On a bustling Tuesday afternoon at St Vincent’s, one of Melbourne’s busiest public hospitals, the atmosphere in the emergency department is palpable with tension. Suddenly, a nurse’s voice crackles over the loudspeaker, announcing a code grey: a distressing indication of an attack on a staff member. This serious incident disrupts a chaotic backdrop filled with the sounds of raised voices, the incessant beeping of medical machines, and the distressed groans of patients awaiting care, many of whom are stretched across chairs or in the corridors on wheeled stretchers.
Just adjacent to this pandemonium lies the hospital’s mental health, alcohol, and other drugs hub—a space that starkly contrasts with the emergency department’s frenetic energy. This isolated section is designed to invoke a sense of serenity and assurance, an essential refuge for individuals grappling with acute mental health crises or the grips of addiction.
In stark contrast to the turmoil unfolding next door, the hub exudes an atmosphere of calm, with its tranquil layout immediately soothing patients’ nerves. The design philosophy behind this space is intentional, aiming to create a reassuring environment that feels secure and restorative.
With spiraling GP costs driving patients to seek help elsewhere, those entrenched in the frontline of Australia’s mental health crisis are facing a disturbing rise in the number of individuals whose conditions are worsening in complexity and severity. This increase underscores a dire need for more accessible mental health services.
Nestled in Fitzroy on Victoria Parade, just on the outskirts of Melbourne’s central business district, this pioneering hub has already treated approximately 10,000 patients since its launch six years ago. It forms part of a broader initiative, with six state-funded hubs across Victoria originating from a significant $32 million investment aimed at bolstering alcohol and drug services. Collectively, these hubs offer 34 dedicated beds.
Following in the footsteps of Victoria, similar mental health hubs are now emerging in Sydney, as authorities respond to the escalating prevalence of mental health disorders and the mounting calls for enhanced support and resources.
The hub boasts eight spacious cubicles, each thoughtfully adorned with images showcasing the natural beauty of Wilson’s Promontory National Park. With an emphasis on safety, the facility is equipped with secure features, including locked storage for potentially harmful equipment.
Liv Bollington, a seasoned coordinator at the hub, explains the distinct setup of these cubicles compared to traditional ED rooms. “If you have someone who’s at risk of self-harming, they don’t have access to unsafe implements,” she elaborates, highlighting the vital safety protocols in place.
Additional security measures include a meticulous approach to the environment, with no affixed items on ceilings that could bear weight and a clear absence of curtains and bin bags. Patients undergo a thorough search of their belongings before being admitted, ensuring a safe atmosphere.
Once admitted, the clinical team assesses whether the individual is agitated, in need of a sedative, or physically injured, tailoring their intervention accordingly. Bollington, who has spent two decades nursing patients with substance addiction, speaks candidly about an urgent need becoming increasingly evident.
According to Bollington, the demand for services has surged, as evidenced by the continuous filling of its eight beds. “We’ve seen a knock-on effect. Patients who previously would have consulted their GP now present directly to the ED,” she explains, noting the financial barriers they face. “With out-of-pocket expenses ranging from $60 to $80, patients often struggle to pursue traditional care pathways, finding it challenging to locate accessible psychologists in the community.”
The repercussions of the pandemic lockdown years continue to echo through the hub. Many individuals who suffered from business losses or isolation during that period are now seeking help for increased alcohol use, alongside a new wave of admissions related to the rampant rise in the cost of living.
“We see patients all the time whose lease is expiring or who can’t manage the rising rental prices,” Bollington notes. “Patients are presenting with depression or distress associated with significant changes in their social circumstances.”
A man in his 40s suddenly exits one of the rooms, seemingly relieved as he prepares for discharge. Josh—whose name has been altered to maintain privacy—engages in a calm conversation with Bollington, who runs through his medication list. She reassures him as tension begins to surface.
“Don’t worry,” she comforts him, and he smiles in response, expressing gratitude. “I wish I had your outlook,” he admits, revealing his coping mechanism of masking severe anxiety with dark humor.
Josh arrived just the previous day, fleeing from a perilous living situation. “You wouldn’t even think you’re in a part of the emergency hospital,” he reflects on his experience. “While I didn’t fully calm down when I came in, the environment took the edge off. I felt more secure.”
This marks Josh’s second visit to the hub within a mere six months. Arriving with scant belongings, he now finds himself without a place to go. In addition to treatment, he has been connected to a social worker and an emergency housing provider, receiving clothes and food vouchers, utilizing the hub’s biscuit jar to ease his hunger.
Josh hopes to send a message to other men: mental illness can affect anyone, regardless of age. He credits his mother’s unwavering support, expressing that she would be proud he is seeking help. “I’m grateful for my mum’s support,” he shares.
The hub is designed with soft color schemes—light blues, creams, and aquas—crafting a soothing decor, complemented by lighting meant to mimic the warmth of natural sunlight. A communal area, furnished with comfortable couches, invites a sense of community and relaxation.
Amidst the ongoing struggles, someone is hurriedly wheeled in on a stretcher, bearing visible signs of self-harm, trailed closely by their family and police personnel. The urgency of the situation reflects the extensive reach of the hub in its efforts to address mental health crises.
Dr. Jonty Karro, the director of emergency medicine, praises the efficiency of the hub in facilitating swift care for patients, saying it effectively creates the capacity of 20 extra beds daily. This operational prowess plays a crucial role in alleviating the pressure on the overflowing emergency department.
Karro underscores that the hub caters to a diverse cross-section of society, revealing a startling truth. Amidst the visible presence of rough sleepers or those in unstable housing, he asserts that mental illness spares no one. “No one is immune to poor mental health,” he emphasizes, highlighting the pervasive nature of these issues.
In the hub’s care, various patients come with stories that illuminate this reality: a businessman who attempted self-harm due to financial strife, a middle-class woman facing her first significant mental health crisis, and individuals battling severe substance abuse. This spectrum of experiences reinforces the notion that mental health issues, coupled with drug and alcohol use, respect no socioeconomic boundaries.
While heroin used to dominate as the primary drug of concern, a notable shift has occurred, with ice taking precedence. Karro notes a recent surge in GHB, a dangerously accessible party drug, with its low price—often as little as $2 to $5 per dose—contributing to its rise in use.
Karro highlights that, while various substances pose risks, alcohol remains the leading culprit behind a majority of physical and mental health issues, significantly impacting individuals’ lives and resulting in many fatalities.
Despite the underlying sadness permeating the hub, it stands as a beacon of hope—a lifeline for individuals seeking assistance. While many require multiple visits to achieve stability, others may receive the support they desperately need at just the right moment, propelling them toward recovery.
“Many people turn their lives around,” Karro affirms, encapsulating the transformative power of the hub.
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.
**Interview with Liv Bollington, Coordinator at the Emergency Department Mental Health Hub**
**Interviewer:** Thank you for joining us today, Liv. It’s great to have you here. Can you start by telling us a little about the purpose and design of the new Emergency Department Mental Health Hub at the Royal Melbourne Hospital?
**Liv Bollington:** Absolutely, and thank you for having me. The hub was designed to provide a safe, calming environment for individuals experiencing acute mental health crises or dealing with substance abuse issues. It starkly contrasts the hectic atmosphere of a traditional emergency department—offering eight spacious cubicles where patients can feel secure and at ease. Our design philosophy prioritizes a therapeutic environment, incorporating soft color schemes and natural light to promote healing and comfort.
**Interviewer:** That’s wonderful to hear. How has the demand for services at the hub changed in recent years?
**Liv Bollington:** We’ve seen a significant increase in demand. Previously, many patients would consult their general practitioners when facing mental health challenges, but financial barriers have led them to bypass that route altogether and seek care directly in the emergency setting. With mounting costs and accessibility issues, our hub has become a crucial point of contact for many struggling individuals.
**Interviewer:** It sounds like the pandemic has had a long-lasting impact on patients. Can you elaborate on how the aftermath of lockdowns has affected your services?
**Liv Bollington:** Definitely. The lockdowns resulted in substantial financial and social stress for many people, which has exacerbated issues like anxiety, depression, and substance abuse. As people face challenges like rising rental prices and job insecurity, our hub has seen a rise in patients presenting with those specific concerns. It’s heartbreaking to witness, but it’s a reality we’re committed to addressing through our services.
**Interviewer:** You mentioned earlier that you conduct thorough assessments upon admission. Can you walk us through the process and how you ensure patient safety?
**Liv Bollington:** Sure! When a patient arrives, we perform a comprehensive assessment to determine their needs—whether they’re agitated and require a sedative, or if they have any physical injuries that need immediate attention. We uphold rigorous safety protocols to ensure that our environment is as secure as possible, from conducting thorough searches of personal belongings to limiting potentially harmful items within the space. Our goal is to provide care in a safe setting where patients can focus on their recovery.
**Interviewer:** It’s heartening to see the level of care provided at the hub. Lastly, what message do you think is vital for the community regarding mental health services?
**Liv Bollington:** I believe it’s crucial to emphasize that mental health issues can affect anyone, regardless of their background or circumstances. Seeking help is a sign of strength, and there are resources available to assist. We’re here to support individuals and their families as they navigate these challenges, and we encourage everyone to reach out if they need help—regardless of how big or small the issue may seem.
**Interviewer:** Thank you, Liv, for sharing your insights and the important work being done at the hub. It sounds like a vital service for the community.
**Liv Bollington:** Thank you for shining a light on mental health issues. It’s important that we continue these conversations and break down the stigma surrounding them.
