attend the ongoing regional forums* should be encouraged to contact Leonie with their insights at the above email address or by phoning HCQ on 07 3012 9090 to arrange the best method and time of sharing your insights to suit your needs and availablity.

So please, urge those you know who have experience in the transition of a young person/s from adolescent to adult mental health services to undertake the survey (at http://www.surveygizmo.com/s3/3542411/Queensland-Health-Public-Mental-Health-Services-Mapping) and/or contact Health Consumers Queensland directly if you have additional insights to share regarding the services needed to address the needs of young people with severe and complex mental health issues. Contributions from those with experience are essential in ensuring that the right approaches, programs and attitudes to mental healthcare for our most vulnerable young people become standard practice as soon as possible.
* There are still places available for the following Youth Mental Health forums:
Townsville: 9.30am - 12.30pm, 19 May - Riverway Function Space, Tony Ireland Stadium.
Mt Isa: 12.30 - 3.30pm, 23 May - MICRRH, James Cook University Mount Isa Centre for Rural and Remote Health, Mount Isa Hospital, Joan St, Mount Isa City.
Logan: 9.30am - 12.30pm, 29 May - Logan Central, 51 Wembley Rd, Ground floor conference room Addiction, Mental Health Services.
Mackay: 10.30am - 1.30pm, 30 May - Ocean International Resort, 1 Bridge Rd, South Mackay.
Bundaberg: 10.30am - 1.30pm, 31 May - Burnett Riverside Motel, 7 Quay Street, Bundaberg.

Youth Mental Health Survey 2012 – 2016 Report

NEWS

Mission Australia, in collaboration with the Black Dog Institute, has undertaken a nationwide study into youth mental health and as reported in the Brisbane Times, it backs up what those affected by youth mental health issues have been saying for some time. The numbers of young people with serious mental health issues continues to increase. And, especially troubling, so does their reluctance to seek help.

The report focuses on the period between 2012 (when the cut-backs by the previous Queensland government began that included the closure of the only long-term inpatient facility) and 2017, so that now 21.9 per cent of young Queenslanders meet the criteria for having a probable serious mental illness – “up from 18.6 per cent in 2012”.

On the release of the report, Mission Australia’s Queensland state director Darren Young said the number of young Queenslanders facing serious mental illness was “alarming“.

“The effects of mental illness at such a young age can be debilitating and incredibly harmful to an individual’s quality of life, academic achievement, and social participation both in the short term and long term,” he said.
                                                                  Brisbane Times, 19 April 2017

The nationwide study also clearly states that:

“ …young people with a probable serious mental illness report higher levels of personal concern across a wide range of issues, meaning that services and supports need to be cognisant of the complexity of worries and concerns young people are experiencing. Services need to be able to support and skill young people to deal with these issues or to provide referrals when needed (as it may be beyond the scope of any one particular service to support young people with the diverse range of concerns noted) and help them navigate an often complex service system.

This emphasises the values in the current Queensland government response to the recommendations from the Barrett Adolescent Centre Commission of Inquiry. Young people and carers with lived experience MUST be part of a co-design team to create that full range of services needed to meet the needs of severe and complex youth mental health issues and a depth of understanding of these issues must be developed across the community – particularly in areas where young might seek help.

The Mission Australia study reports that:

“Young people with a probable serious mental illness have consistently reported that the top three sources they would go to for help with important issues in their lives are friends, parents and the internet.”

But even the statistics indicate that there are declines in seeking help from these preferred sources.

The would tend to indicate that any public rhetoric about the reduction in stigma is purely that – rhetoric – and, although positive publicity campaigns are a good starting point, more actions must be taken and/or attitudes changed at all levels for young people to have confidence in and/or knowledge of available support/services, particularly as the range of these expands to meet all needs.

The full report can be accessed here. We should all view it as a reinforcement of a call to action to do whatever we are able to make sure that future studies tell a very different story.

New centre to be built at Prince Charles Hospital + SURVEY announced

NEWS

The Queensland Premier announced today that a new facility for young people with severe and complex mental health issues would be built in the grounds of Prince Charles Hospital at Chermside in Brisbane’s northern suburbs. A site visit was then made where Premier Palaszczuk and Health Minister Cameron Dick were joined by community members directly affected by the closure of the Barrett Adolescent Centre in January 2014. The Minister had met with families linked to the Barrett Centre yesterday to update them on the progress of the government’s response to the recommendations from the Commission of Inquiry (COI) into the closure and reassure them that health service consumers and carers would continue to play a significant role in planning and developments. Continue reading

MENTAL HEALTH WEEK – Time for ACTION

A BLOG POST

It’s Mental Health Week. And in the past, that has meant a lot of awareness-raising, stigma-quashing and acknowledgement of an issue that has for too long been treated like a shameful secret. And that’s all good, useful stuff. But the time has long since passed for more than knowing nods and pleasant words from those with the capacity to DO instead of DISCUSS.

Mental illness needs ACTION. NOW.

Health service providers, governments, mental health commissions/ advocates/ peak bodies and communities must move from rhetoric to establishing equitable service provision immediately. Otherwise how can anyone believe that mental health issues are, in fact, the cruel scourge afflicting millions unfairly as the annual PR tells us? We know they exist. And, thankfully, we now have knowledge of a range of pharmaceutical adjustments, treatment methods and support programs that mean these issues can be addressed. People CAN heal and progress and discover lives without the agony they once believed was infinite. BUT until the money, time and effort allocated to mental health is in line with those physical health issues that have the same level of impact, people affected by mental illness can’t feel as far from personally responsible for their health concerns as those with a blood disease or multiple sclerosis can. Continue reading

AN INQUEST … families still waiting

A BLOG POST

Talieha Nebauer passed away in April 2014
Will Fowell died in June 2014 and
Caitlin Wilkinson Whiticker took her life in August 2014

Two of those young people were in the care of the state when they took the actions that would end their lives. The other was living with family who had no access to any information on that young person’s treatment plan or assigned clinicians; state of mind and attendance at sessions; or the appropriate behaviour and support to be adopted by those close to her.

Prior to the closure of the Barrett Centre, families had the security of knowing that their loved ones were so well supervised that they would be safe from the fatal outcomes that their mental health issues could lead them towards. They knew that they were in an environment where they were surrounded by friends who’d look after them, who’d demonstrated the kind of caring that would at least help to nullify the feelings of isolation that had previously plagued them. And, for many, there was the hope that long-awaited progress brings – that one day, they would be leading independent lives in the community with all that things that that entails – study, work, social activities, sport, relationships, a family of their own …

but that ended as the turbulent years of uncertainty and decline led to the disintegration of that understanding community. Young people found themselves in unfamiliar places, sometimes surrounded by adult patients and expected to bear the burden of levels of self-sufficiency that they had no experience with; or living in the community and wielding the rights and authority of adulthood without the maturity or capacity to have such a huge responsibility.

April, June, August 2014.

And still no answers for their families. 

Continue reading