Mental health care is heading towards a crisis in NSW with one quarter of the state’s psychiatrists considering leaving the public system this year because of “grossly inadequate” resources and low morale. The exodus comes amid allegations that some local health authorities are systematically siphoning off mental health resources and refusing to fill key clinical positions so money can be diverted to other areas. Sources have told Fairfax Media that immense pressure being exerted on resources, particularly in some rural areas and parts of western Sydney where needs are greatest, with people suffering acute psychiatric crises often left without help until the problem escalates and police are called. However, the government said it takes the problem extremely seriously and has introduced ongoing auditing to prevent the diversion of funds. Paul Fanning, who worked as a director of mental health services in NSW for 23 years, said local health districts had been forced to find efficiency savings at the same time as improving treatment times. “To me there is a straight-line relationship between the financial state of the districts … and the degree to which mental health is impacted,” he said. “Where we mostly see that is in community mental health services … where an enormous amount of work is needed in following up on people when they are discharged from hospital and doing early intervention work so things don’t escalate into a crisis.” In its inaugural report last December, the Mental Health Commission said if the siphoning of funds away from mental health services was not addressed within two years it would consider asking the government for independent auditing powers. The commission, which started in 2012, was set up by the NSW government to advise on how it should improve mental health care across the state. No-one knows exactly how much money is being lost, although one 2009 report seen by Fairfax Media estimated so called budget “leakage” could be as high as $20 million annually.
Survey of psychiatrists paints ‘grim picture’
Doctors’ groups were so concerned they surveyed the state’s psychiatrists, with the interim results showing more than half believe resources have decreased over the past year and a third say they are “grossly inadequate”. One quarter are likely to leave the public sector this year if nothing changes. AMA councillor and psychiatrist Choong-Siew Yong said it painted a grim picture, and more needed to be done to ensure psychiatrists were included in the health district decision-making so they could protect resources. “Psychiatrists look after some of the most vulnerable groups in the state … but historically mental health has had less funding in relation to need and there is still a huge catch-up to do”. The exclusive survey of more than half the psychiatrists in the public system – 250 doctors – undertaken by the NSW branches of the AMA, the Australian and New Zealand College of Psychiatrists and the Australian Salaried Medical Officers’ Federation, also found 44 per cent of doctors believe positions are deliberately left unfilled and one third believe the number of doctors employed in their area has declined. Dr Yong said the scale of the problems varied from district to district, but more resources were needed everywhere to improve morale.
Lack of transparency around budgets, lack of services in some areas
Alan Rosen, a professorial fellow at the University of Wollongong and a clinical associate professor at the University of Sydney’s Brain & Mind Research Institute, said he believed tens of millions of dollars that could be spent on community workers and other treatments was being siphoned out each year, often through excessive corporate fees and charges, with the problem increasing in some areas after greater control was given to local areas over budgets. “If we don’t do something we are going to end up with an inquiry into the disasters,” he said. “It’s time for the government to act”. The differences in approaches between local health districts also meant a person’s ability to access services could depend simply on where they lived and what time of day they became sick. “In NSW we do very little consistently and on an equitable basis around the state, and based on the building blocks of evidence,” he said. “We don’t even have out-of-hours crisis teams in every catchment … Crises occur maybe a third of the time in weekday periods, a third at night and a third on the weekend, so you need your crisis teams to work 7 days a week, 24 hours a day.” Last month Fairfax Media revealed the number of people with mental illness dealt with by police had grown massively over the past decade, with a lack of mental health services in the community partly to blame. However, the director of mental health and drug and alcohol for NSW Health, Peter Carter, said major costing reviews were undertaken twice yearly to examine corporate charges. He said that over the past three years corporate and other related costs have ranged from around five to six per cent, although he acknowledged there was “volatility” between districts the ministry was trying to abolish. However, Professor Rosen disputes the figures, saying it does not accord with what he has heard from clinicians working in the area.
Ministry aware of the problem, and trying to fix it
The Ministry of Health says it is working hard to fix the problems, including recruiting more staff in areas where it has been hard to attract qualified people. The chief psychiatrist of NSW, Murray Wright, said the ministry took the staff survey very seriously, and he intended to discuss the issue further with the staff professional bodies and follow up with individual districts about any concerns. “Local health districts have assured me that they are implementing recruitment strategies to deal with what are, in many instances, long-term challenges in recruiting and retaining skilled psychiatrists.” Minister for Mental Health Jai Rowell said since its election the government had ensured mental health budgets were listed separately in service agreements with the local health districts. “The NSW Government is committed to meeting community need for mental health care services,” he said. “This financial year alone the NSW Government invested $1.62 billion in mental health – a record spend on our state’s mental health system.”
This article first appeared The Sydney Morning Herald, 9 March 2015.