There's calls for a specialist 'ice' unit in the region to deal with the escalating problem and relieve pressure on emergency departments and mental health units.
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Two of the region's senior mental health specialists told this week's Nowra hearing of the NSW Government's Ice Inquiry that an influx of patients affected by the insidious drug was putting a drain on existing health resources.
Illawarra Shoalhaven Local Health District acting mental health director Adam Bryant said the region's mental health facilities were not specifically designed to care for amphetamine users - in particular users of crystal methamphetamine or ice.
However due to the fact that many ice users also had mental health issues, those suffering psychotic episodes were often treated in acute mental health facilities such as the high-care Eloura unit at Shellharbour Hospital.
Those who were being "acutely aggressive" due to their ice use, required increased sedation and longer medical monitoring in the ED before being admitted to a mental health unit.
"The most significant challenge for mental health services is the appropriate treatment location for patients who are acutely affected or withdrawing from (ice)," he said. "This has a significant impact on resources."
In a statement to the Commission, Mr Bryant said the behaviour impacted on all patients - and could increase the trauma experienced by other mental health patients.
"In my opinion, specialised treatment units meeting the consumer's medical, drug and alcohol and mental health needs are required," he said.
"An example of this model is the Psychiatric Alcohol and Non Prescription Assessment Unit (PANDA) at St Vincent's Hospital, Sydney."
The district's director of nursing for mental health, Wade Norrie, also called for a dedicated service model for patients to ease the impact on EDs and mental health services.
In his submission, Mr Norrie said "standalone or silo responses" to the issue were not appropriate - with an interdisciplinary response required.
"Current ED environments are not conducive to safe containment of these complex patients who require thorough assessment and management," he said.
"We historically have inappropriate areas within the ED to manage these patients with an expected length of stay commonly in excess of four hours."
Mr Norrie has experience dealing with ice-affected patients as a clinical nurse consultant at Wollongong Hospital's ED.
"Many patients acutely affected by (ice) have behavioural disturbances that can make assessment, care and safety challenging," he said.
"Agitation, aggression and physical health emergencies are all difficult presentations. Safety for both patients and staff is certainly a priority."
Meantime Shoalhaven Hospital's interim clinical director Dr Simon Tucker told the inquiry on Thursday that ice-affected patients could wait up to 12 hours in that hospital's ED before they were ready to be assessed.
"They quite often come in in a heightened state and need time cooling off before an accurate mental health assessment can be made," he said.
"...They need to be assessed as being competent and compliant enough to have that assessment."
Those delays could often escalate their condition, he said, and could lead to hospital workers sedating or restraining them for their safety and others.
Dr Tucker also said the "mental health room" in the ED, where ice-affected patients were often taken, was not the best environment for them.
He hoped that a more suitable area, close to security services, could be constructed during the redevelopment of Shoalhaven Hospital.
Users 'more violent, paranoid, agitated'
Ice leads to psychosis far sooner than other illicit drugs according to South Coast Police District acting commander Superintendent Kevin McNeil.
Supt McNeil told the NSW Government's ice inquiry that he first observed the use and effects of ice around 15 years ago, and had seen a substantial increase in its use in the past decade.
He'd also seem the damage caused by drug users switching from low purity amphetamine-type stimulants, and becoming addicted to the higher purity ice.
"The purity of drugs being seized in the late 90s was around five to six per cent," he said.
"The rise of that purity increased from about 2004/5 ... and we started seeing (amphetamines) getting towards the high purity levels of 40 to 50 per cent.
"With that we noticed that the people using amphetamines that went towards the more pure stuff, the behaviours became a lot different. ... (They became) more violent, paranoid, agitated and unresponsive to police commands.
"In the 80s and 90s ...for those using amphetamine-based drugs, psychosis didn't appear to occur until later in life and after prolonged use, whereas now it's quite clearly that the timeframe appears to have shortened."
In his submission to the inquiry, Supt McNeil told of the devastating impact of ice on the South Coast community.
"My experience and knowledge indicates that the use of prohibited drugs by an individual within a family can interrupt or even cause the total breakdown of that family unit," he said.
"The drugs that I have witnessed that have caused such turmoil, vary from cannabis to heroin however the impact of crystalline methamphetamine 'ice' has consistently introduced greater violence upon family members."
