The Australian Government’s new mental health workforce strategy must be implemented urgently according to the Royal Australian and New Zealand College of Psychiatrists, with health professionals interviewed for InSight+ saying our country’s psychiatric workforce is in “crisis” and cannot meet the needs of Australians.
Two in five Australians aged 16–85 years have experienced a mental disorder in their lifetime, according to statistics released earlier this month (here).
It’s prompted the Royal Australian and New Zealand College of Psychiatrists (RANZCP) to declare that the existing psychiatry workforce cannot support the mental health needs of Australians.
“Right now, the mental health system is fragmented, under-resourced and unable to keep up with the burgeoning demand for mental health support,” said Dr Elizabeth Moore, RANZCP President said.
“We also have a critical and chronic shortage of psychiatrists. As a result, many Australians, particularly those in regional, rural and remote areas, and First Nations people, are going without the mental health care they need.”
The College said the solution lies in the government implementing the recommendations of the Australian Government’s Mental Health Workforce Strategy.
The strategy, released on 10 October 2023, has four pillars:
- attracting and retaining Australia’s mental health work force;
- aligning the skills, availability and location of mental health professionals with the needs of consumers;
- appropriate investment to improve workplace cultures by reducing administrative burdens, addressing the causes of stress and burnout, and improvement employment stability and remuneration; and
- removing barriers to the mental health sector so different teams can access data, and improving the use of digital technology.
Multiple issues blocking supply of psychiatric services
A number of systemic issues are reducing Australians’ access to psychiatrists, said Associate Professor Jeffrey Looi, the head of the Academic Unit of Psychiatry and Addiction Medicine at the Australian National University and Federal Council representative for psychiatry for the Australian Medical Association (AMA).
“The reason that there’s a shortage of psychiatrists is there’s a shortage of health care workers internationally,” Professor Looi said.
“The shortage existed even before the [COVID-19] pandemic. This means there are fewer psychiatrists in public and private health care to train junior doctors. This in turn decreases their ability to provide timely and accessible psychiatric care, leading to increased waiting times, shorter care episodes, and shortfalls in follow-up.”
“When there is demand, our trainees will be asked to do more work, which won’t help with their training. All of this makes working in those environments less attractive.”
The funding from the Australian Government is often insufficient for the state governments to provide enough services, he said.
“This is something that Australia has struggled with for more than 30 years,” Professor Looi said.
“There’s no easy solution, other than having to look at how we do work differently.”
A system in crisis
Greater investment in the public sector may help improve the problem, Professor Ian Hickie said, who is co-director of health and policy at the Brain and Mind Centre at the University of Sydney.
“We’ve had a shortage for a long time, but now we have a crisis,” Professor Hickie said.
“We have solutions at hand. They’re multifaceted, and they’re politically difficult. The public sector part must change. [It needs] more services, but better services.
“This means working with other disciplines. We’ve got to look at investments in the public sector doing more of these assessments.
“For example, assessments for ADHD [attention-deficit/hyperactivity disorder] that you might have to pay $1000 for; if that could have been done through a public hospital for free through a training registrar, it would be much more equitable. Rather than entirely outsourced to the private sector, and therefore restricted to those who pay the most.”
Community programs take a different approach
Some community health organisations are looking at providing psychiatry services in a different way.
The Primary Care Psychiatric Liaison Service (PC-PLS) model supports general practitioners (GPs) to provide psychiatric services both to assist GPs and to see patients who can bulk bill their services. The program also offers GPs access to psychosocial support through peer workers.
“Many people live with severe and complex mental health issues and don’t have good support systems in place. This program tries to do a bit of early intervention,” said Mr O’Brien, the general manager of services at Flourish Australia.
“The PC-PLS program has four objectives:
- to build the capacity of GPs to provide mental health treatment, because they see patients who have coexisting physical and mental health issues;
- to increase access to bulk-billed psychiatric assessments and consultations;
- to create a collaborative decision-making process with GPs, carers and family members; and …
- to increase service coordination within underserved communities in Western Sydney.”
The model is based on similar models trialled in New Zealand, such as the Kia Haha: Manage Better, Feel Stronger program, Mr O’Brien said.
“GPs are time poor and they’re supporting people who experience severe and complex mental health issues, such as schizoaffective disorder and bipolar disorder,” Mr O’Brien said.
“GPs have training. But we also had feedback saying, ‘We want to help this person, but it’s beyond our skill set.’ So having psychiatrists available helps.”
Flourish employs one psychiatrist who works part time with 11 general practice clinics. The psychiatrist also runs a private practice.
“We were originally funded to have a full-time psychiatrist, and we had two employed part time,” Mr O’Brien said.
“But the other psychiatrist chose other work. As you know, psychiatrists are ‘as rare as hen’s teeth’.”
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