Psychiatry: A system under siege

NSW is facing a crisis in mental health, as dwindling numbers of psychiatrists are left to care for increasing numbers of patients.

Depression is now the fourth highest cause of disability in Australia, and suicide claims twice as many lives as the national road toll.

In NSW, the number of mental health-related presentations to emergency departments increased by 76% between 2004-05 and 2017-18.

And while the burden of mental distress and illness is growing, the number of medical professionals available to help patients is in decline.

“By the time we recognise how serious the situation is, I am concerned we will have passed the tipping point and it will be too late to make the significant changes necessary to turn things around,” said Professor Gordon Parker, UNSW Sydney Scientia Professor of Psychiatry and Founder of the Black Dog Institute, when he launched the 2019 Australian Mental Health Prize at UNSW.

“Australia is a global leader in many areas of mental health including community awareness, public advocacy and innovative service delivery, but the pressures faced by mental health professionals in the public sector needs urgent attention,” he added.

The specialty is severely under-subscribed, with potential trainees turned off by an overburdened system.

NSW currently has 60 vacant training positions for psychiatric trainees.

“I see so many young psychiatrists enter the public sector with a genuine commitment and wish to help those with serious psychiatric problems but who become profoundly disillusioned. Psychiatrists and trainees in the public sector are often unable to find beds for patients at suicidal risk. They see patients who need close observation prematurely discharged or patients who are discharged into homelessness, rather than public housing.”

Professor Parker said it was not uncommon in public hospitals for up to 30 people to be waiting for an acute psychiatric assessment every day without adequate beds available, with mental health disorders one of the leading causes of emergency room delays.

Department of Health workforce projections indicate a future undersupply of 125 by 2030 for the psychiatry workforce.

The modelling is based on an anticipated 2% increase per year (from 194 in 2015 to 234 by 2030) on the first year intake to the program.

The projections also included the high reliance on overseas trained doctors (OTDs) continuing, with OTDs being projected at 55 new Fellows per year. To meet the expected undersupply projected by 2030, the new intake would need to increase from the projected 197 to 200 in 2016 up to 269 in 2025, which equates to an average annual increase of 3.3%.

The NSW Health Ministry and the Royal Australian & New Zealand College of Psychiatrists are developing a workforce plan to improve workforce culture and address burn-out.

Giving Hope

The 2019 Australian Mental Health Prize is a critical opportunity to recognise and acknowledge those working tirelessly in mental health, said Professor Gordon Parker, UNSW Sydney Scientia Professor of Psychiatry and Founder of the Black Dog Institute at the launch.

Chair of the Australian Mental Health Prize Advisory Group, Ita Buttrose, said the prize is helping to improve mental health care in Australia and ensure mental health stays top of mind for Australians.

“I would like to see this year’s prize highlight some of the world-class work being done in the field of mental health, to give hope not only to those with mental illness and their families, but other mental health professionals working in this challenging area.”

For more information or to nominate, visit australianmentalhealthprize.org.au. Entries close 30 August 2019.