South Australia’s peak body for doctors who treat people with severe, complex, and chronic mental health conditions is calling for mental health to be a priority this election.

The Royal Australian and New Zealand College of Psychiatrists (RANZCP) SA Branch is urging all parties to commit to and invest in better mental health strategies and services.

These should not only fill gaps in our current system, but grow long-term capacity and improve services and supports to prevent people reaching crisis point.

South Australians deserve a mental health system where everyone has access to affordable, accessible and effective help when they need it.

RANZCP SA is calling on all parties to commit to improve SA’s:

Mental health workforce

1) Lock in financial and resourcing commitments to implement recommendations of the Psychiatry Workforce Plan: South Australia

Health system capacity and capability

2) Community Mental Health Services (CMHS)

• Establish a multi-functional outreach service and expanded non-acute services, encompassing recommendations from the CAMHS Strategic Review
• Add a minimum extra 7 locally based Rural and Remote Mental Health Service (RRMHS) community psychiatrists within the next four years

3) Launch an Australian first Centre of Excellence in Neurodiversity

4)  Establish Safe Assessment Units, in line with proposals for Acute Behavioural Assessment Units (ABAUs)

1)  Ensure the long-term viability of the state’s psychiatry workforce

Lock in financial and resourcing commitments to implement recommendations of the Psychiatry Workforce Plan: South Australia

Australia has a critical – and growing – shortage of psychiatrists, with the psychiatry workforce only meeting 56% of the national demand for psychiatrists in mental health services. This undersupply is worsened by approximately 43% of psychiatrists intending to retire in the next decade.

South Australia has an advantage shared by no other state - a long-term Psychiatry Workforce Plan (PWP) which leads the way in Australia. It takes a holistic view of both the public and private sectors, addresses critical workforce shortages, includes workforce strategies and gap analyses, and finally quantifies the number of psychiatrists we need to serve South Australians’ needs both now and in the future.

While the plan is currently on track, uncertainty remains about its most important recommendation – staged, permanent increases in the number of South Australian doctors training to become psychiatrists.

The only path to long-term sustainability of our mental health workforce is to grow the domestic supply chain.

The initial recommended increase to SA’s psychiatrist trainee intake of 2 per year for the next 5 years, reaching an ongoing increase of an additional 10 trainees per year, requires long-term, sustained escalation of funding and resources.

The government has funded the 2026 increase, however a doctor studying to become a psychiatrist takes 5-6 years to complete their training.

This crucial capacity-building therefore requires funding certainty over the next decade, so that SA Health, Local Health Networks, mental health services and training providers can engage in meaningful future planning.

2)    Community Mental Health Services

• Establish a multi-functional outreach service and expanded non-acute services, encompassing recommendations from the CAMHS Strategic Review
• Add a minimum extra 7 locally based Rural and Remote Mental Health Service (RRMHS) community psychiatrists within the next four years

People in mental health crisis waiting for hours in emergency departments and contributing to ambulance ramping at hospitals make headline news. The demands on our emergency departments and other crisis services must be addressed, and we must make changes to those services and environments to better manage people in crisis.

However, it is important to remember that South Australia’s Community Mental Health Services (CMHS) are the first point of call for those seeking support and assistance from our public health system.

These public community services are fundamental for supporting people whose needs cannot adequately be addressed in the primary care setting. There is a “missing middle” of patients with moderate to severe mental illness, who are unsuitable for inpatient care but do not receive the necessary support in the community.

Even for those capable of funding their own care, there is limited support from the private sector. South Australia has the smallest private psychiatrist workforce per capita in the country (except for the NT) and with pending retirements it’s about to get smaller.

Expanding public CMHS to treat people where they live and work needs to be a priority for any future government.

RANZCP SA recommends:

Establishment of a multi-functional Child and Adolescent Mental Health Service (CAMHS) encompassing an:

• Adolescent day program
• Intensive Community Care Service (ICCS)
• Hospital outreach post-suicide engagement service, and
• Hospital discharge step-down option from within the Women’s and Children’s Hospital inpatient unit, or incorporated within the role of mobile assertive outreach teams

These services are ‘supported in principle’ by SA Health’s Interim Response to the Review of the Child and Adolescent Mental Health Service (CAMHS) and would represent a badly-needed increase in the ability of CAMHS to perform a supportive, preventative, and non-crisis driven role for South Australia’s young people.

The SA Health response identifies a main barrier to their implementation being ‘resourcing requirements’.

A pending SA Government should commit to removing that barrier.

A minimum extra 7 locally based Rural and Remote Mental Health Service (RRMHS) community psychiatrists within the next four years.

RRMHS provides clinical services across the 6 regional Local Health Networks in South Australia, in which live 520,000 people (28.7% of the state population) living in peri-urban, regional and remote locations. It employs a total of 25.25 FTE Consultant Psychiatrists who provide psychiatric cover for 14 Community Mental Health Services, 4 acute inpatient units, the Emergency Triage and Liaison Service, the Telepsychiatry Service, the Older Persons Mental Health Specialist Service and the Youth Mental Health Service.

Of these psychiatrists, only 5.75 are dedicated to community psychiatry, with the remaining working across all services.

The Review of the Rural Mental Health Services of South Australia (the review) recommended an increase of 50 FTE RRHMS psychiatrists, while the PWP recommends government incentivise and fund 10-12 FTE permanent, locally-based psychiatry positions in country local health networks over the next decade.

This increase in dedicated Community Psychiatry would improve the health and wellbeing of regional South Australians, enable more people to be assessed and treated locally, and reduce acute admissions in general country beds and metropolitan mental health beds.

By 2030, the duration of the PWP will be 70% complete. The next SA Government should therefore commit resources and funding for a minimum extra 7 locally based RRMHS community psychiatrists within the next four years.

3) Launch an Australian first Centre of Excellence in Neurodiversity

Fund and establish a holistic, multidisciplinary, state-wide SA Neurodiversity Centre of Excellence

The South Australian faculties of the Royal Australian Colleges of Psychiatrists, General Practitioners and Physicians are united in their support for South Australia establishing itself as the nation’s leading state for neurodiversity care, as recommended by RANZCP SA’s State Budget 2024-25 submission.

A centre of excellence should be established where clinicians can work together to provide holistic care, advice to health and other public services, provide multi-disciplinary training and support multiple specialities (GPs, Psychiatrists, Paediatricians, Education providers, and Allied health) working together to enhance treatment pathways for neurodivergent care.

Neurodiversity covers a broad range of conditions, all of which exist on a wide spectrum of severity. They include intellectual disabilities, motor and communication disorders, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), learning disorders, and others. This is a major area of unmet need in the South Australian health system.

Too many South Australians are finding themselves on long wait lists in both the public and private health systems and facing large out of pocket expenses for diagnosis and care. Not only that, many of the neurodiverse conditions co-exist (ADHD, Anxiety, Depression) so rather than holistic treatment, each condition follows a separate pathway with patients having to navigate different diagnostic and treatment pathways for each. People deserve holistic care that encompasses all neurodiverse conditions.

All South Australians, regardless of their circumstances, should have fair and equitable access to high quality care for neurodevelopmental disorders.

4)  Safe Assessment Units

Establish Safe Assessment Units, in line with proposals for Acute Behavioural Assessment Units

The Australasian College for Emergency Medicine Still Waiting report has shown that over the last seven years, South Australia has had:

• The greatest decrease in emergency department (ED) mental health-related presentations being seen on time.
• The greatest increase in the 90th percentile ED length of stay for mental health-related presentations.

In absolute terms, SA is the worst performer in the country on both metrics.

Recent government investments in SA’s mental health bed capacity should have a positive effect on ED patient flow and bed block – but these are not yet fully opened, and their impact will take place over time.

Increasing the capacity and capability of South Australia’s EDs to manage mental health and substance use has been a priority for years.

The Mental Health Services Plan 2020-2025 called for Acute Behavioural Assessment Units (ABAUs) to manage mental health and Alcohol and Other Drug (AOD) presentations, and a priority action of the South Australian Alcohol and Other Drug Strategy 2025-2030 is to, “Increase access to comorbidity services across the community and hospital settings through the implementation of expanded or new approaches, such as Acute Behavioural Assessment Units, and evaluate the impact of these.”

A safer environment and better ways of managing mental health and AOD presentations to SA’s emergency departments should be a priority for the next Government.

There are however many ways of doing so, some of which are better than others for patients and doctors alike.

RANZCP SA therefore recommends such units be established in SA hospitals under best practice principles:

• Rescoping as Safe Assessment Units, as labels relating to behaviour can be unnecessarily stigmatising.
• Fit for purpose, more private, low stimulus, safe and therapeutic environments.
• Co-located with emergency departments and designed to fast-track the admission of patients affected by intoxication, mental illness or psychosocial crisis.
• A co-designed, co-managed and shared care model encompassing emergency medicine, mental health, and Drug and Alcohol Services South Australia (DASSA)

Most importantly to achieve a genuine and meaningful impact, they should be funded for and represent:

• Additional beds, not rebadging of existing ED or mental health beds.
• Extra emergency mental health clinicians, psychiatrist consultants, psychiatry registrars, DASSA clinicians and nurses - not an expansion or shift of existing staff workloads.