Australia’s public psychiatric system is in slow and painful decline, with “profoundly disillusioned” psychiatrists leaving for private practice, senior specialists warn.
The “psychiatric breakdown of the public system” is driving away overburdened psychiatrists who were dedicated to treating some of the most vulnerable mentally ill patients, UNSW Scientia Professor Gordon Parker says.
The veteran public hospital psychiatrist and founder of the Black Dog Institute will call for urgent reforms to arrest “the slow death in quality” in public psychiatric care at the launch of the 2019 Australian Mental Health Prize at UNSW on Wednesday.
“The tipping point has been passed,” Professor Parker said. “The system has been under threat of deterioration in quality and sophistication of care for several years.
AdvertisementLoading
“My concern is that so many excellent psychiatrists who have worked in – and solidly contributed to – the public psychiatric sector are leaving or planning to leave the system and to take up more attractive jobs. Principally at private practice.”
The Herald and The Age have learned multiple senior psychiatrists have resigned or are planning to resign from a handful of Sydney psychiatric units within the year.
Other specialties have a shortage of training positions for their oversupply of trainee doctors. But psychiatry is struggling to fill positions with their demanding and unrewarding workloads.
NSW has a record 60 vacant training positions for psychiatric trainees, Professor Parker discovered.
“Trainees are rapidly falling away,” he said. "This is a canary in the coal mine signal."
“I see trainees and young psychiatrists … with a genuine commitment and wish to help those with serious psychiatric problems, who, over the next few years, become profoundly disillusioned.”
He described the stress of overstretched EDs where 50 per cent of up to 30 patients waiting for a psychiatric assessment should be admitted to the psychiatric units that are full to capacity.
Psychiatrists were “under tremendous pressure” to discharge patients before they were fully well to make room for new patients, Professor Parker said.
“[They] end their day aware that they were unable to find a bed for someone at high risk of suicide, that the depressed patient who needed close observation as their treatment unfolded has been prematurely discharged," he said.
“…that the patient who should have been discharged to public housing is now going to sleep rough and that their colleague assaulted by an ice addict may never return to work.
“It’s not surprising that the public system becomes a target for frustration, anger and complaints by those who experience or witness the system close at hand."
Professor Parker criticised the "exponential growth" in hospital middle managers and untenable amounts of paperwork. “Staff are therefore most commonly observed in their offices and nursing stations completing forms and thus having minimal therapeutic time with patients,” he said.
He said the pressure on acute psychiatric units could be reduced by up to 50 per cent by treating three key patient groups in other settings: forensic patients in forensic environments, drug-affected patients in separate facilities, and long-stay patients who cannot be discharged into the community should be treated in fit-for-purpose accommodation with constant care.
NSW chief psychiatrist Dr Murray Wright agreed that the loss of public sector psychiatrists was a serious national issue.
Loading
“It’s a very challenging environment and you’re dealing with a lot of risk. It can be a very heavy burden and really wear people down,” he said.
“But I don’t take the view that the system is a critical as Gordon describes.”
Nor did Dr Wright believe segregating patients was the solution.
“If we had some national windfall and could increase our resources then some of the pressures which are contributing to the dissatisfaction of the medical workforce could be addressed," he said.
“In the meantime, we are working to improve workforce conditions to attract and retain people."
The NSW Health Ministry and RANZCP are collaborating on a psychiatry workforce plan – in line with the state’s mental health workforce plan – to correct workplace culture, improve leadership and address the other drivers of burn out.
Last year, the Sydney Children's Hospital was forced to close its psychiatric ward for several weeks after its only consultant psychiatrist resigned and her position could not be filled. The ward had a long history of high psychiatrist turnover, grueling hours and heavy workloads.
Acting head of the UNSW School of Psychiatry Scientia Professor Henry Brodaty – who backed Dr Parker's concerns – said it was critical to acknowledge the individuals working tirelessly in mental health.
UNSW’s Australian Mental Health Prize is awarded annually to an Australian who has made outstanding contributions to either the promotion of mental health or the prevention or treatment of mental illness.
Nomination forms can be found at australianmentalhealthprize.org.au.
Applications close August 30.