Despite promises of funding boosts Australia’s mental health care system is groaning under the weight of demand, with those in crisis often forced to wait days for vital care, experts have warned.
The case of Melbourne woman Bridget Flack, who went missing last week, has highlighted gaps in the nation’s mental health system, and raised questions over where the extra funding announced during the pandemic has gone.
The 28-year-old social science graduate had been struggling with her mental health during the coronavirus lockdown and was waiting for an inpatient bed to become available at a mental health facility, Ms Flack’s sister told the Huffington Post this week.
Tragically, a bed only became available two days after Ms Flack went missing.
Most of the extra mental health funding promised by governments in response to the pandemic hasn’t arrived yet, University of Melbourne’s head of psychiatry Christopher Davey told The New Daily.
When it does, it won’t be enough to meet demand.
The short answer is we don’t have enough beds,” Professor Davey said.
“There isn’t a coordinated enough system to step in and provide care when people are in crisis.”
Mental health beds are just “one component of the system” that is under-resourced.
“We don’t have enough crisis care teams or access to clinicians either,” Professor Davey said.
During the pandemic, most state and territory governments announced more mental health funding.
It was $870 million in Victoria for a complete overhaul, $73 million in NSW, $46.5 million in Queensland.
Federally, Prime Minister Scott Morrison threw in $74 million to boost Medicare funding for psychologist visits.
But many Australians do not receive the treatment they need, and a recent Productivity Commission report found there is little evidence the system is getting better.
“Costs have been rising over time, with no clear indication that the mental health of the population has improved,” the commission said.
Many community mental health organisations are overloaded, leaving some Australians nowhere to go but the emergency department.
A recent report by the Australian College of Emergency Medicine found Australia had a chronic shortage of beds and almost 1000 people visiting emergency departments each day for mental health issues.
In 2018 and 2019 almost 30,000 Australians were hospitalised for self-harm.
“People are often traumatised by their experience – brought in by ambulance workers or police, shackled, chemically restrained and left for days until the next place for them to go to,” the Productivity Commission report said.
“The staff in EDs often don’t have the skills to work with someone affected by their mental illness and the culture in EDs is often ‘they are taking up beds’ – like the person with mental illness is not justified in being there.
“The ED is often the last place anyone wants to go.”
Professor Davey said there is widespread recognition the system is completely broken.
There needs to be reform. It’s fragmented, underfunded and overstretched,” he said.
The missing middle
The current system has a gaping hole in it, and a huge cohort of people are falling through it.
There is nothing for the “large cohort of people” in the “missing middle”, Professor Davey said.
“State governments focus on the pointy end, severe mental illnesses, they fund hospitals and acute crisis care for mental health,” he explained.
“For people who have severe problems but are not seen as risky enough to get into state-funded care, they have to rely on the federal government subsided care with a psychologist.”
Many Australians who are in the “missing middle” have complex health problems, which are exacerbated by poverty and social disadvantages, Professor Davey said.
They might not be able to get psychologist appointments, organise a referral, or pay the portion of the fee not covered by medicare.
The Productivity Commission report revealed that many patients and their families are struggling to get into care or navigate the system.
The bill for the broken system is large – mental health and suicide cost the country $220 billion a year.
The report said the system doesn’t just need more cash, it needs coordination between state and federal governments
And the latter needs to take the lead said, Professor Davey said.
“There is a real need for new systems of care,” he said.
“It’s not just about money, the answer is more coordinated care.”