An inquest into the death of Carley Metcalfe is under way.
An inquest into the death of Carley Metcalfe is under way.

Mum’s disappearance, death sparked big change in ED

Significant changes have been made to the way people with mental illness are initially assessed at hospital emergency departments, an inquest has heard.

An inquest into the circumstances of Carley Metcalfe's disappearance and death has continued this week.

Ms Metcalfe, 41, was taken by ambulance to Lismore Base Hospital in a disoriented state about midday on November 1, 2017.

While the psychiatric registrar on duty believed she was intoxicated and wanted her to stay in the emergency department overnight before conducting a mental health assessment, there is no objective evidence Ms Metcalfe had consumed any intoxicating substance.

She left the hospital the following day and was seen a few more times before her disappearance.

Her remains were found on the bank of the Brunswick River near Mullumbimby on November 29.

Deidre Robinson, currently the Northern NSW Local Health District's general manager of mental health, alcohol and other drugs, has told the inquest of changes to some emergency departments in recent years.

The inquest has heard evidence Ms Metcalfe was initially assessed as not suitable for admission to the mental health unit. Psychiatric clinicians had hoped she would be held in ED to be properly assessed the next morning.

There has been evidence from clinicians she was subject to a "demarcation dispute" between the doctors in charge of the mental health and ED units.

"When a patient arrives in the emergency department and they're triaged, what we now have in place (is) a mental health emergency care team who work 24/7 at both Lismore ED and Tweed ED," Ms Robinson said.

She said this team was initially operational 8am to 10pm before being expanded to all-hours.

"During the day it could be a mix of a nurse, senior psychologist, registrar, an on call psychiatrist is attached to that team," Ms Robinson said.

She said someone who presents to either hospital today in a similar situation to Ms Metcalfe would fall under the MHEC team for assessment if mental health concerns are identified.

She said electronic referrals were also now being used to connect patients with the right services.

The inquest has also heard evidence there was ambiguity in communication between senior clinicians while Ms Metcalfe was in the hospital, and in clinical notes pertaining to her treatment plan.


Forensic psychiatrist Dr Andrew Ellis told Byron Bay Coroners Court on Thursday it was vital for treatment plans to be clear.

"I think when you make written notes they need to be very clear specifically if you're making a treatment plan that someone else is going to follow," he said.

"What you're writing for (is) a person who doesn't know the patient, a person who doesn't know the situation.

"If you have a clear action plan it's more likely to be followed."

The inquest has heard psychiatric registrar Dr Robert Byrne toned down his language in notes, as advised by psychiatric consultant Dr John Wardell, to avoid a perception from emergency department staff they were making a direction.

Dr Ellis said it would have been possible to make a "clinical recommendation" for Ms Metcalfe to remain in the ED, without sounding unprofessional.

Ms Metcalfe's family are expected to address the inquest before the parties' final submissions today.

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