“The cause or major reason for the ACT’s nation-worst performance in the delivery of mental health services across both the community and in acute settings is money,” writes columnist JON STANHOPE.
I WROTE last week about the impact that COVID-19 and our response to the pandemic, most particularly lockdowns, is having on the mental health and wellbeing of people across Australia.
I wrote, in the main, about community based mental health services.
My interest was stimulated by a news report of a deeply worrying surge in mental-health admissions to hospital in Victoria, including of teenagers admitted as a result of self-harming and/or suffering suicidal thoughts.
I mused, as a result of the Victorian experience, about the state of preparedness of ACT hospitals to meet a surge in mental health related admissions.
Following publication of the article, my attention was drawn to a range of mental-health data produced by the Australian Institute of Health and Welfare (AIHW) for the financial year 2018-19, which was relevant to acute mental health services, ie those delivered through the public health system.
The data revealed that in that year the ACT had the lowest number of mental health nurses per capita of any Australian jurisdiction. It reported that the ACT employed a total of 68 clinical full-time equivalents (FTE) per 100,000 population compared to the average across Australia of 81 FTE per 100,000. Certainly a very worrying disparity in staffing levels and suggestive, perhaps, of a mental health system under stress.
In the course of the research I did before writing this article, in addition to looking at the relevant AIHW reports I found a “Canberra Times” report from November, 2019, which referenced the then chair of the Royal Australian & NZ College of Psychiatrists, Dr Jeffrey Looi, and asserted that: “The ACT’s mental health system is on the brink of an all-out crisis with years of warnings about staffing and bed shortages falling on deaf ears”.
The most recent report of the AIHW, a report titled “Mental Health Services in Australia”, which was released on July 20, tends to validate that dire prediction.
For example, it reveals that in 2019-20 the ACT had the longest mental health related emergency department wait times in Australia with a median wait time of 47 minutes compared to a national average of 18 minutes and, interestingly, a wait time of only 14 minutes in NSW.
In addition to the longest median wait time, the ACT also had the longest wait time at the 90th percentile, of 184 minutes, compared to a national average of 101 minutes. The wait time in Queensland at the 90th percentile was 73 minutes.
The ACT’s poor performance was further confirmed by the revelation that we also had the lowest proportion of patients seen on time (41 per cent) compared to the average across Australia of 68 per cent. In NSW, the best performing jurisdiction, 76 per cent of patients were seen within clinically agreed benchmarks.
Exacerbating the challenges already faced by our clearly over-burdened acute mental health system, a comparison of the number of presentations, as reported by the AIHW in 2018-19 and 2019-20, reveals that the ACT had the highest increase in the number of presentations as well as in the rate per 10,000 people.
I am not particularly well equipped to offer a view on the possible cause of the massive increase in the numbers of Canberrans seeking to access mental health services through the emergency departments of Canberra and Calvary Hospitals, but I think it reasonable to surmise that it reflects difficulty in accessing either timely and/or appropriate and/or affordable access to community based mental health services.
However, I am more comfortable in suggesting that the cause or major reason for the ACT’s nation-worst performance in the delivery of mental health services across both the community and in acute settings is money.
I have perused the ACT Budget over each of the last five or so years and in that time the Canberra public health system has endured, across the system, a cut in real terms of well in excess of $100 million a year. It is reasonable I think, to assume that mental health has borne its share of, and been severely impacted by, those cuts.
Having said that I think it imperative, going forward, that the mental health system be subjected to rigorous external review and thorough needs assessment.
If there is anyone with up-to-date information about the current state of our public mental health services and if, for instance, we have developed a mental health surge capacity that is fully staffed, safe and with adequate beds and other resources and that the clinical staff, including registrars actually get to go home at night and spend time with their loved ones or families on weekends, I would welcome hearing from you.
PS: Is it true that six mental health registrars resigned, en-masse, in the middle of last year in protest at their treatment and working conditions?
Jon Stanhope was chief minister from 2001 to 2011 and represented Ginninderra for the Labor Party from 1998. He is the only chief minister to have governed with a majority in the Assembly.
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