Inside The Frontline Of The Mental Health Crisis

A new report by the Association of Salaried Medical Specialists Toi Mata Hauora reveals 45% of psychiatrists would like to leave their job in the face of soaring demand for mental health services.

The report ‘Inside the Frontline of the Mental Health Crisis’ details the stresses and challenges facing the country’s psychiatrists. It is based on responses from 368 psychiatrists who took part in an ASMS survey.

It follows on from an earlier ASMS report ‘What Price Mental Health?’ which detailed rising demand for mental services, reduced bed capacity and clinically stressed services.

ASMS Director of Policy and Research and report author Dr Charlotte Chambers says the fact mental health services are in crisis is no secret, but this new report provides a unique snapshot of how our psychiatrists are faring within that context.

Some of the key findings are:

• 95% report an increase in demand for specialist mental health services in the past three years
• 86% report an increase in the complexity of their caseload
• 76% report an increase in the size of their caseload
• 45% agree they would leave their current job if they could
• 87% don’t feel they are working in a well-resourced mental health service
• 35% report high levels of burnout

Psychiatrists serve as cornerstones of the teams responsible for the delivery of mental health services. The report highlights the struggles they face in providing the psychiatric care New Zealanders need, and the effect on their own wellbeing.

Some of their comments include:

“We often feel like patients are being discharged to the community to fail. This failure takes the form of suicide, homicide, estrangement and homelessness.”

“Due to high caseloads, patients are not seen as often as required by best practice guidelines, often slowing their recovery.”

“I love working with my clients/patients however the current system is unsustainable. We do not have enough staff or resources to retain staff, the staff around me are burnt out.”

“Very distressing to see very unwell patients who are unable to be admitted due to lack of beds.”

“I am referred more complex patients but with less resources and too little time.”

“When I look back on patient files, I am reminded how much care we could provide five, ten and fifteen years ago to specific patients compared to now”.

“I think my health will deteriorate if I stay in my current job”.

Dr Chambers says psychiatrists report no meaningful change or improvement out of the 2018 inquiry into mental health and addiction, or the $1.9 billion set aside for mental health in response. In addition, she says the Government’s most recent 10-year plan for mental health is, at this stage, nothing more than a set of aspirations.

The report lays down a challenge for the new national health employer Health NZ to ensure staffing rates are adequate in mental health services across the country, including nurses, psychologists and counsellors, and that buildings and infrastructure are fit-for-purpose.

“The emphasis in this report on the impact of poor physical work environments, absence of functional IT systems and logistical challenges to complete the simplest of tasks is not going to improve doctor wellbeing or health outcomes for mental health patients,” says Dr Chambers.

There are also warning bells over recruitment and retention of psychiatrists and the desperate need for succession and workforce planning.

“It is concerning that a number of mental health services do not employ trainee psychiatrists, and New Zealand’s high reliance on foreign-trained psychiatrists points to an urgent need to address medical pipeline planning. We need to encourage medical students to consider psychiatry as a sound option for their specialist training.

“We know Covid is creating even more challenges. The mental health system can ill afford to lose any more doctors. Looking after psychiatrists is good for everyone’s mental health,” she says.

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