By Mickey Skidmore, AMHSW, ACSW, MACSW

In May 2016 I sent the following email to an ADHC representative in an effort to advocate on behalf of a patient. ADHC’s plan to return her to her previous community arrangement after years of broken promises prompted this effort. *(Please note all names and other identifying info have been changed/adjusted to ensure privacy and confidentiality).

Dear *Debbie,

Pursuant to our conversation regarding the above mentioned individual earlier this week, I’d like to formally offer this written addendum for the record. You mentioned that you were not directly involved with this case so you were unaware of the details. I’d like to highlight some details in an effort to advocate on behalf of *Sally.

*Sally is currently 38 years old. After suffering a significant stroke in 2009, that exacerbated her mental illness, and left her with serious cognitive deficits, she was accepted for ADHC services. At age 31, although this was an inappropriate and less than ideal arrangement, she was placed in Braeside hospital  for 5 years waiting for ADHC to secure a recommended Group Home placement with 24hr supports. I acknowledge that there is a dearth of such resources overall. However, it is difficult to believe that some type of supported group home accommodation could not be identified in 5 years time.

Given that ADHC was not forthcoming with a recommended placement, her public guardian reluctantly approved a return to the community with high support packages. And while ADHC would no doubt take the view that they met their duty of care by providing a funding package to a sub-contracted NGO to serve her in the community; it should be noted that since this community experiment began in July 2014, she required two (2) psychiatric hospitalisations and 15 documented referrals to on-call Community Mental Health Emergency Team (COMHET). Moreover, there is evidence of deterioration and relapse of psychotic symptoms on approximately 16 occasions where this continued to be “managed in the community’; and 14 documented instances of concerns from staff regarding impaired decision making and sexual safety concerns.

I would characterise this as a disastrous ad failed community experiment; and compelling evidence that this was another inappropriate placement effort that again ignored the original recommendations from the health services that she be placed in a Group Home placement with 24hr supports. To be clear, this was a multi-disciplinary team recommendation supported by three (3) comprehensive neuropsychological assessment reports; OT assessments; and supporting documentation from Social Work and physicians.

Prior to her extended stay at Braeside Hospital, she also had a lengthy hospital admission from September 2005 to March 2006. She also appears to have had 4-5 additional psychiatric hospital admissions between 2007-2009. Despite experiencing numerous hospital admissions that are often lengthy in duration, it is unclear how anyone could conclude that placing her in the community was an appropriate placement arrangement.

Prior to her most recent re-admission to Liverpool Hospital (23/02/2016), it was discovered the the public guardian may have rescinded authorities of “accommodation” and “services” following an independent review that did not include anyone in the health service. The Mental Health treating team was unaware that such a review was taking place; was absent from the hearing subsequent to not being informed of its occurrence; and no feedback was provided to the Mental Health Service following the hiring, including the determined changes in Guardianship.

From my perspective, it is difficult to see how any of this can be considered acceptable duty of care. The hospital and Mental Health Treating Teams have consistently and repeatedly made its recommendation for the level of care she requires. Yet years later, these recommendations are ignored and all that has been offered is sub par, inadequate, or inappropriate.

This young woman’s horrendous experience with the health care system should give us all pause. I find the explanation that ADHC has provided a funding package for and thus is no longer “directly” involved in her care to be disingenuous and convenient posturing. You acknowledge being “indirectly” involved by virtue of referring her to one of your sub-contracting agencies. Now that she is back in the hospital, the only service that can be realistically provided to her are social supports by escorting her and supervising her during leave from the hospital. To insist that she is no longer an ADHC client and that she must re-apply for ADHC services from the beginning is little more than a politically expedient manoeuvre to pass here on to NDIS.

Despite my serving as acting Team Leader in the in-patient Social Work MHU team on multiple occasions, it was obvious from this point forward that I had been blacklisted.

This letter apparently ruffled the feathers of several individuals in multiple organisations. In my view, it became the index event leading to my being blacklisted from the administration of the mental health services at Liverpool Hospital. I was summoned by administration and reprimanded for my “inappropriate” use of emails, among other things. 

Less than 6 months later, a formal complaint process followed allegedly related to subsequent advocacy efforts with the Public Guardian around their refusal to approve admission of a gentlemen with a clear and compelling diagnosis of dementia due to his not being 65; and for a separate allegation of inappropriate documentation in the medical record. However, make no mistake about it, the pretext for this complaint process remained the ADHC letter of May 2016.

From my perspective, this was a one-sided process. It was explained to me that I would be provided details around the allegations and an opportunity to prepare a response accordingly. However, a date was set for the official complaint and I was informed during the event that this was my opportunity to respond — even though I had not been provided any of the details of the allegations as promised. Even when asked directly, they were reluctant to provide any specific details. Yet, it was clear they had “investigated” the allegations of my accusers. I had specifically encouraged them to interview my treatment team whom I consulted with every step of the way prior to communicating with the public guardian. Yet, there was little indication that this was done, or if it was they did not acknowledge it. I also noted that one of the representatives grilling and admonishing me in this process was the immediate supervisor of one of the individuals levelling allegations against me. I pointed out the organisation’s policy that she should recuse herself from this process to avoid the appearance of a conflict of interest — which she flatly refused to do.

Ultimately, this was nothing short of the administration’s sanctioned mechanism for bullying and reprimanding me for advocating for my clients. The HR process finalising this process also dismissed my observations of “abuse of process” (not adhering to their own policies) based on the observation that a conflict of interest in their judgment fortunately did not occur. In the end I was informed that this matter was concluded.

Fast forward several years, I am pleased to report that *Sally was eventually placed in an appropriate Group Home facility with 24hr supports. Also, the gentleman previously mentioned was likewise successfully admitted to a nursing home with an Alzheimer’s unit. I also heard rumours that there were meetings within the office of the Public Guardian to adjust some of its internal policies and/or processes in dealing with complex health issues. In short, I felt 100% vindication from my perspective and advocacy actions, despite having been clearly blacklisted by the mental health administration of Liverpool hospital.

Despite this, I endured several years wherein during my performance review, these matters were continually brought up as “issues” despite the fact that HR had officially finalised and brought this matter to a conclusion. I objected to this process and conveyed that I continued to be targeted and bullied. A collusion of talking points had been established by the administration to filter my performance into a prism that filtered all my direct and  straight-forward communications as “curt”, “rude”, and/or “offensive”. (Never mind the fact that I often felt that people were rude to me nearly every day!). While I pointed out how I made efforts to mitigate this feedback from my end, these tired themes were repeated in subsequent performance reviews. It was even suggested on more than one occasion from my immediate supervisor that I should leave the service.

I have repeatedly been removed from consideration of EOI’s of several positions of leadership. And last year, after initially being advised of being the preferred candidate for a temporary Senior Social Work position, the administration once again recalled that they didn’t care for my leadership very much and derailed this as well at the eleventh hour.

The most alarming aspect of this experience is that the mental health administration has cultivated a contempt for expertise highlighting pervasive systemic issues within their organisation, combined with a distain for warnings that is different from anything they have already made decisions about. The have mobilised their bullying pulpit and weaponised their position against me for simply doing what Social Workers are trained to do.

And while it is difficult to tolerate such a toxic and hostile work environment, there is always the part of me (speaking truth to power) that accepts this blacklisting as a badge of honour.