Dire shortages of psychiatrists in regional Australia are leaving those patients struggling to access treatment with chronic conditions and contributing to the health professionals’ burnout in the workforce.
A new Royal Australian and New Zealand College of Psychiatrists (RANZCP) report has found that 94 per cent of regional psychiatrists say this lack of specialist healthcare is having a detrimental impact on patients.
It also reveals almost three-quarters of regional psychiatrists are experiencing multiple symptoms of burnout and a third are considering leaving the profession in the next five years.
It came as no surprise to the chair of RANZCP’s rural section associate professor Mat Coleman.
“The demand on services has just exponentially increased and unfortunately, the number of psychiatrists throughout rural and remote Australia has always been low,” Dr Coleman said.
“Access to care has always been difficult for people living in rural communities and that situation is only getting worse.
Residents struggle to access services
Taegen moved from Adelaide to South Australia’s south east in early 2022 after her partner secured a job in the region and to be closer to family.
She lives with a chronic mental health condition and had been attending regular appointments with a GP, psychiatrist and psychologist in Adelaide to manage the illness, but said she struggled to access mental healthcare in the south east.
“Moving down after 20 years away, I was really quite shocked at what was available and definitely not available,” Taegen said.
She still has not managed to secure an appointment with a local psychiatrist, instead having to rely on telehealth or travelling to Adelaide.
SA Health said they had two permanent resident psychiatrists based in Mount Gambier covering inpatient units that also supported the local community mental health team and a team of psychiatrists that made monthly visits to regional South Australia.
No change in two decades
General practitioner Michael Nugent has been working in the state’s Clare Valley, more than 100 kilometres north of Adelaide.
He says residents face “long waiting times” trying to access local psychiatry services, with one visiting private psychiatrist and one public psychiatrist who was heavily overloaded with her workload.
“The local mental health service does its best to try and prioritise people who need to be seen, Dr Nugent said.
“But at the end of the day, people are being seen long after they really need to be seen. That can lead to crises, crises with family and with their general mental health.”
He said while in the past two decades, community attitudes to mental health had improved and there had been many more counselling and psychology services in the region, access to psychiatry had not improved.
“I think the situation is very much the same as it was 20, 25 years ago,” Dr Nugent said.
“It’s good that the other mental health services have improved vastly over that time, but as far as psychiatry, it’s much the same.”
No ‘pipeline’ of psychiatrists
A major issue, Dr Coleman said, was the requirement for aspiring doctors and specialists to relocate to capital cities, like Adelaide, to complete their studies.
Aspiring psychiatrists must spend four to six years studying for a medical degree before completing “on the job” training in a hospital for one year and five years of specialist training with RANZCP.
“Unfortunately, we’ve got a system that says if you want to become a healthcare professional, in this case, a psychiatrist, you have to leave your community for a period of anywhere up to a decade to go and get the training,” Dr Coleman said.
He said by the time they had completed their studies, specialists could have established lives in the city with mortgages, children or partners, and to move back to regional South Australia would be “completely unrealistic and unsustainable”.
“The issue is that there’s no pipeline of psychiatrists coming out into regional South Australia,” Dr Coleman said.
Studying in regional areas will help retain specialists
To address the scarcity of regional psychiatrists, Dr Coleman called for the education model to be “flipped”, allowing aspiring medical practitioners in regional areas to complete qualifications in their hometowns.
Last year, the federal government allocated $90 million to support medical students to undertake their entire studies in regional areas, which has supported 40 students at Flinders Medical Centre.
The Workforce Incentives Program — Rural Advanced Skills payment also provided payments between $4,000 and $10,500 to doctors with advanced qualifications to work in regional areas.
However, both Dr Coleman and Taegan said incentives should be increased to attract the specialist.
“We’re not retaining health professionals, or we’re not inviting health professionals down with enough incentives,” Taegen said.
“It’s definitely a hard problem to fix but I think putting our heads in the sand generally as a community or government-wise, it’s definitely not safe and not working.”
A spokesperson for federal Minister for Health Mark Butler said the government was “committed to reforming the mental health and suicide prevention systems” for all Australians.
They said the government had committed $40.5 million until 2026 to support up to 30 full-time psychiatry training posts in Australia and develop a Certificate of Psychiatry to broaden the skill sets of GPs to deliver care.
He said the government restored bulk-billed telehealth psychiatry consultations in November 2022.
