W(h)ither psychiatry? Contemporary challenges in Australian mental health workforce design

Abstract

Objective: To consider the changing profile of Australia’s mental health workforce and the implications, particularly for specialist psychiatry services. Method: We analyse data from a national collection that describes changes in the workforce over a decade, to 2017–2018. Results: While single practitioner-based psychological services flourish, other areas of more complex and team-based care are struggling to remain relevant. Psychiatry and mental health nursing, two areas that previously led Australia’s response to complex mental illness, are under enormous pressure. Conclusion: The shifting balance of specialised mental health workforces is affecting the mental healthcare available in each region of Australia. Questions arise regarding the desired or optimal mix of professionals we wish to deploy. What roles should each professional group play and how should they work together? What does this mean for how various groups should be trained and paid? These data challenge the role specialist psychiatry wishes to play in leading reform. Current mental health reforms risk foundering should psychiatrists fail to take up the challenge of leadership.

A new bottom-up method for the standard analysis and comparison of workforce capacity in mental healthcare planning: Demonstration study in the Australian Capital Territory

“…The results of this study show that the mental health workforce in the ACT was, overall, larger and more highly skilled than all the comparator regions except Helsinki, with the exception of its psychiatrist workforce, the rate of which was higher in the international and one Australian regions, particularly in outpatient care. The high rates of psychologists, but relatively low rates of psychiatrists in the ACT aligns with an observed national trend in Australia [20,52] of expansion of the psychologist workforce, which is more likely to be individual practitioner based; and contraction of the psychiatrist and psychiatric nursing workforce, which are more likely to provide "more complex, team-based care". This trend may not be providing better outcomes for patients [53] or a more integrated system of care.…”