The $2.3 billion commitment to mental health in last week’s Federal Budget has been widely welcomed as a major step towards fixing Australia’s broken mental health system but the task ahead is huge and exacerbated by the ongoing stresses of the COVID-19 pandemic.
Many of the issues at stake for psychiatrists, from critical workforce shortages and inequities through to the existential crises of the pandemic and climate change, will be on the agenda at this week’s Royal Australian and New Zealand College of Psychiatrists (RAZCP) 2021 Congress.
Croakey’s Dr Amy Coopes and Jennifer Doggett will cover the event for the Croakey Conference News Service. You can follow their tweets at @coopesdetat and @croakeynews and join the discussion at #RANZCP2021.
Coopes previews the discussions below.
Amy Coopes writes:
In a year defined by uncertainty, isolation and grief, our mental health has been tested in new and perhaps unprecedented ways, and we are only now beginning to see the first aftershocks in a system already stretched to capacity to respond.
The impact of the COVID-19 pandemic on mental health will be the focus of talks at this week’s annual congress of Australian and New Zealand psychiatrists in Hobart, a COVID-era hybrid event offering a mix of live and live-streamed content for some 800 in-person attendees and hundreds more tuning in virtually from across the two countries.
It will be the first time that members of the RANZCP – the Royal Australian and New Zealand College of Psychiatrists – have come together in such numbers in almost two years, with the pandemic forcing the postponement of last year’s congress, an event which was to be – rather prophetically – themed Influencing and being influenced by the world around us.
Though the program has been tweaked, not least to accommodate COVID-safe requirements around strictly capped socially distanced face-to-face registrations, the theme has been retained and only resonates more now from the pandemic, explains RANZCP President John Allan.
“In just about everything you do now you have to take into consideration what other people do, and the effect you might have on other people as well,” says Allan. “The idea of influencing has become, to me, multiplied ten thousandfold.”
The pandemic has underscored not only our interdependence and interconnectedness, but how essential these are to mental health. These conversations, which began before the coronavirus epidemic as Australia reeled from the cataclysmic 2019-20 summer bushfire crisis, thrust psychiatry and associated disciplines into the spotlight like never before.
Allan and his colleagues were called to educate and reassure the public on how to weather the anxiety and grief of a world in lockdown; to advocate for mentally ill people in the community at risk of falling through the gaps as services were shuttered; to work around the clock day in and out to meet demand; and to support frontline colleagues in the healthcare system. The College also had to continue supporting and delivering supervision to trainees and ensure exams went ahead, lockdown and all.
“You are called upon to respond and you have to respond,” says Allan. “We just had to keep going on with the things we would normally be doing, but in completely different forms.”
In concert with many other specialist and peak medical groups, RANZCP helped realise a three-year telehealth implementation plan in the space of just three weeks, allowing locked-down psychiatrists to continue serving their patients and extending access in new and more equitable ways.
Rural and remote Australians and those unable for mobility, safety, or other reasons to easily leave their homes, were some to benefit most from the changes, which were extended in last week’s Federal Budget after lobbying by many groups, including the College.
Incoming RANZCP President Vinay Lakra, who formally takes the mantle from Allan at this week’s Congress, continued seeing clients remotely while home-schooling his children aged six and 11 during Melbourne’s COVID lockdown. He says it has been both a game-changer and eye-opener for the profession, underscoring that for many – including some of the most disadvantaged and at-risk – services remain out of reach.
“It has provided better access, and that certainly has been a good news story, but it has made us aware of inequities in the system, and in a sense the pandemic has heightened some of those inequities,” says Lakra. “Even though telehealth has been helpful in addressing some of those inequities, I think there is still some work to be done.”
Key social, political determinants
As an outward-looking specialty focused on the whole person and their context, psychiatry has a particular emphasis on the social determinants of health, and these feature prominently in the #RANZCP2021 program, ranging through the “biological to the personal” and political, Allen says.
There are keynotes on hate speech and family violence, several sessions focused on Indigenous mental health and cultural safety, symposia on homelessness, patient rights, COVID-19, aged care, and a closing session on bushfires and climate change.
Allan and Lakra both consider housing, education, employment, and the criminal justice and migration systems as key determinants of mental health and important spaces for the College to advocate in.
Both have spoken out recently on the mental health impact on Australians in India, as the COVID-19 catastrophe has been unfolding there, from the Federal Government’s threats of jail and big fines for any who tried to get back home during the travel ban.
“It adds to their psychological distress and mental ill health for them, and also too of course for people living in Australia who have families there,” said Lakra, who is among those with close personal ties to India.
“We are distressed and worried,” he told Croakey as the RANZCP called on the Federal Government to place a “humanitarian and compassionate lens” on India’s disaster, to avoid being punitive and negative and to ensure Australia has sufficient quarantine capacity.
Workforce issues also will be discussed at length at the Congress, with the College to launch its 2021-31 Rural Psychiatry Roadmap focused on addressing significant access challenges for Australians outside of metropolitan areas, a “cycle of rural psychiatry disadvantage”.
While almost one in three Australians lives outside a major city, only 14% of psychiatrists practice in these areas – and this number is just 10% for full-time clinicians. A paucity of culturally appropriate services greatly compounds this problem for Maori, Aboriginal and Torres Strait Islander populations.
While the pandemic has deepened and brought these disparities into sharp relief, it has also demonstrated what is possible, “that we can make change in the system really quickly” when governments are committed to a common cause, says Allan.
This sentiment is echoed by Lakra:
When the pandemic started we invested significant amounts of money to set up additional beds, ventilators, things we fortunately didn’t need, but the government demonstrated that it was committed to do something about it, and I think the same thing is required, the same kind of commitment, to mental health.”
Allan says the profession has been surprised by some of the downstream effects of the bushfires and pandemic, particularly for young people, where there has been a spike in crisis presentations and eating disorders.
“The thing that worries me most is we have had this increase in presentations, this grumbling mental health thing in our community, and it’s not really stopping despite what people say about a recovery economically and so on. We have still got these levels of stress, particularly for young people,” he said.
I don’t think we actually realised the existential threat to young people that all of this has presented; the whole future of their world seemed at stake.”
If previous disasters are anything to do by, we may have some way to go before seeing the real impact in the system, with peak demand and presentations taking anywhere from 12-24 months to manifest, Lakra adds, with the potential multiplier effect of the consecutive bushfire and COVID crises also a big unknown.
It is not, of course, all doom and gloom. While the past 18 months have tested us all, Lakra says they have also brought a new perspective for many: gratitude for the small things, an appreciation of our resilience and of the value of connection.
“This is a globalised world, we are not immune to things which are happening outside our sphere of influence,” says Lakra. “We are all interconnected in some way; we are not safe unless everyone else is safe in the world.”
“That’s why investment from government in a range of issues including the social determinants of health and mental health is actually important; our welfare is dependent on everyone else’s.”
The Royal Australian and New Zealand College of Psychiatrists 2021 Congress, Influencing and being influenced by the world Around us, is being held at the Hotel Grand Chancellor Hobart and online from May 16-20. Croakey journalist Dr Amy Coopes and editor Jennifer Doggett will be there for the Croakey Conference News Service. Follow their tweets at @coopesdetat and @croakeynews and join the discussion at #RANZCP2021.