Great Expectations (A tale of two systems): a saga of mental health care access
By Dr Bernadette Wilks, Deputy Co-Chair AMA Council of Doctors-in-Training
They say it takes a village to raise a child. I say it takes seven doctors, four friends with a spare room, and over $20,000 in under two weeks for a junior doctor to access appropriate mental health care. At least that was my experience over a five- month period when I assisted a friend and colleague to navigate the Victorian mental health care system.
I naively anticipated that my friend, as a doctor, would have streamlined access to the best mental healthcare. But the experience was nothing of the sort. Instead, I have been left in shock over the complete lack of affordable services, the scarcity of acute services, and the disenfranchisement felt by patients and their loved ones when engaging with mental health care services.
This shock is not a response to the work of health care workers. On the contrary, it is their herculean hard work that compensates for scarce resources. Instead, it is a disbelief that despite increased societal focus on improving the mental health of all Australians, the required infrastructure is crumbling.
The process to assist my friend started with a call to the CATT team, a 24-hour psychiatric crisis assessment service linked with public hospitals, who triage the need for inpatient or outpatient care. The wait time was three hours and, as compassionate and informative as the CATT team was, they could provide no guarantee they would be available if my friend needed an acute admission to a public psychiatric hospital. Unfortunately, one night, when there were concerns she was a danger to herself, the CATT team were called but were already busy with another mental health crisis. So, we had to resort to calling the police. As can be anticipated, having the police turn up to my friend’s house and force her into a car bound for a hospital at which she had previously worked only added to the trauma.
The next challenge faced by patients admitted to hospital after an acute mental health crisis is the step-down to outpatient care. Only patients at risk of imminent harm to themselves, or others, access acute public hospital beds, of which there are too few, and consequently patients are often discharged prematurely. My friend applied for admission to a private psychiatric hospital but there were no beds immediately available and there was no time frame for when the bed would be available. In the interim, she needed a place to stay. She was not well enough to be on her own so, rotated between friends and family with enough space, time, and dollars to assist until a private inpatient bed became available.
The total cost for my friend’s one-and-a-half-week admission was over $20,000. To add insult to this bank injury was the poor care provided. My friend saw her psychiatrist for around 10 minutes a day, except for one day when the consultation lasted 20 minutes, but ended with a throwaway line that my friend may have a borderline personality disorder and should look up for herself what such a diagnosis means.
Clearly, this experience deterred her from wishing to seek further care, confused her parents as to why so much money had led to such poor care, and exasperated me as to what I could actually do to help her get better. Even being in a position to access additional advice from psychiatrist friends was not sufficient to bridge the gap between need and service provision.
At the most recent CDT meeting, the Council were updated on the progress of Caring for Those Who Care: Preventing anxiety, depression and suicidal behaviour among Australia’s medical workforce project, overseen by the AMA in conjunction with BDI, Orygen, United Synergies, and Everymind, and funded by the Government and the Black Dog Institute as part of a broader $47 million suicide prevention initiative. Updates were also provided by a Director of the AMA’s subsidiary, Doctors’ Health Service, on innovative proposals to utilise the further funds promised by the Health Minister at the 2018 AMA National Conference. CDT discussed the promising avenues of telehealth, incentives such as CPD points for GP visits to promote self-care, and the continued issue of poor DiT awareness of free services such as State-based doctors’ health advisory services.
And yet, I left the discussion with an inescapable sense of futility that we are directing doctors to seek help from a broken system. My heart breaks to think how much harder it must be for the rest of society to access mental health care.
The system is broken.
The Medicare rebates for clinical psychology sessions are capped at six to 10, and yet evidence clearly demonstrates that at least 16 sessions are needed to evoke change in conditions such as eating disorders and obsessive-compulsive disorder. Patients who attend ED with suicidal ideation attempts may be coerced into falsely denying their intent to make it easier for hospitals to manage the mismatch between service demand and beds. Australia needs more psychiatric care workers and yet, at present, the Royal Australian and New Zealand College of Psychiatrists struggles to fill its training places.
While efforts to address the unique aspects of doctors’ mental health abound, tailored approaches do nothing to fill the void where quality, broadly available, adequately resourced mental health services should be. Urgent, bipartisan support is needed to raise the bar of mental health care provision to meet community demand. Doctors aren’t always that different, after all. Doctors and medical students needing help can get access to the Australia-wide network of independent, confidential, doctors’ health advisory and referral services.
These services are coordinated by Doctors’ Health Services Pty Ltd, with funding from the Medical Board of Australia. To contact your local service, visit www.drs4drs.com.au
Published: 17 Aug 2018