1 IN 5 AUSTRALIANS WILL EXPERIENCE A MENTAL ILLNESS The Ramsay Way 2017 | 02 9 More beds, more doctors on the horizon for mental health Albert Road Clinic Professor of Psychiatry Malcolm Hopwood recently stepped down as President of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) after 2 years at the helm. Here he answers the most-asked questions on the greatest mental health care challenges patients, hospitals and doctors face in Australia. Outgoing RANZCP President Professor Malcolm Hopwood is the new President Elect of the Asian Federation of Psychiatric Associations and the Ramsay Health Care Professor of Psychiatry at the University of Melbourne where he leads the Professorial Psychiatry Unit at Albert Rd Clinic. What are the top challenges mental health patients face in Australia today? Mental illness is the third leading cause of disability and burden in Australia and every year, one in five Australians will experience a mental illness. One of the biggest challenges for patients and health professionals is finding the best ways to implement good models of “stepped care” – so patients get the care they need in a timely way. This could start with timely interventions on the Internet through to easier access to inpatient care in hospitals. There is also a chronic shortage of psychiatrists - by 2025 it is estimated there will be a shortage of 452 fellows in Australia according to the latest 2016 Workforce shortage report – and this is particularly problematic for patients in regional and rural areas. What about better accessibility through health insurance? The other main issue for patients is poor transparency amongst private health insurers. Choice recently reported on a suicidal patient who was denied hospital admission by his health fund because he had already used up the maximum yearly number of psychiatric admission days. There are also considerable other issues with cover limitations for day programs and outreach programs providing mental health services in the patient’s home. There’s no question mental health should be recognised as a serious and often life-threatening medical issue that is covered by all private health insurance without caps - like other specialties. For instance there are some fund caps on ECT treatments but we wouldn’t have those caps on chemotherapy if patients needed extra chemotherapy. Hopefully, the outcomes of the current Commonwealth Government Review of Private Health Insurance will address some of these problems. What does the private hospital system offer patients that the public system cannot? The key advantage for patients treated in the private system is the ongoing link with their private psychiatrist, instead of frequently seeing a different person every time. The private system also deals with a broader range of health problems including depression and anxiety as well as substance abuse problems. In the public system patients are often sent back to the GP for these issues. This isn’t a question of the quality of care I’m talking about either it’s purely about capacity. The private system needs to be more accessible to more patients. It also has some excellent, evidence based on-site day programs such as DBT (dialectical behaviour therapy) which helps assist those with impulsive behaviours to regulate emotions. Ramsay is today the largest provider of private mental health care services in Australia and operates 25 mental health units across the country with approximately 1000 beds; turning over 70,000 patients per annum. These facilities are vital for patients who would otherwise face huge waits and gaps for treatment – and are even more important in rural areas. What could the private system do better? One area the private system could look at is the development of more early psychosis treatments. Many psychiatrists would also like to see a greater range of peri-natal psychiatry services which are incredibly patchy. There is a huge need at this critical point in a mother’s life. Perhaps the public and private systems could work more closely in these areas, or the private hospitals could better identify at risk mothers in their mainstream hospitals for an easy-access referral pathway to Ramsay mental health facilities. Why is there such a big shortage of psychiatrists when so many other specialties are in over-supply? In years past psychiatry was seen as a ‘Cinderella’ speciality. Psychiatry was highly stigmatised and challenging work. It was also very difficult for doctors to get cover in regional areas for holidays. Psychiatry was also identified by the Commonwealth Department of Health as the least remunerated specialty for the value it creates for the community. It’s a dilemma for private psychiatrists to provide the best patient care and still be able to maintain an income. Things have changed a lot in the past decade, yes there is still a shortage within the specialty, but the gap has certainly closed a lot. We are also seeing more commitment to research and training. Ramsay for instance has committed to the Professorial Chair at Albert Road Clinic. The RANZCP has recently undertaken to address this problem through the development of the Psychiatry Interest Forum (PIF) an innovative program engaging medical students in psychiatry. This includes sponsored attendance at the RANZCP congresses held in May every year. Preliminary data suggests this has increased recruitment significantly. We need more government and private support like this so young doctors can get travel and access to thought leaders across Australia. What about the high rate of mental health issues amongst doctors? Last year a BeyondBlue study of 14,000 students revealed that 25 per cent of doctors had suicidal thoughts prior to the past 12 months. The recent suicide of Dr Chloe Abbott has sparked a government forum into young doctor suicides. What are your thoughts on depression amongst doctors? In the past the attitude of the medical community has been to minimise doctors’ mental health issues. There has been an inference doctors who have mental health issues are lesser beings for having such a problem. But doctors are just like everyone else and have lives outside of medicine. We need RAMSAY MENTAL HEALTH to encourage people seek treatments; to take leave and comply with treatment – and then there’s no reason to involve the Medical Board. These doctors also need the support of their employers. It is paradoxical that doctors are not good at attending their own health, but the reality is many are not. They fear that by discussing any issues it may limit their career prospects. It’s also worth acknowledging that doctors are not unique, and the same issues affect all health professionals. However we know nurses for instance are more likely to leave a job they no longer find rewarding while doctors tend to stay.” THE RAMSAY HEALTH CARE BOARD AND KEY EXECUTIVE VISITED RAMSAY SIME DARBY IN MALAYSIA IN JUNE. The trip encompassed visits to Ramsay Sime Darby’s three hospitals: ParkCity, SubangJaya and Ara Damansara Medical Centres. The Board with key personnel from Ramsay Sime Darby representing Malaysia and Indonesia.
The Ramsay Way - Winter 2017
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