We welcome the input of our psychogeriatric colleagues on the mental health crisis that so often ignores the needs of the aged – in particular those suffering from the behavioural and psychological symptoms of dementia (BPSD). We thank Neilson et al. for highlighting – like us – the paucity of psychogeriatric beds and the insufficient planning that continues to plague the specialty.1 We agree that a whole-system approach to dementia is important; this would include planning and resources across in-patient, community and residential care. We are pleased that the authors have used their collective voice to – like us – draw attention to the poor design of our hospitals. We note the Australasian-specific publications that demonstrate the ongoing safety and ethical issues of shared rooms.2, 3 Our experience is that dedicated psychogeriatric wards use single occupancy design. Hence, we hope that the authors will use their collective weight in advocating for changes to the fundamentally flawed Australian Health Facility Guidelines, which continue to accept shared rooms as an appropriate standard of care. The current AusHF guidelines will ensure that even new hospitals will have dementia-‘unfriendly’ hospital environments with the intrinsic breach of standards and rights that goes with shared occupancy design.4 We also thank the authors for highlighting the unequivocal security, standards and rights breaches implicit to admitting dementia patients presenting with violence to medical wards unable to provide for their care. With regard to their recommendations, we are pleased with an acknowledgement of the need to ‘speak up’. However, the experience of physicians is that too often ‘the system’ demands that we take responsibility for BPSD regardless of severity and risk and despite our own bed crisis; for example, recent data show Wellington hospital medical ward bed capacity is consistently at 100%–115%.5 We reiterate that such patients have no medical problem requiring a medical ward or a physician.6 Speaking of silos and using colourful military references is appealing but does nothing to help physicians pressured into managing psychiatric presentations alongside their own overwhelming medical loads. We agree that language should not be stigmatising, but it does need to be accurate – regardless of the discomfort that may cause. If someone is presenting with violence, sexual aggression or intrusive behaviour, failing to identify that behaviour or minimising presentations does not reduce harm from ‘othering’ or decrease ‘stigma’; it increases risk. Harm from such patients is demonstrable, not potential, especially with the high rates of mixed-gender bedding that continues to compromise hospital safety in New Zealand and Australia.7, 8 We affirm that dementia is everybody's business, but expecting general medical wards to manage the psychiatric presentations of this condition is unsafe and unethical and not within the scope of general physicians. Our collective duty of care requires that we be brave, direct and accurate in discussing this growing problem. Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.
Towns et al. (Wed,) studied this question.