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PSYCHIATRISTS have sounded the alarm about Australia’s low number of acute psychiatric beds, calling on policymakers to urgently tackle this “huge national problem”.
In a Perspectives article published today in the MJA, Dr Stephen Allison, of Flinders University, and Dr Tarun Bastiampillai, of the South Australian Health and Medical Research Institute, said Australia’s comparatively low numbers of acute psychiatric beds could block access for mental health patients when the risks of suicide and aggression were at their highest. (1)
They cited an Organisation for Economic Co-operation and Development (OECD) report that ranked Australia 26th of 34 countries in terms of hospital psychiatric beds per 100 000 population. In 2013, Australia had 29 fewer beds per 100 000 than the OECD average.
They also noted that Australia’s 30-day readmission rates were high in comparison to other OECD countries.
The authors’ call came after the federal government released its response to the National Mental Health Commission (NHMC) report on the Australian mental health sector. (2)
The NHMC had called for a shift in federal expenditure away from acute illness and crisis towards primary prevention, which the government said it supported in principle.
However, the government said “hospital funding should reduce over the medium to long term through embedding early intervention in mental health reform and better planning and targeting primary and community care services”.
Professor Malcolm Hopwood, president of the Royal Australian and New Zealand College of Psychiatrists, said the college was supportive of the NHMC’s intent to improve community and early intervention services, but not at the expense of inpatient services.
“We really shouldn’t see inpatient mental health care inherently in a negative light. It is a vital part of good mental health care when it’s needed, just as it is in other areas of medicine and it should be appropriately supported”, Professor Hopwood told MJA InSight.
“I am very supportive, where possible, of attempts to intervene early and prevent the development of severe disease. However, our capacity to prevent severe disease currently does have limits and it’s very difficult to imagine that we’re not going to continue to require acute inpatient mental health care for the foreseeable future.”
He said the multilayering of federal and state funding added to the integration difficulties in the mental health care system. “We would certainly be encouraging the states and territories to not reduce their funding of the acute inpatient and acute mental health sector.”
Professor Hopwood said the comparison of bed numbers per capita was not necessarily indicative of inferior mental health services.
“To some degree, this reflects that Australia’s community mental health care system is better than many OECD countries and it’s a good balance in many ways. We would prefer to treat people in the community where possible”, he said.
“But both elements of that system continue to need development and further funding. We still spend considerably less as a proportion of [gross domestic product] on mental health care than mental health care-related disability costs us.”
Professor John Mendoza, adjunct professor of health and sport science, University of the Sunshine Coast, and director of ConNetica, welcomed the government’s approach to mental health funding following the NMHC’s review.
“The Commission proposal is to move growth funding of approximately $1 billion over 4 years, starting in 2017-2018, to community services. Beds will not close as some have claimed”, he said, adding that shifting resources from acute to community care was supported by all mental health commissions.
“We need to be alert to sectional interests who do not want to see this happen”, Professor Mendoza said.
Dr Caroline Johnson, a Melbourne GP and board member of Mental Health Australia, said she was in favour of the spending pendulum swinging more towards prevention and early intervention.
“When I see a patient who needs specific types of care — like additional support from a mental health nurse or a consultation liaison opinion from a psychiatrist in the community — and I can’t get those things, I can see that patient is likely to get worse and reach a point where a crisis is more probable”, Dr Johnson told MJA InSight.
“For most patients with a mental health problem, the majority of their care should be able to be delivered in the community, and yet most of the money is going in the other direction.”
Geoff Harris, executive director of the Mental Health Coalition of SA, said the NMHC was proposing a long-term, system-wide reform to support people to get well, stay well and thereby minimise their use of emergency and acute care services.
“It is well established that if you can provide better care earlier and support people to avoid or reduce acute episodes then this has lifelong benefits of reducing the burden associated with mental illness”, Mr Harris said.
(Photo: XiXinXing / shutterstock)
These poor people were dumped on the streets by Whitlam, with nothing to defend themselves, huddling together in low doss houses etc to survive, as they often have to do to-day. They are at the mercy of greedy landlords, robbery, assault and the like.
Acute pychiatric breakdown is a medical emergency, completely out of the league of our poor harried police force.Modern psychiatric medicines, if taken properly and regularly ,can render a schizophrenic patient perfecly normal and employable, if he takes his medecine(s) ! This does not happen in the dumps they are forced to live in, of necessity. Where are those wonderful havens these poor people need to survive and live near-normal lives, where their medication is properly administered and monitored?
One more thing puzzles me about the preventitive side of psychiatric practice, is that dementia praecox (premature dementia or schizophrenia in the younger patient) can largely be prevented by regular ingestion of omegas in the teens etc ? put it in the water supply, bread etc. If this is true, then why isn’t this being instituted.
This is no surprise at all. Prior to the 1970s there were as many psychiatric beds available in the Australian hosptial system as there were medical/surgical beds. The ALP under Mr Whitlam decided that this was totally unacceptable because of abuses recorded in a number of psychiatric establishments around the country e.g. Townsville. Along with the usual cavalcade of political fellow-travellers and legal activists, it set about instituting the closure of virtually all of these units accompanied with lavish promises of financial support to establish halfway houses and extended in-community care services and facilities for these unfortunate ill people. Virtually none of that eventuated of course and like almost all political social engineering enterprises by governments, the promises only lasted as long as it took state governemnts to make windfall profits by flogging off these buildings and land to developer friends who in turn made vast profits. This process of divestment lasted about one to two terms of office by the respective state governments with nothing significant put in place to meet patient needs. We now see that police cells and the prisons are our default homes for large numbers of these ill people with large numbers of homeless people this policy’s true legacy. The statistics supplied in the article clearly reflect the revolving door model of ”care” that by neccessity now passes for the governmental response to psychiatirc illness in Australia. No long-term beds exist anymore in any degree. “The road to hell is paved with the best intentions.”
Merry Christmas to all readers as we celebrate the birth of a very well-known and revered individual who turned water into wine.