I keep seeing reports come across my desk that speak to the crisis that is affecting the sustainability of mental healthcare across Australia and Aotearoa New Zealand. 

National workforce data highlights this strain, the number of psychiatrists per capita in both countries remains below the OECD average, and access is particularly poor in Australia’s regional, rural and remote areas. In fact, there are more than twice as many psychiatrists in cities compared to remote regions. And Aotearoa New Zealand continues to have the unenviable position of having one of the lowest psychiatrist-to-population ratios in the OECD.

This is particularly prevalent in the public system, where increasing service demand is not being matched by workforce growth. The recent Australian Government Psychiatry Supply and Demand Study found community demand for psychiatric services will far outstrip supply over the next 25 years, with a projected 20.7% undersupply of psychiatrists by 2048. 

The AMA Public Hospital Report Card Mental Health Edition 2025 similarly highlighted how the workforce crisis impacted on patients with mental illness in emergency departments, calling for more beds and more staff to expand capacity to meet demand. The report demonstrated reduced system capacity with steady decline in the number of mental health beds per person over the past 30 years. The latest figure of 27 beds per 100,000 Australians remains the lowest per capita figure on record. We need more than twice this to achieve international best practice (60 publicly funded beds). The report, while finding that follow up community care to reduce re-admissions has improved across the board fragmentation in the system does lead to poorer patient outcomes.

The Productivity Commission’s final review of the Mental Health and Suicide Prevention Agreement found the Agreement is "not fit for purpose" and has made little progress towards meeting its objectives, while the mental health system continues to turn its back on those in greatest need. The commission made a recommendation about making workforce sustainability a key measure of success. 

Mental Health Australia recently made a submission to the Commonwealth Economic Inclusion Advisory Committee that there is an estimated $8 billion funding shortfall for services for people with chronic severe mental illnesses (around 2% of the adult population). Almost half a million people aged 12 to 64 – known as the forgotten middle -have unmet need for psychosocial supports outside the NDIS. Almost half these people have severe mental illness. 

Mental illness and substance-use disorders now carry the second highest burden of disease in Australia, yet investment remains fragmented and inadequate. Lack of community services that offer the full suite of mental health treatment and psychosocial support services to people are causing more people to turn to emergency departments as the default entry point for mental health care than ever.

The reality for one in ten Australians seeking mental health care in our hospitals is almost a full day’s wait in an emergency department, with some patients waiting for more than 23 hours. The Australian College for Emergency Medicine (ACEM) released it’s Still Waiting report which found that mental health presentations to emergency departments increased by 11 per cent between 2016 and 2024, with people arriving in greater complexity and urgency. Emergency departments have become the default, and often only, option for people in mental health crisis because community services are underfunded, private psychiatric hospitals are closing, and Medicare doesn't cover the complex care people need.

When people reach out their hand for help, it’s our workforce that reaches back. However, the mental health workforce faces a greater risk of stress, burnout and mental illness compared to the general population. A diverse set of skills are required to meet the complex needs of those with mental illness, and psychiatrists have a unique role to play as specialists and more generally. 

As psychiatrists, we understand the realities of the system better than anyone. We need to harness that knowledge to set our priorities, strengthen our collective advocacy, and make sure psychiatry is represented where decisions are made. The mental health systems we work in are many things. They are fragmented, hard to navigate, under resourced, and some even say fundamentally flawed or broken. Psychiatry is at the heart of the system because we provide clinical leadership, supervision and expertise that holds it together.

The College recently came together for the Securing the future: Addressing the psychiatry workforce crisis | RANZCP summit with senior binational public health officials to discuss options for going forward and psychiatrist's role in leadership for the issue. I look forward to seeing the results of this work and seeing the College lead the change required. 

Dr Astha Tomar
President