Introduction by Croakey: Much of the discussion about the resignation of public sector psychiatrists in New South Wales has obscured wider inequities in mental health – most especially that the burden is carried by the least privileged in Australian society, writes Giancarlo de Vera, CEO of BEING Mental Health Consumers.
In the article below, de Vera calls for long-overdue reform and investment in community mental health supports based on the principle that “access to mental health support should not depend on how much money you have”.
Meanwhile, the NSW Industrial Relations Commission has scheduled a five-day hearing from 17 March to arbitrate the dispute over psychiatrists’ pay claims.
Giancarlo de Vera writes:
The recent mass resignations of public psychiatrists in New South Wales have spotlighted psychiatrist pay disparity across Australia.
However, the NSW mental health crisis is far more than a mere pay dispute; the pay dispute reveals a deeper systemic neglect caused by inaction and chronic underinvestment in the NSW mental health system that demands urgent attention.
Resolving this crisis requires more than pay parity. Fixing the mental health system requires much bigger political ambition and will, to drastically overhaul the mental health system.
Mental health support should be seen as a fundamental social good. When most long-stay patients in psychiatric hospitals were de-institutionalised in the 1980s, their funding should have been reallocated to community-based supports so the people leaving institutions could live well and with dignity in the community. But that didn’t happen.
Instead, as mental health issues affected more and more people in society, successive governments have failed to correct this historical wrong of ignoring their responsibility to fix the systems that drive mental health issues, leading to systemic neglect and chronic underfunding of a mental health system designed for those most at risk.
Making things worse has been the lack of coordination between the states and territories and the Australian government, which are jointly responsible for mental health.
At the same time as societal awareness of mental health improved, the prevailing social narrative framed mental health as the problem of the individual, paving the way for stigmatisation of those with mental health conditions, despite health research pointing to factors outside of an individual’s control such as the environment, genetics, social determinants of health and the ongoing impacts of colonisation.
Rights matter
It should go without saying but it needs to be said: if a person has their basic human needs met, with stable employment, housing, strong and vibrant connections to community and accessible healthcare, then that individual is far less likely to experience mental health issues.
The World Health Organization articulates a number of key social factors that are determinants of mental health. These include income and social protection, unemployment, working life conditions, food insecurity and housing amongst others. Just this year the Australian Institute of Health and Welfare (AIHW) has also supported this view. They note that every step up the socioeconomic ladder is accompanied by health benefits.
It is unsurprising then that, as security in these basic human rights has eroded, the mental health system has become increasingly strained and stretched.
Currently, AIHW research shows mental health represents 15 percent of the burden of disease in NSW but only receives five percent of overall NSW Government healthcare funding.
While the NSW mental health system operates on a third of the budget it should, access to it has become increasingly unequal. In a 2021 study of income levels and health inequity, the Australian Council of Social Services showed that people whose household incomes were in the bottom half of the population had significantly worse levels of mental health than those with higher incomes (read more here).
The regrettable truth is the burden of mental health issues is carried by the least privileged in Australian society, an issue almost entirely missing in the recent debate about the mass psychiatrist resignation.
If you have money, mental health support is still available if you can pay private sector rates, while those who rely on public health are left to try their luck with the very small number of bulk-billed psychiatrists, facing long waits, if you can get an appointment at all.
Access to mental health support should not depend on how much money you have.
Ongoing mental health supports and psychotherapeutic services, including psychiatry, can mean the difference between staying well and functioning and contributing to society or involuntary hospitalisation, the denial of legal capacity, human rights abuses including the deprivation of liberty, and coercive medical interventions – all sanctioned by our laws, and propped up by a chronically underfunded public health system.
These diametrically opposed lived realities exist because mental health has not been viewed as a fundamental social good following deinstitutionalisation.
It’s been easier for successive governments to pass the buck, skirt around the edges, or blame individuals – and often treat individuals as criminals – not as products of a system that has let the individual down.
Perhaps more importantly, these diametrically opposed lived realities also exist because there has been the lack of political vision, will and leadership to reform a system in crisis.
Clarion call
To fix the mental health system in NSW we need to see consumers at the forefront of reforms, alongside strong political ambition and leadership.
Consumers will tell you that a better service mix which makes more use of peer-run services and more accessible community mental health services is needed. We need to see increased investment in alternative models of care that promote prevention and the ongoing wellbeing of consumers, while recognising human rights and the role of social determinants like secure housing and employment in reducing mental distress.
This must include non-clinical alternatives to clinical mental health services, and the better use of alternative community-based and peer-led supports to prevent people having a mental health crisis in the first place.
As part of the Towards Zero Suicides program, NSW Health has already begun piloting a network of peer-run Safe Haven mental health drop-in centres across NSW. These alternatives have been a great success, with a recent NSW parliamentary inquiry into mental health services recommending further funding to expand the network (see recommendation 27).
As part of the ongoing reform of the National Disability Insurance Scheme, National Cabinet agreed to bring online community mental health delivered by, as well as co-funded by, the states and territories by the start of the next financial year.
Now is the time for reform.
With billions potentially being injected back into state and territory budgets to bring online community mental health, it’s time to correct the failures of the past and reallocate funding that should have been redirected following deinstitutionalisation back into community-based supports.
Mental health is not a luxury – it is a cornerstone of a just and compassionate society and is fundamental to a productive and well-functioning economy.
Let us not allow this psychiatrist mass resignation to deepen the crisis but view it rightly as a clarion call to create a mental health system that the people of NSW deserve and have been deprived of for far too long.
Author details
Giancarlo de Vera (they–them) is CEO of BEING Mental Health Consumers, the peak body representing consumers living with mental illness in NSW. They are an award-winning human rights lawyer and disability and racial justice advocate who has represented Australia at the United Nations multiple times.
Further reading
Statement by Sane Australia: “This current situation will have severe consequences for all NSW residents but particularly those living with mental illness, as well as for their carers, families, and communities. Access to psychiatry has been a major community concern for many years, with long waiting lists and escalating costs in the private sector driving people into already stretched public services.
“It will also worsen the already critical shortage of mental health professionals in NSW, leading to longer waiting times, reduced access to services, and a decline in care quality and continuity. Vulnerable groups, including those with severe mental illnesses, disabilities, and disadvantage, will be the most affected.”
The Guardian (21 January): Wards in NSW’s largest psychiatric hospital close as mass resignations begin
ABC News (21 January): Former NSW psychiatrist says public mental health system ‘on the brink’, amid mass exodus from today
ASMOF NSW statement (21 January): Premier missing in action as negotiations stall
AAP (20 January): Last-ditch bid to stop psychiatrists quitting en masse
The Conversation (17 January): What should I do if I can’t see a psychiatrist?
RACGP, GP newshub (13 January): Concern psychiatrist walk-out will trigger mental health crisis
RANZCP update (10 January): Update on New South Wales workforce issues
Support services
Lifeline: 13 11 14 or text 0477 13 11 14 for 24/7 crisis support and suicide prevention services
13YARN: 13 92 76
The Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention (CBPATSISP)
Suicide Call Back Service: 1300 659 467
Kids Helpline: 1800 55 1800
MensLine Australia: 1300 78 99 78
Beyond Blue: 1300 22 4636
QLIFE: 1800 184 527
StandBy Support After Suicide: 1300 727 247
headspace: 1800 650 890
See Croakey’s archive of articles on mental health matters