It’s a Tuesday afternoon in the emergency department at one of Melbourne’s busiest public hospitals, St Vincent’s. Over a loudspeaker, a nurse announces a code grey: an attack on a staff member. It punctuates a cacophony of yelling voices, buzzing machines and groaning patients. Police mingle amid the chaos while people wait on stretchers or strung over chairs outside.
Immediately next door, the hospital’s mental health, alcohol and other drugs hub is quiet and, for the most part, calm.
People treated in this sealed-off section of the emergency department (ED) are either having an acute mental health crisis or are struggling with addiction. But you wouldn’t know it.
Away from the tumult of the ED, the hub is designed to feel calming, soothing and safe. The effect is almost immediate.
As GP costs have skyrocketed, those on the frontline of Australia’s mental health crisis say demand is increasing as patients’ cases grow more complex and severe.
Located in Fitzroy on Victoria Parade, just outside Melbourne’s CBD, the hub has treated about 10,000 patients since it opened six years ago. It was the first of six state-funded hubs in Victoria announced as part of a $32m package for alcohol and drug services. Together, the hubs have 34 beds.
Similar models to Victoria’s hubs are now being rolled out in Sydney as mental health disorders increase there, triggering growing calls for more support.
Each of the eight generously sized cubicles at the St Vincent’s hub are decorated with pictures of Wilson’s Promontory national park. They all have safety features, including locked-away equipment.
Liv Bollington is one of the hub’s coordinators. “These are slightly different setups to a main [ED] cubicle,” she says from inside one of the rooms. “So if you have anyone who’s at risk of self-harming, they don’t have access [to unsafe implements].”
Other safety measures include having nothing attached to ceilings that can hold any weight. There are also no curtains or bin bags, and patients’ belongings are searched before they are admitted.
The team then determines if the patient is agitated, in need of a sedative and/or physically hurt.
Bollington has been a nurse for 20 years, primarily specialising in patients with drug and alcohol addictions. She talks in a no-nonsense way that many nurses adopt. She is sharp and doesn’t suffer fools.
She says there has been an increase in patients needing the service, with its eight beds filled twice daily.
“We’ve seen a knock-on effect of patients who would have, in the past, gone to their GP now presenting to the ED,” she says. “We say to patients ‘here, go to your GP, go get your mental health care plan’. Well how realistic is that really when going to the GP is $60 to $80 out of pocket?” Patients then need to find a psychologist in the community, she says. “And that is so difficult.”
Bollington says the hub is still experiencing the reverberation of the lockdown years; people who lost businesses or were isolated and started drinking continue to be admitted. But now there is a fresh wave of people who need help due to the rising cost of living, including rent increases.
“We see patients all the time whose lease is expiring, or they can’t afford the rental increase,” she says. “We’re seeing a lot of patients [coming] in with depression or distress regarding changes to their social circumstances.”
She pauses and nods.
“It’s huge.”
A man in his 40s bounds out of one of the rooms. Josh, whose name has been changed for privacy, is about to be discharged. Bollington runs through a list of medications with him.
“Don’t worry,” she says when he starts looking stressed.
He raises his hands and smiles.
“I wish I had your outlook,” he says. “I’ve just been using a lot of black humour to hide the severe anxiety.”
Josh arrived the day before. He fled an unsafe situation and is severely distressed.
“You wouldn’t even think you’re in a part of the emergency hospital,” Josh says. “When I came in I was still going through a lot, so I didn’t calm down, per se, but it took the edge off. I felt more comfortable.”
This is Josh’s second time in the hub in six months. He arrived with very little and now has nowhere to go. In addition to treatment at the hub, he has been linked with a social worker and an emergency housing provider. He has also been provided with some clothes and a few food vouchers. He’s been raiding the hub’s biscuit jar.
Josh says he wants other men to know you can become unwell at any age. He came to the hub for one person, he says. “I’m grateful for my mum’s support. She would be happy I’m getting the help I need.”
The hub is painted in soft tones, light blues, cream and aqua. Its focal lighting is designed to feel like sunlight, and a common area houses comfortable couches.
Someone is wheeled in on a stretcher with evident signs of self-harm. His family, then police, trail behind him.
The hospital’s director of emergency medicine, Dr Jonty Karro, says the hub’s patients are seen quickly, which frees up beds in the ED. He says the hub creates the equivalent of 20 extra beds each day.
Karro says staff see the “full gamut” of society. While there is a large cohort of rough sleepers or people with unstable housing, no one is immune to poor mental health, he says.
In the hub is a businessman who attempted self-harm after financial troubles, a middle-class woman experiencing a mental health crisis for the first time and patients with “significant substance abuse issues”.
“Mental illness and drug and alcohol use and abuse doesn’t discriminate, but there is a correlation with the social determinants of health, housing, upbringing, schooling, refugee status and some First Nations people,” Karro says.
Heroin used to be the dominant drug, but now it’s ice. The hub has recently seen a notable uptick in the dangerous party drug GHB, Karro says.
“It’s very cheap,” he says. “People are buying this drug by the litre and it’s $2 or $5 for a dose.”
But it’s alcohol, he says, that harms more people, causes most physical and mental issues and is most fatal.
The hub simmers with sadness. But it also offers people a lifeline. Sometimes it takes multiple visits, while someone else can get the right help at just the right time.
“Many people turn their lives around,” Karro says.
• In Australia, support is available at Beyond Blue on 1300 22 4636, Lifeline on 13 11 14, and at MensLine on 1300 789 978. In the UK, the charity Mind is available on 0300 123 3393 and Childline on 0800 1111. In the US, call or text Mental Health America at 988 or chat 988lifeline.org.
