Introduction by Croakey: Researchers have cautioned against the use of “Band-Aid solutions” to the current crisis in public psychiatry in NSW, saying it should be used as “a catalyst for long-overdue and major structural reforms” in mental healthcare.
They call for a shift away from outdated financing models and workforce practices towards a “technology-enabled mental health system” that champions roles like digital navigators and peer-support specialists.
“The current crisis in NSW reflects major national issues and emphasises the urgent need for more affordable, personalised, and high-quality models of mental healthcare,” write the researchers, who are from the University of Sydney’s Brain and Mind Centre.
Their article below follows another recent call at Croakey for consumer-lead national mental health reform in the wake of the NSW crisis.
William Capon, Sebastian Rosenberg, Ian B Hickie, and Frank Iorfino write:
More than 200 psychiatrists in the NSW public system have resigned in recent weeks, or have pledged to resign. Over 70 hospital beds have closed across the state, placing further strain on our struggling mental health system.
Headlines typically describe this as a public-sector pay dispute, the kind that often impacts states and territories as they compete for the services of teachers, paramedics, and health professionals.
The public psychiatrists are seeking a 25 percent salary increase to align with pay-packages in other jurisdictions.
On closer examination, however, this issue transcends remuneration, exposing much deeper and persisting structural flaws in the design of the system.
Current model is failing
Psychiatrists who have remained in the NSW public system report immense strain. Many critical positions are unfilled as ever-increasing numbers of people present with acute mental health conditions.
The vast majority of Australian psychiatrists agree the workforce crisis negatively affects patient care.
People often present to hospitals and their linked public and acute services because they have not been able to access or afford real care anywhere else. Either appropriately skilled services were non-existent or inaccessible, or their treatment needs were improperly assessed.
Opportunities to intervene earlier in the course of illness are routinely missed so that by the time people reach crisis, emergency departments and hospitals are their only option.
Ideally, ambulatory care and early intervention centres, where people often first seek help, would be staffed to identify and respond to significant mental health concerns, treating conditions before they develop into more persistent or life-threating situations.
Research shows that timely, effective care helps people recover faster, meaning fewer people ending up in crisis, freeing more resources to intervene before things worsen.
The unfortunate reality is that ambulatory care services, most notably those operating within the public sector, are grossly unequipped to meet demand.
They lack capacity to provide and coordinate indicated prevention and early intervention. This requires large scale change to rapidly identify those needing more specialised care (for example, treatment delivered by a psychiatrist, psychologist, or coordinated team).
The current mental health system is highly fragmented across public and private sectors, government and non-government agencies, and health and non-health service providers. People who are unable to access specialist assessment privately, or the limited public early intervention services, are largely neglected, increasing their risk of disengagement or illness progression.
It’s unsurprising that psychiatrists in the deteriorating public system, particularly those who occupy leadership roles, are now saying “enough is enough”.
Transformation
The current crisis in NSW reflects major national issues and emphasises the urgent need for more affordable, personalised, and high-quality models of mental health care.
Changes like public purchasing of private sector capacity (not just more beds) will be critical to meeting the shortfalls in skilled assessment and ongoing specialist care.
NSW now spends the second-lowest of any state or territory per capita on mental health services and has the third-lowest number of psychiatrists per 100,000 people.
Instead of blindly injecting more money into a fragmented system, funding needs to focus on transformative, systemic change. The whole of the state’s capacity, not just that remaining in the diminished public sector, needs to come into play.
NSW Health’s proposal for a temporary virtual hub to mitigate workforce shortages is an admission of the system’s shortcomings, with sustained investment in technology being one of those more obvious reforms that could prevent these crises from occurring.
The Federal Department of Health and Aged Care’s 2024 tender for youth mental health signals growing recognition of system-wide issues and a need for reform.
By seeking advice on better models of care, the Federal Government is creating an opportunity to improve the mental health system. Adopting 21st-century technology and data infrastructure is an obvious component.
Ways forward
As seen in most private services over the last decade, smart digital and aggregated data systems could markedly improve standardisation, access, and choice in mental healthcare.
An important component would be standardised initial assessment at all entry points to the system to identify multidimensional treatment needs (spanning clinical, psychosocial, and comorbid domains) and determine appropriate treatment type and intensity.
Digital methods can be conducted remotely, reducing waiting times so that people don’t wait endlessly to be assessed.
Standardised assessments can also be complemented by Artificial Intelligence predictive models to identify early risk, allowing for timely intervention and indicated prevention.
Technology removes most geographical barriers by expanding access to specialist assessment and some interventions.
Importantly, these digitally-delivered interventions do not replace all face-to-face care. They free up resources while offering effective alternatives.
Additionally, technology enhances choice for consumers. There are multiple avenues to enter the mental health system (GP, community service, hospital), but these often determine one’s treatment journey.
With a standardised, tech-assisted model, individuals can be guided to the most appropriate care, regardless of their entry point.
Modelling suggests that technology-enabled care, combined with smart service reforms (for example, including suicide-risk screening, increasing annual capacity growth rate of mental health services), could reduce youth mental health-related emergency department presentations by 26.6 percent by 2032.
Catalyst for change
However, technology alone isn’t enough – its success relies on workforce innovation.
Rather than forcing the system to fit old funding models, we must design an ideal system and structure funding models around it.
The outdated fee-for-service model and workforce practices must be realigned with the capabilities of modern technology. This includes championing roles like digital navigators and peer-support specialists to improve engagement and equip staff with the knowledge and skills needed to deliver effective care.
While technology offers significant potential, access isn’t universal. Some young people face barriers such as unreliable internet or limited capacity to engage with online care, particularly those experiencing financial difficulties.
Expanding digital support roles can help bridge these gaps, ensuring that technological advancements enhance inclusivity rather than widening disparities.
Clearly, mass resignations of NSW psychiatrists will have immense negative impact on vulnerable populations. However, it also presents a rare opportunity – a catalyst for long-overdue and major structural reforms.
It is now crucial for state and federal governments to consider mobilising our whole national capacity (as during the COVID-19 crisis), unleashing valuable public-private partnerships, and building a smart, technology-enabled mental health system – one that doesn’t simply ‘Band-Aid’ the hospital care bottleneck, but addresses many of the fundamental failings across our entire mental health system.
Author details
William Capon is a PhD student and Research Officer at the Brain and Mind Centre, University of Sydney
Dr Sebastian Rosenberg is a Senior Lecturer at the Brain and Mind Centre, University of Sydney
Dr Frank Iorfino is a Senior Research Fellow at the Brain and Mind Centre, University of Sydney
Professor Ian Hickie is the co-director of Health and Policy at the Brain and Mind Centre, which operates early-intervention youth services at Camperdown under contract to Headspace. He has previously led community-based and pharmaceutical industry-supported (Wyeth, Eli Lily, Servier, Pfizer, AstraZeneca, Janssen Cilag) projects focused on the identification and better management of anxiety and depression. He is the Chief Scientific Advisor to, and a 3.2 percent equity shareholder in, InnoWell Pty Ltd, which aims to transform mental health services through the use of innovative technologies.
See Croakey’s archive of articles on mental health matters
