As both major parties jostle for poll-driven primacy in the mental health space, Australia’s psychiatrists are urging a deeper commitment to mental health and its determinants — particularly for vulnerable populations — ahead of next weekend’s Federal Election.
The Royal Australian and New Zealand College of Psychiatrists meets in Cairns this week for its annual Congress, #RANZCP2019, bringing together hundreds of mental health professionals from across the two countries to discuss the latest issues and advances in the field.
Croakey journalist Marie McInerney will be there for the Croakey Conference News Service, and previews the event below.
Indigenous mental health features prominently in the program, as the College ramps up its advocacy role, urging funding reform to promote recovery-oriented models and reflecting on the individual and collective role psychiatrists can play in improving the system.
Marie McInerney writes:
Psychiatrists need to become stronger in their advocacy for vulnerable groups and step up in their practice for some patient groups – such as people with intellectual disability – where they have been “missing in action”, says Royal Australian and New Zealand College of Psychiatrists president Dr Kym Jenkins.
Practitioners also need to better look after their own mental health and be careful that “self-stigma” does not contribute further to the discrimination that affects many of their patients, Jenkins said ahead of this week’s RANZCP annual congress in Cairns.
The four-day event will provide a timely focus on mental health in the final week of the May 18 federal election campaign, in which the RANZCP and other major health peak bodies and colleges have been pursuing broad reforms in the sector.
Jenkins told Croakey she is not impressed to date with the mental health focus of the major parties – giving her personal verdict as “woeful” – saying they are opting for the “low hanging fruit” of more headspace centres.
The Coalition’s last Budget committed $737 million to mental health over seven years, including a big injection into headspace and a $114.5 million ‘adult headspace’ trial.
Labor has announced it would match those commitments, and promised nearly $200 million for what it describes as ‘headspace Plus’ centres, to provide more specialised, intensive and extended care for young people with mental health issues.
Making the qualification that this was only her personal view, Jenkins said:
I need something from both parties that goes further than creating more headspace centres. That’s not the beginning and end of mental health care.”
It’s a critique echoed elsewhere in the mental health sector during the election.
Professor Pat Dudgeon from the Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention is urging an approach beyond services.
“Both sides are offering new @headspace_aus centres,” she said last week during Croakey’s #AusVotesHealth TwitterFest.”That’s good, but better mental health for Indigenous youth also needs policies to address disadvantage.”
More on the election below.
Culture, diversity and mutual learning
More than 1,200 mental health professionals from across Australia and New Zealand are set to attend this week’s RANZCP Congress in Cairns, which has as its theme: ‘Continuity in a world of change: culture, diversity and mutual learning’.
Highlights include a session with Australia’s first Indigenous psychiatrist, Professor Helen Milroy, and reflections from a Māori healing and psychiatry partnership between Allister Bush & Wiremu NiaNia.
— RANZCP (@RANZCP) May 11, 2019
Other streams will examine eating and dieting disorders, old age, anxiety disorders, voluntary-assisted dying, military and veterans’ mental health, mood disorders, trauma, first responders, professional burnout, and neurobiology, including one presentation on attachment, titled ‘Why is love so dangerous?’
Keynotes will include:
- Professor Ernest Hunter: Dreamers of the day — interrogating changing patterns of mental disorders in remote Indigenous Australia
- Professor Felice Jacka: Can we prevent and treat depression using diet?
- Professor Patricia Resick: The evolution of cognitive processing therapy for PTSD
- Associate Professor Mark Taylor: Insight or intrusion? Correlating routinely collected data with health risks, and
- Associate Professor Sam Harvey: The mental health of junior doctors
Professor Julian Trollor, the inaugural Chair of Intellectual Disability Mental Health School of Psychiatry at UNSW, will deliver a keynote as winner of the RANZCP’s Senior Research Award for his work on improving the mental health and wellbeing of people with an intellectual disability.
“I think that’s a really important area, psychiatrists have been missing in action on that one for too long,” Jenkins said.
“You could actually get votes on mental health”
In the leadup to Saturday’s election, the RANZCP has been calling for urgent improvement in the quality of crisis mental health care in Australia where “all too often, for a range of reasons, the emergency department is the only option for people at a time of acute crisis.”
The RANZCP last year partnered with the Australasian College of Emergency Medicine to stage a national summit on mental health and Emergency Departments – see Croakey’s coverage of the event.
The forum produced a consensus statement urging action to address protracted and harmful delays that undermine patients’ health and recovery, place considerable stress and strain on ED teams and waste limited health resources.
We spoke with Associate Professor John Allan, RANZCP president elect, on the sidelines of the summit, about some of the issues.
In its election statement, the RANZCP has called for a shift in the design and investment of the mental health system to a recovery-oriented model, where people with mental illness are supported in the community, and by intensive services when needed.
Its priority areas are:
- comprehensive perinatal care, including dedicated 24-hour mother-baby units
- more alcohol and other drug services
- mental health targets in a refreshed Close the Gap Strategy
- an expanded dementia care sector
- more accessible private services.
Jenkins said ongoing commitments to address the mental health of young people through headspace funding were welcome, but failure to invest in mental health care for older people “is part of the stigma and ageism in society reflected in our government”.
While acknowledging that significant reviews are underway into mental health – the inquiry by the Productivity Commission as well as Royal Commissions nationally into aged care and in Victoria into mental health – she was disappointed by the limited mental health election promises to date.
“It’s sad, it’s woeful. I would have thought in today’s climate you could actually get votes on mental health.”
Huge disparities in access to care
Psychiatry is facing its own scrutiny and questions – including existential ones about the future of the profession as The Lancet has explored, asking:
- What will psychiatrists do, and how will this be delivered and financed?
- How will psychiatry’s relationship with society change?
- How must mental health laws adapt?
- Can psychiatry go digital?
- How will psychiatrists of the future be trained?
In Australia there are also big questions about cost, equity of access, and – particularly from consumers – quality and safety of treatment.
As highlighted by Dudgeon above, mental health is about so much more than health care, while experts also warn that mental health spending is not filtering through to people in the areas that need it most.
The dramatic workforce maldistribution in psychiatry was highlighted by former National Advisory Council on Mental Health chair John Mendoza at Labor’s health summit in 2017.
According to Mendoza, Blacktown in Sydney’s west — an area with a population of 330,000-plus people — did not have a single private psychiatrist, while the 32,500 residents of Mosman in the city’s moneyed lower north shore had access to 100 local psychiatrists, a thousand-fold gap.
Such socioeconomic disparity is also pronounced between metropolitan and remote Australia, with just one or two psychiatrists for every 100,000 people in remote Australia, versus around 16-17 per every 100,000 people in metropolitan regions.
Jenkins is all too familiar with the issue, which she says is not confined to psychiatrists but applies to all sub-specialties in mental health.
With her term as RANZCP president set to end at the Congress, Jenkins has had people “begging me to go to rural and regional places”, including to fill a senior vacancy that has been open for five years – but it’s not something she can consider for family reasons.
She agrees that financial barriers are also a significant issue, with the majority of psychiatrists working in private practice and big out-of-pocket costs for treatment.
While advocates like Professor Ian Hickie are arguing for team-based care models and funding to shift away from fee-for-service, the RANZCP says a big problem is that rebates for psychiatry services under the MBS have not kept pace with costs.
Last month, leading Victorian public psychiatrist Associate Professor Richard Newton wrote that the workforce in Victoria was “in crisis”.
“My colleagues are leaving the public sector in record numbers due to a number of reasons including, safety and ethical concerns, with low morale created by the inability to provide the level of care they desire,” he said.
Jenkins says many people, particularly those with severe anxiety or severe and enduring eating disorders, are forced into the private sector because there aren’t services for them in the public system.
“So we do need to look at the systemic issues as well,” she said.
Challenging the status quo
As it embraces a more active advocacy role, the RANZCP has recently focused on addressing the disproportionate physical health toll experienced by people with poorer mental health.
Psychiatrists came under fire from consumer participants at a recent symposium for their contribution to that toll through medications and treatments.
Jenkins, who was a keynote speaker at the symposium, is open to the criticism and the need to move to patient-centred care and truly informed consent.
You can watch our interview with her at that event below.
“As a profession we’ve got a lot to answer for in the past,” she said, referring to a history of shocking scandals.
“But we can’t be complacent about what we’re doing at the moment (either),” she added.
Ahead of the congress, Jenkins called on the profession to be more willing to challenge the status quo, and act on the needs of vulnerable populations.
“We need to be less afraid of speaking out when we see injustice, or when we see things that aren’t fair or aren’t right”,” she said.
She also is urging a greater focus on the wellbeing of the profession itself, with a number of congress presentations this week looking at burnout, self-care, and the “self stigma” of being a psychiatrist with a mental health issue.
Addressing this was important, not just for the sake of psychiatrists themselves, but also their patients; breaking down “that barrier of the person with mental illness being ‘the other’ when actually we’re all the same”, Jenkins said.
The RANZCP 2019 Congress runs in Cairns from May 12-16.