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For almost two decades, the Australian Medical Association’s Public Hospital Report Card has tracked the health of our public hospital system, and in the past four years, dedicated mental health editions of the report have highlighted the unique challenges patients face when accessing mental healthcare in public hospitals.
This year’s mental health edition paints a stark picture: Australia’s mental health system is at breaking point, and the consequences are being felt in emergency departments and communities across Australia.
As a general practitioner, I know firsthand how vital it is to have a connected and well-functioning mental health system. In my practice, I see the significant burden of mental illness every day — from early, mild symptoms to chronic and complex conditions.
I wish this report showed something new. But sadly, as in previous years, it highlights logjams on the way into and out of mental health units. Despite the tireless efforts of our doctors, nurses, and allied health professionals, patients in acute mental health crisis are waiting far too long for care. In 2023–24, the median wait in emergency departments for patients with mental health conditions requiring admission was more than seven hours. Even worse, the data shows that about 10% of the patients who are eventually admitted to a mental health unit spend more than 23 hours in ED.
The problem is systemic. We have just 27 specialised mental health beds per 100 000 people, which remains the lowest per-capita capacity on record. At the same time, demand is soaring; mental health-related ED presentations have risen 67% over two decades, and the severity of cases is increasing. More than half of these presentations arrive by ambulance or police vehicle.
Behind every statistic is a person — a teenager in crisis, an older Australian grappling with dementia, a parent overwhelmed by depression. These are people in acute distress, often at their most vulnerable, and our system is failing them. And behind every patient is a healthcare team stretched to breaking point.
Emergency departments are life-saving but are not designed for mental health care. They are bright, noisy, and overwhelming environments. For someone in crisis, these conditions can escalate distress, agitation, and even violence. Staff are doing their best, but they are working in spaces that were never intended for this type of care.
Community resources play a pivotal role in reducing the need to visit the ED in the first place. Properly resourced general practice and community mental health services — including child and adolescent health services, older persons mental health services, and acute care teams — are critical to reducing hospital presentations. Growing demand and under-resourcing have led to clinically unacceptable waiting lists for many of these services.
There is a significant bottleneck resulting from reducing the availability of mental health beds; bed blockages occur due to a shortage of appropriate community services to discharge patients to safely; and the lack of interoperable electronic patient records or smooth communication across care settings results in time-consuming administrative burdens. For many of these reasons, patients are waiting in the emergency department far longer than clinically appropriate — compounding an already difficult situation.
The AMA is calling for bold, coordinated reform. Our four-point plan is clear: improve performance by reintroducing targeted funding to reduce ED and elective surgery wait times; expand capacity by funding more beds and staff; invest in community care to strengthen out-of-hospital alternatives; and increase funding by lifting the federal contribution and removing the artificial growth cap so funding reflects real-world health needs.
Governments have a crucial opportunity with the next National Health Reform Agreement. Gone is the time for piecemeal solutions — Australia requires lasting reform. We need a system that supports prevention and early intervention, that ensures smooth transitions between hospital and community care, and that values the wellbeing of healthcare workers as much as the patients they serve.
If we fail to act, the consequences are clear: worsening hospital logjams, rising suicide rates, and a workforce in crisis. If we act now, we can build a system that delivers timely, compassionate care — and restores hope for patients and clinicians alike.
Dr Danielle McMullen is the President of the Australian Medical Association.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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