General medicine wards and the mental health crisis: invisible and unsafe

The behavioural and psychological symptoms of dementia (BPSD) are common and include physical and sexual aggression. Unlike delirium, BPSD is a purely psychiatric presentation with no additional medical condition requiring treatment. New Zealand has a paucity of psychiatry beds for older adults, but despite the ageing population, limited attention has been given to this growing problem. BPSD patients present acutely to hospital when their behaviour becomes unmanageable. They need specialist attention and facilities. However, despite inappropriate design and no resourcing, hospitals routinely expect medical wards to accept these patients when no psychogeriatric bed is available even when the presentation is complicated by physical or sexual violence. The authors contend that this practice is unsafe and unethical. It breaches the Code of Rights for all patients and places physicians at medico-legal risk.