It’s chaos out here ...

To the Editor

There is no doubt that there is a crisis in acute in-patient psychiatric treatment in Australia as evidenced by a recent commentary in Australian & New Zealand Journal of Psychiatry (ANZJP), ‘Intense pressure on the Royal Hobart Hospital (RHH) after psychiatric bed cuts’ (Benjamin et al., 2018).

But there is also a crisis in mental health treatment more generally, at both the state and federal levels. Why?

The decline began with deinstitutionalisation and was continued by mainstreaming. The monies saved in closing psychiatric institutions and moving (too few) beds into the general hospitals were to be redirected to effective community programmes, but this has largely not occurred.

There has been systemic demedicalisation of psychiatric care. We now call psychiatric care mental health care. The new Primary Health Network Advisory Committee on National Mental Health consists of just 3 psychiatrists and 13 non-psychiatrists. The widespread use of ‘consumer experts’ to guide mental health policy might appeal to the public but will not create the best outcomes for the health system.

Federally, the ‘Better Access Scheme’ commenced in 2006 and costs approximately AUD$0.83 billion per year Australian Institute of Health and Welfare statistics 2016-17 and is increasing. Despite high hopes, it has not improved mental health outcomes. There has been a 20% increase in Australian suicide rates over the decade 2006–2016 (ABS statistics 2016). Concerningly, most of the Better Access consultations occur in the most socio-economically advantaged postcodes (Meadows et al., 2015).

In my state, the federally funded ‘Primary Health Tasmania’ recently rolled out mental health programmes with minimal advice from psychiatrists, despite the local state branch of the Royal Australian and New Zealand College of Psychiatrists’ (RANZCP) best efforts to be involved.

Meanwhile, the virtual mental health space is bursting with non-governmental organisation (NGOs) advertising their mental health bona fides. Collectively, they create the grand illusion that much is being done for mental health, but their efficacy is questionable. In fact, I would propose a new rule, namely that the efficacy of a mental health service is inversely proportional to the number of NGOs working in that service.

It’s chaos: everyone’s an expert and there are more stakeholders than you can poke a stick at.

If ‘improving the mental health of the community by providing high-quality psychiatric leadership’ is a true aim of the RANZCP, it must step up, find its voice and be more active in promoting our profession and contributing to government policy. Then perhaps our patients would have a chance of receiving the quality treatment they deserve.