Patients ‘critically impaired’ by complex mental health waitlists

From schizophrenia to bipolar disorder or severe anxiety, almost 900,000 Australian adults live with a complex mental illness, but professional help is becoming harder to reach for many patients in need.
 
More than 90% of psychiatrists say their workforce crisis is negatively impacting patient care, 73% of those working in cities have a waiting list, and a growing number of clients are waiting more than six months for an appointment.
 
At the same time, GPs say they have been bombarded with a concerning rise in severe and complex mental health patients who are increasingly struggling to access care.
 
Dr Cathy Andronis, Chair of RACGP Specific Interests Psychological Medicine, says it is an all-too-familiar scenario for many GPs.
 
‘In fact, it’s now more usual to not see patients with simple mental health issues as they are usually able to manage them without our assistance, especially if they maintain a healthy lifestyle and remain connected with others,’ she told newsGP.
 
‘Unfortunately, our patients are increasingly isolated, unsupported by family and friends, and stressed by overwork, financial difficulties, and social media.
 
‘These factors combine to create complexity and intensify their mental health problems.’
 
Earlier this month, the nation was left in shock by the Bondi Junction attack, in which six people were fatally stabbed and several others were seriously injured by a man with a long history of mental health diagnoses.
 
In the wake of this tragedy, SANE, a national organisation for people with complex mental health issues, said Australia’s current mental health system is ‘filled with gaps’.
 
‘Effective early intervention and ongoing treatment and psychosocial support can prevent significant deterioration and enable people with complex mental ill health to live healthy, productive and meaningful lives,’ it said.
 
Dr Caroline Johnson, a senior lecturer at the University of Melbourne’s Department of General Practice, told newsGP that while one tragic story cannot reliably represent the whole situation, it can be a catalyst for change. 
 
‘The ability of the public mental health system to offer vulnerable patients the right intensity of support and follow up over time is a key point to focus on,’ she said.
 
‘We need models of multidisciplinary care, with teams working collaboratively with the GP, located in local communities where people’s ability to access care isn’t impacted so much by their postcode and their ability to pay. 
 
‘We need to avoid turf wars between the different members of the team, so they don’t compete for the “easy” aspects of care but instead work together to achieve outcomes centred on the patient.’
 
The RACGP has long been calling for sweeping changes to better facilitate complex mental health presentations and consultations, with GPs increasingly ramping up their calls for change.
 
Mental health continues to be the one issue causing most concern for GPs, with 72% of doctors saying it is in their top three reasons for patient presentations.
 
According to a new survey from the Australian Psychological Society, released on Tuesday, ‘things will only worsen without strong government intervention’.
 
Of more than 2060 community members polled, 75% reported that cost was in their top three biggest barriers to care, followed by a lack of local availability, and patients not knowing where to go.
 
More than half think the Federal Government is not doing enough to support psychology services, and 75% want psychology services to be fully funded by Medicare.
 
It is now calling for the establishment of free Medicare-subsidised psychology sessions for young people and increasing and indexing the Medicare rebate to make psychology services cheaper.
 
Meanwhile, with this year’s Federal Budget just weeks away, the college is advocating for a 20% increase to Medicare rebates for general practice mental health items, as well as funding for longer consultations.
 
It comes as the Black Dog Institute defines the characteristics of a ‘good mental health assessment’ from a GP as one which includes questions about a patients’ lifestyle, family history, psychological experience, cultural background, childhood, or financial situation.
 
‘It is not possible to do a thorough mental health assessment quickly,’ the institute said.
 
‘A GP who already knows you may be able to assess your situation in 20 minutes but a GP who is unfamiliar with you, your life circumstances and your general health will need to take a lot longer to get a clear idea of the nature of your illness and the appropriate treatment for you.’
 
But Dr Andronis said ‘critically impaired’ access to psychiatrists is putting both GPs and patients at risk.
 
‘This leaves the community vulnerable to deteriorating health outcomes and is incredibly stressful for GPs struggling to manage emotionally dysregulated patients,’ she said.
 
‘We need more time to see patients in a supportive environment so that we can get to the bottom of problems and challenges that are presented to us.
 
‘The Government has a duty of care to maintain safety for providers and prevent burnout and vicarious trauma that is a major risk when we deal with mental distress in unsupportive environments every day.’
 
Dr Johnson added that treating a patient with complex mental health comes with several nuances and individualities specific to each patient which cannot be rushed.
 
‘Some of these levels of “complexity” are difficult to measure at a population health level, but dealing with the intersection of these issues is core to the work GPs do,’ she said.
 
‘Many GPs feel well-equipped to help these patients but will lament the lack of additional support they can access, as well as feel frustration at the way the funding for GP care doesn’t reward the time it takes to deal with this complexity.’
 
Further details on the RACGP’s wish list, including its mental health asks are available in its Pre-Budget Submission 2024–25, with the Treasurer to hand down the Federal Budget on 14 May.
 
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