Severe psychiatrist shortage causing ‘rapid readmissions’

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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