The Australian mental health crisis – A cautionary tale for developing nations
Prof Philip Morris
MB BS BSc med PhD FRANZCP FAChAM (RACP) ABPN
Consultant Physician in Psychiatry
Bond University, Gold Coast, Australia
Australian and New Zealand Mental Health Association
Gold Coast Medical Association
Is Australia a good example of providing mental health services?
Since the mid 1990s Australia has had many national mental health plans
It has a national health insurance scheme – Medicare – all citizens are covered at a basic level
Compared to other countries Australia is a wealthy nation and can spend money on mental health
But is it an example to follow?
Australia has a mental health crisis
Despite national plans and commissions of enquiry major problems remain
Suicide numbers continue to increase beyond population growth:
2004 – 2098 suicides; 2017 – 3128 suicides – a 49% increase
During this time the population of Australia has increased:
2004 – 20.1 million, 2017 – 24.7 million – a 23% increase
Behind Estonia and the USA, Australian has the third highest rate of increase in suicide deaths from overdose between 2001 to 2015
Although stigma and discrimination has reduced for individuals suffering from depressive illness, individuals with schizophrenia remain less understood and an ‘outcast’ group
Mental illness remains a barrier to employment
Despite multiple national mental health plans and a decade of changes to public mental health services, concerned individuals and patient support groups are saying that the care of mentally ill individuals is a disgrace
Recent reports condemn widespread emergency department access block due to lack of inpatient beds for psychiatric patients and condemn the prolonged treatment of psychiatric patients in emergency departments
This results in inappropriate care and violations of human rights for these patients
In response to another proposal for a royal commission into mental health in Victoria, two senior academics complained that there have been too many enquiries but not enough action on these enquires’ recommendations
But do not just believe me!
Two senior colleagues from Sydney – Prof Gordon Parker and Prof Henry Brodaty in late May this year have raised the same concerns
‘Impending breakdown of public psychiatry in Australia’
More and more senior psychiatrists leaving, and a recent decline in interest of younger doctors to train in psychiatry – causes critical psychiatrist shortage
Work pressure – too many emergency department assessments, 90% acute presentations, 50% require hospitalization but no beds, up to days spent in emergency departments, pressure to discharge rapidly before patients are well, too much paperwork (computer data entry), psychiatrists forced to ‘cut corners’ – leads to demoralized, disillusioned, burnt-out doctors!
No rural-based psychiatrists, rural regions serviced by fly-in doctors are now also resigning
Psychiatrists leaving to join private hospitals or early retirement
Private hospitals admit insured patients – very different caseload – more motivated, less violent
Suggestions for improvement
Need immediate actions – not just another macro mental health plan or enquiry
Remove micromanagement of psychiatrists, eliminate excessive documentation
Forensic patients to be admitted only into forensic units, not general units
Acute ICE induced psychotic patients into alternate facilities
Residential clinical units needed in the community for long-term patients
‘One size does not fit all!’ – Challenges ‘mainstreaming’ ideas
So, is there anything developing countries can learn from Australia?
We can learn from not repeating the mistakes made in Australia
Stop closing mental hospitals – reform them instead – can this apply to local facilities
Establish 24-hour clinically supervised long-stay residential units in the community with embedded rehabilitation services
Stop rationing inpatient treatment – provide needed inpatient beds and community residential rehabilitation care (step up and step down)
Rewrite mental health acts based on ‘least restrictive treatment’ and ‘patient autonomy’ that have operated to deny patients access to treatment – across the world new ‘least restrictive treatment’ mental health acts are associated with increased suicide rate – in a way that puts the patients’ clinical needs first
Stop ‘mainstreaming’ of mental health services – this denies the unique needs of individuals suffering from mental illness – opt for a ‘parallel but integrated (with general health services)’ model
Treat mortality statistics and suicide rates (national suicide toll) as an index of the access, equity, and quality of mental health services – use audits of mortality and suicide to enhance accountability
To prevent mental illness (especially the ‘high prevalence’ conditions like depression, anxiety disorders and substance abuse) – Focus on improving the quality of the relationship between the developing child and his or her main carers from conception to age 5
Strong, secure, and trusting emotional attachments or bonds lead to better-coping skills, greater resilience, and a higher threshold for developing mental illness
This applies to developing or developed countries, to those with black, brown, yellow or white skin, and to all ethnicities and cultures
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