Only about one-third of people in Victoria who need clinical mental health care receive it in the public system, and Victoria spends the least per capita than any other State or Territory.
The recently released report ‘Access To Mental Health Services’ from the Victorian Auditor General’s Office (the VAGO report) provides a startling and compelling commentary on the current state of mental health services in Victoria. It also confirms what we already know: the mental health sector has been neglected. The system is in crisis. Planned, targeted improvements are needed now. The Victorian mental health system cannot afford to wait for the Royal Commission to make recommendations.
Even when people are acutely ill, it can be difficult to access inpatient care with Victoria having one of the lowest bed bases nationally. Patients are being prematurely discharged to make room for other patients with more acute symptoms. The average length of stay in an adult Victorian inpatient unit is only 9.2 days. This is not long enough for many pharmacological and psychotherapeutic treatments to take effect.
A number of shortfalls in the mental health system has resulted in mental health services only being able to treat those who are most unwell, meaning many get turned away and opportunities to intervene early are lost. Recovery from a mental illness is possible, but without access to services we risk losing that hope. Despite there being clear understanding of what constitutes effective evidence-based care (both psychotherapeutic and medication-based) there is no clear strategy to ensure delivery of care to people in need.
Mental health services in regional and rural areas also face additional challenges, and no actions yet have accounted for the inherently higher operating costs faced by rural mental health services. Inadequate and poorly distributed workforce, with shortages in specialist positions, in regional and rural areas greatly affects people’s ability to access services close to home. It is important that wherever possible, people are supported to remain in the community in which they live, work and have support networks, for treatment.
Our workforce is in crisis. With a number of factors contributing to difficulties in recruitment of all mental health disciplines, and no clear strategy to address this effectively, the sector is struggling to maintain a sufficient workforce. My colleagues are leaving the public sector in record numbers due to a number of reasons including, safety and ethical concerns, with low morale created by the inability to provide the level of care they desire. The RANZCP Victorian Branch is calling for a dedicated psychiatry workforce strategy to address current and future workforce shortages.
As outlined in the report, additional funding needs to be accompanied by practical guidelines and a plan. The plan must focus on improving outcomes for those accessing services. This way we can deliver what works, as well as improve peoples’ mental health and access to care and bring Victoria back to being a world leader in mental health services. However, first we need to agree on effective solutions to address known shortfalls.
We are strongly supportive of the Royal Commission into mental health as it provides an unprecedented opportunity to design a mental health system that meets the need of Victorians in the 21st Century. However, it may be years before the Royal Commission’s recommendations are actioned. Victorians cannot wait that long. We need urgent investment now and we need a dedicated plan for how we are going to do it.
Richard Newton, RANZCP Victorian Branch Chair