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Shocking stories from the frontlines drive calls for innovative mental health solutions

A senior psychiatrist has called for private hospitals to help address a surge in demand for mental health services in Sydney’s south west, and has also identified poverty and insecure housing as critical concerns that need addressing.

The psychiatrist’s comments follows a survey painting a devastating picture of the mental health toll of the pandemic, reports journalist Cate Carrigan in the first of a series of articles from south western Sydney, where she lives.


Cate Carrigan writes:

The head of the peak psychiatrists’ body in New South Wales has called for spare capacity in private hospitals’ mental health services to be made freely available to public patients as health professionals battle a surge in demand in Sydney’s south west amidst lockdown anxiety.

The call follows a survey of New South Wales psychiatrists that shows patients, families, psychiatrists and staff are struggling to treat people in increasing distress, with many new patients having lengthy waits for treatment.

Psychiatrists in both the private and public sectors have told of increasingly distressed patients, of growing concern about Year 12 students facing HSC trials, and of people from diverse backgrounds feeling discriminated against. Psychiatrists also report feeling stretched to capacity and burnt out.

Dr Angelo Virgona, Chair of the NSW branch of the Royal Australian and New Zealand College of Psychiatrists, says with psychiatrists and psychologists already under the pump, he’d like to see private hospital services take as many patients as they can.

“There should be agreements between NSW Health and the private hospitals so ensure public sector beds and resources are freed up to help those most in need,” he told Croakey.

It’s not an unprecedented suggestion. In March last year, Federal Health Minister Greg Hunt said Australia’s 657 private and not-for-profit hospitals would be integrated into the public hospital system during the COVID-19 pandemic response under an historic arrangement with governments that aims to boost capacity to cope with surge in demand.

Psychiatrist Dr Angelo Virgona

Disquiet

Virgona said there was disquiet amongst psychiatrists and the general medical community about the NSW Government’s slow lockdown journey.

“It’s a no-brainer that short sharp lockdowns are better for everybody’s mental health than what we have endured the last two months and will endure for at least another two,” he said.

“This isn’t hindsight. Frustration is clear in the medical community, and the uncertainty is difficult for everyone. Not having a clear path out of this is a recipe for increased psychological distress.”

On a similar theme, prominent psychiatrist Professor Ian Hickie said a lack of vaccines, political infighting and parochialism meant people were becoming distrustful of government generally. He told ABC that the strong emphasis on law enforcement and control had also put a lot of people offside.

“The public messaging is in danger of being all wrong,” he said. “It doesn’t promote social action together. You’ve got to get back to people acting collectively, not individually or selfishly.”

Tackle poverty

Virgona is also concerned about a shortage of psychiatric and psychological services in outer-metro and rural areas, no priority service access for the most severely unwell, and a rise in gap fees as rebates stay on hold.

For vulnerable communities, such as some of those in south west and western Sydney, Virgona believes avoiding the degrading, corrosive and destructive impacts of poverty is the biggest single thing governments can do.

“We need much more service coordination,” he said. “Health, welfare, disability support staff can end up sitting in never-ending service coordination meetings, talking about common clients, without anybody delivering the needed service.”

Housing is a huge problem in this country, says Virgano, who wants investment in public housing, or support to private sector to provide housing with rent controls, when the housing market is out of control.

“Having a roof over your head, money to appropriately feed and clothe yourselves and kids, are the basics we should expect of government,” he says, adding that a universal income program should be experimented with in Australia.

Virgona’s comments come after members of the College responded to his request for feedback on the impact of the latest outbreak on communities in south west Sydney.

Insights from the frontlines

Below are some of the psychiatrists’ edited replies:

My patients from Culturally and Linguistically Diverse (CALD) backgrounds in the south west repeatedly talk about feeling discriminated against and singled out by the government. Those with PTSD have almost universally said they feel retraumatised.

There are long waitlists everywhere to access psychological and psychiatric care. There are financial stressors due to loss of employment or reduced hours, social isolation due to prolonged lockdowns, compassion fatigue in usual carers and treatment providers, delayed presentation due to fear of contracting COVID, more family violence, more substance use disorders, closure of physical activities such as sport and gyms.

The very isolated and more unwell are not coping as they can’t get enough support and it triggers all the trauma. One patient was told by a crisis team they were too busy to speak when she called via the mental health access line.

My experience of being on-call after hours is that the emergency department is absolutely heaving. The presentation numbers are more numerous and more intense/acute in their presentation.

The previously well and or reasonably functioning are coming undone.

Kids with mild to moderate mental health conditions and Autism Spectrum Disorder (ASD) are being smashed by anxiety and effects of remote learning. Younger kids in particular, where the non-academic value of school is in socialisation forming and sustaining friendships etc. We’ll have a whole generation of kids set back by this. Don’t even get me started in kids with severe ASD, ADHD, eating disorders, anxiety, mood disorders or schizophrenia.

Expect a further rise in emergency presentations/acute mental health presentations of year 12s in Sydney starting next Monday (HSC trials starting) – return to school is associated with rises in serious self-harm presentations consistently, including during pandemic.

There have been many suicides amongst Year 12 students during the pandemic. It’s high stress to do the HSC via lockdown;

Students who began university in 2020 or 2021 have had poor, online, detached university experiences. Most of my young university patients have either left or dropped their subject load. Online university is very isolating.

Community and hospital mental health services are seeing lots of presentations and reduced beds, staff, everything because of furloughing and distancing.

NDIS providers are closed during lockdown leaving families without usual services and autistic kids are not coping with changes to routines. Some end up presenting to ED.

Every time we go into lockdown, my consult times increase by 30 percent and clinical risk immediately increases.

Demand has gone through the roof, both early psychosis unit and private – I had to reopen my books and seeing nearly one new patient every two weeks and already operating beyond capacity.

Access to psychologists (is) non-existent – mega wait times. Some patients struggling to access their GPs.

People don’t want to come into hospital – so they are really sick when they do come in.

Huge well of need out there, with patients waiting many months to be seen (privately).

Local GPs, desperate, ring me for advice, then I’m in position of, ‘do I give advice on a patient I haven’t seen?’

Every single patient on my books with depression/anxiety disorders is clinically worse during pandemic.

Much more anxiety and depression, and substance use. Much higher impact on those with precarious finances and unstable employment due to COVID.

Haven’t seen it this time yet but last time access to super allowed many patients to blow tens of thousands of their super on addictions – substances and gambling, increasing their use, but then presenting for treatment down the track once funds were exhausted

Technology has been a saviour for most of my patients – not just to connect to me but to keep track of their symptoms. I shudder to think what it would have been like managing these patients without Zoom etc. and apps.

Telehealth consult doesn’t build the same quality of rapport for some patients, whilst for others much prefer convenience it offers.

Uncertainty is a problem – in lockdown but rules unclear. We have no shops within five km and nowhere within five km I could safely walk.

Finding my patients are struggling more this time – the uncertainly about the future is hard to manage.

Eating disorders referrals to public health very high.

The public subacute unit in northern NSW has the longest wait list ever for admissions. It may take months for some people to be admitted.

Like so many from India, I haven’t seen my parents for over two years now. I have heard similar stories – worse – from so many colleagues from the subcontinent who work in health. I hear the words “exhausted”, “burnt out” at least once a day. Providing care to people in SWS is challenging at the best of times. That’s now turbocharged. I don’t think the pollies get that.

At all my workplaces we have staff and vulnerable patients (due to psychiatric and physical illness) who have contracted COVID-19 from within hospital wards and ED.

I’m really tired and drained. Can’t say no for people seeking help and asking officially or friendly for support.

Exhausted, burnt out, demoralised struggling with depressed women with new babies that can’t get support face to face i.e. no mothers groups, refusing to go into hospital due to no visitors/ no leave policies, young people unable to see friends eg stuck at home with parents but no peer interactions.

Workload is non-stop and an overwhelming; many of us … have no available new patient appointments for the rest of 2021.

Plug the funding gaps

Virgona said spending on mental health must be boosted across Australia and should be much more than the current level of seven percent of the NSW health budget.

He described money to be provided under by NSW and the Commonwealth governments under the $2.3b National Mental Health and Suicide Prevention Agreement – to be signed in November – as a “contemptuous response” to the Productivity Commission’s report on mental health.

Over five years, it would amount to $80 million a year in funding, which Virgona described as “a spit in the bucket” and nothing like the wholesale reform proposed by Productivity Commission.

There is also concern Commonwealth money will be funnelled through Primary Health Networks, leading to more fragmentation of services, rather than properly funding the state to deliver comprehensive services in the community.

Virgona says currently the State community mental health centres only see the most severely mentally ill, those on treatment orders – with severe psychotic illness, or those requiring acute follow up from emergency department presentations.

Twenty years ago, people with eating disorders, and anxiety and depressive disorders could be seen in the State centres but now they are part of what Virgona calls the “missing severe”, because they are seriously distressed people.

By contrast, Virgona says Victoria is pumping billions into mental health over the next decade, by taxing businesses with turnovers greater than $10 million.

“It is bold, but it’s the reality, that you can’t have services if you don’t have income,” he said.

“Mental health services have been told to do more with less for decades. We reached ground zero a long time and have been stuck there.”

Significant reform would be a 5 to 10-year project and will need to include a significant growth in workforce, and must address Medicare-delivered services by GPs, who he says aren’t currently funded to provide good mental healthcare.

“Lastly,” he said, “we need political leaders with guts. Macklin, Shorten and Gillard gave us the NDIS. It’s their legacy. Who will have mental health as their legacy?

“It’s ripe for the picking, if only there was someone with nous and fortitude to seize the day. We can create a functional mental health system in this country which won’t break the bank.”

Community messages, Belmore, south west Sydney. Photo by Cate Carrigan

Distressed workforce

Virgona also described the mental health toll on colleagues.

When he was the Director at South West Sydney Mental Health Services, the workforce was largely made up of doctors from India and the Middle East.

“They trained here, got their qualifications and stayed on, becoming citizens and a vital part of mental health service delivery,” he says.

“It was a similar story in western Sydney, Hunter and other places. They have been really struggling with watching the deteriorating situations in their home countries, as only a few have their families here. Some have had very sick and dying relatives, very distressed they can’t return.”

Cate Carrigan will be reporting more on pandemic health issues from south west Sydney.


Croakey acknowledges and thanks donors to our public interest journalism funding pool for supporting this article.

See Croakey’s archive of stories about mental health.

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Croakey Conference News Service 2013 – 2019
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
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2014 conferences
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AIDA Conference 2014
Congress Lowitja 2014
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Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
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Population Health Congress 2015
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