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Severe psychiatrist shortage causing ‘rapid readmissions’


Michelle Wisbey


6/05/2024 4:14:41 PM

GPs are being overwhelmed with complex consults, as the workforce crisis leads to a ‘revolving-door situation in mental health inpatient units’.

Male patient sitting on hospital bed.
Psychiatrists report feeling pressured to discharge patients prematurely, leading to a revolving-door situation in mental health inpatient units.

As new data reveals psychiatrists are leaving their profession in droves, GPs have been left fearful for patients and their ability to connect to life-saving treatments.
 
According to a recent newsGP poll, 97% of the 1285 respondents said it is becoming increasingly difficult to access specialist psychiatric support for patients with complex mental health presentations.
 
At the same time, more patients than ever are reaching out to their GP for mental health support.
 
An investigation from The Australian has shed a light on the workforce crisis facing psychiatrists, revealing that as many as one quarter of all public sector psychiatry positions are ­vacant in some states.
 
It found that in New South Wales and the Australian Capital Territory, one in four specialist psychiatry positions in public hospitals are vacant.
 
The National Association of Practising Psychiatrists (NAPP) confirmed the investigation’s findings, saying the ‘severe workforce crisis’ is being caused by staff burnout, low salaries, and inadequate support.
 
It said that even when positions are filled, they are often taken on by locum psychiatrists, leading state and territory governments to spend hundreds of millions of dollars annually on short-term staffing arrangements.
 
‘The workforce crisis is negatively affecting patient care, with psychiatrists feeling pressured to discharge patients prematurely, leading to rapid readmissions and a revolving-door situation in mental health inpatient units,’ the NAPP said.
 
‘Without adequate staffing levels, hospitals are described as “just not functional”, posing safety risks for patients.’
 
Dr Cathy Andronis, Chair of RACGP Specific Interests Psychological Medicine, said this crisis has trickled down to general practice, with many GPs now treating complex mental health conditions.
 
‘It is extremely concerning that psychiatrists are leaving the public sector as this has been happening for many years already and is now critical,’ she told newsGP.
 
‘When patients are unable to access public services, the onus falls onto GPs predominantly and our current MBS system is poorly suited to complex mental health patients who require time and other supports that usually involve significant out-of-pocket expenses. 
 
‘The system is broken.’
 
The shortage comes as Australians of all ages battle through a mental health epidemic, with rates of loneliness and psychological distress skyrocketing.
 
In 2021, in the midst of the COVID-19 pandemic, 42% of people aged 15–24 were psychologically distressed, up from 18% a decade earlier.
 
Between 2007 and 2021, the overall prevalence of psychological distress increased by 51% for men and 63% for women.
 
Meanwhile, 2021–22 saw more than 205,000 mental health-related overnight hospitalisations within the public sector.
 
In the past decade, these overnight stays have increased by 10% in the public system and 22% in private hospitals.
 
However, Dr Andronis said psychiatric crisis care in the public sector is minimal due to too few beds and too many patients in need.
 
‘They are not staying anywhere near long enough to have a thorough assessment and multidisciplinary plans,’ she said.
 
‘Many patients are left destitute and homeless as a result … outpatient treatment is almost non-existent as well, perpetuating the problem.’
 
But at a time when specialist services are more needed than ever before, the workforce shortages show no sign of easing.
 
A recent report from the Royal Australian and New Zealand College of Psychiatrists (RANZCP) found 93% of Australian psychiatrists believe the current workforce crisis negatively impacts patient care.
 
Additionally, of the 1269 members responding to the college’s nationwide survey, around 30% said they are considering leaving the profession in the next five years.
 
Dr Andronis said although the workforce crisis is not new, government action has been ‘frustratingly slow’.

‘We are seeing many high-need, complex patients in desperate states with few supports, and social isolation and poverty are major challenges,’ she said.
 
‘The state–federal divide is a major contributor to this parlous state with the NDIS servicing too few patients, sometimes poorly, and the states axing good psychiatric community services in the hope that the NDIS will take the load.
 
‘Too many psychiatric patients have been abandoned by our public health system – it is unfair and inequitable.’
 
The RACGP is calling for next week’s Federal Budget to include a 20% increase to Medicare rebates for general practice mental health items, as well as funding for longer consultations.
 
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Dr Shanthini Seelan   7/05/2024 8:25:02 AM

This scenario is only too true and despite being the largest health workforce in the nation , primary care professionals are groaning under the burden of having to deal with every discipline of medicine there is .Mental health has long been a major domain in G P land as we always take it into consideration when looking after our flock . Having to rely on the speacialists is fast becoming a farce as appointments with a private psychiatrist now is at least 2-3 mths away , they seem to have prized themselves out of existence with fees ranging in the high three digits . All this while trying to treat extremely vulnerable individuals who are sick , unemployed and simply have no money ! The public system is overwhelmed and understaffed . Only solution is bolster Prinary Care services both with training and remuneration and as usual we will always rise up to the challenge .


Dr Sanjeevan Nagulendran   7/05/2024 9:42:39 AM

The WHO data show Australia has double the suicide rate of the UK. This is a shameful statistic. There could be training issues that may explain this. If one looks at the mental health syllabus of the RACGP vs RCGP there seems to be some big differences. I have over 300 ADHD patients and most have been misdiagnosed or received a delayed diagnosis of ADHD many being labelled as anxiety etc despite having seen many GPs and psychiatrists. Some cannot get a diagnosis as they do not have the funds. The health services union report says the health system is 'completely out of wack' with many doctors actively avoiding treating complex patients and that a royal commission is required. The training of GP's and psychiatrists may not be meeting the requirements of the current mental health pandemic given what happened in Bondi with system redesign and review of training as well as culture in the Australian workforce likely required. Lack of money may not be the sole reason.


Dr Murray John Schofield   12/05/2024 11:01:37 AM

Much appreciated update....but the bone always seems to be pointed at governments for not listening of being progressive enough.
May be a proactive solution for long term and sustainable community mental health management could be a programme to develop GP's to have a dedicated sub-speciality as a Para-Psychiatrist. This would say involve a dedicated intensive for GP's to undertake as a collaborative developed programme between the college of Psychiatrist, the RACGP and a national University and include a bursary as a student not dissimilar to an honours/PhD type programme which could be conducted over say a 1yr period and at successful completion as a Para-Psychiatrist we as GP's could have dedicated sessions (with uplifted/new medicare item numbers/or equivalent State health creditialling value) during a week for mental health patients who need ongoing review or have been recently discharged. The solutions are there we juts have to lead. thx


Dr Murray John Schofield   12/05/2024 11:08:26 AM

Thx for the update....with an ongoing and complex problem.
We need to become qualified as para-psychiatrist....this could easily be enabled with a collaboration (between RACGP/College of Psychiatrists/one national university/federal and state governments) with a dedicated, bursary funded short and intense course of say 1yr to be qualified and...to allow us to be effective with this ongoing and enlarging health issue. Once doing this dedicated say 1-2 sessions/ week work there would be comparable medicare rebate for these dedicated tasks. WE MUST BE THE LEADERS AND INNOVATORS IN THIS SPACE....happy to talk with any upfront mouth piece.