It’s no secret that Victoria has spent the least amount of money on mental health services per person of any state or territory over the last 10 years.

With the Royal Commission into Victoria’s Mental Health System underway, it is expected the process will provide a thorough assessment of the mental health system and recommendations to provide a modern system to meet the needs of people with a mental illness across Victoria.

While its recommendations are awaited, the RANZCP Victorian Branch has recommended that Victoria’s mental health system receive urgent investment across the sector, and commitments to increase funding until Victoria achieves parity with other states. One of 6 priority areas identified, and probably the most important one is to address, is the workforce shortages across the region.

How can these much-needed services be delivered without the human resources in place?

The Issue

A history of underfunded services has led to an inadequate and poorly distributed workforce with shortages in specialist positions in public practice, causing inequitable access to care, and an unstable workforce. Along with population and demographic changes over recent decades, public mental health services have experienced a reduction of funding in real terms to cope with these changes.

This has created a shortage and a maldistribution of the psychiatry workforce across metropolitan, regional and rural Victoria.

So severe is the shortage of psychiatrists that inner regional areas such as Ballarat and Bendigo have only 5.1 psychiatrists per 100,000 population. In outer regional areas, this falls to 1.2 psychiatrists per 100,000 population. In stark contrast, there are 16.9 psychiatrists per 100,000 population in Melbourne.

Two distinct specialist areas of psychiatry have been identified as critical, these being Addiction, and Child & Adolescent Psychiatry. So dire is the current situation that there are only 4 publicly funded full time equivalent (FTE) Addiction positions across the whole state, and approximately 20 – 30 publicly funded Child & Adolescent positions.

Addiction psychiatry is a critical tool in managing addiction, as they are uniquely trained to focus on both the psychological and physical health of the person, as well as to understand the social context and public health approaches.

Likewise, Child & Adolescent Psychiatry is key to early intervention and diagnosis of emotional disturbance and abnormal behavior, and to identify any chronic disorders at an early stage.

RANZCP Victorian Branch has recommended the following solution:

Funding to be provided to the tune of $20 million each year to fund these extra psychiatry positions and it should be allocated with shortages in regional psychiatry in mind. Suggestions are the yearly additional funding would be made up of the following:

  • 29 addiction psychiatrists and 29 trainee addiction psychiatrists across Victoria at a cost of $17.7 million per year.
  • 12 Child and Adolescent Psychiatry trainee positions at a cost of $2.4 million per year.
  • A tailored leadership program should be established for psychiatrists at a cost of $189,000 per year.
  • One SIMG Director of Training at a cost of $405,000 per year.

But these recommendations aren’t without their challenges

  • There aren’t enough child and adolescent psychiatry training places, creating a bottleneck of trainees and restricting the overall number of psychiatrists that are trained in Victoria.
  • Addiction Psychiatrists are in critical demand across most states currently. 
  • Only 9 psychiatrists gained Advanced Training in Addiction Psychiatry in 2018, and only 3 psychiatrists obtained this training in 2017.
  • Around 30 psychiatrists gained Advanced Training in Child and Adolescent Psychiatry across 2017 and 2018.

With this in mind, the question must be asked;

How is Victoria’s Mental Health services going to recruit these 43 specialists that are urgently required?

A dedicated and immediate psychiatry workforce strategy is needed to address current and future workforce shortages. Failure to do so will make it extremely difficult to provide a modern system to meet the needs of people with mental illness across Victoria.

Suggestions and initiatives to consider:

  • Create post fellowship positions available for trainees that offer advanced training. These positions should be promoted to trainees who are due to gain their fellowship over the next 6 months. This will avoid the new fellows moving interstate or abroad.
  • Focus on a more efficient and transparent recruitment process that keeps candidates engaged throughout every step the process. Current recruitment process within the public sector are somewhat protracted and ineffective.
  • Commitment from all stakeholders is required to refine the recruitment campaigns. This includes setting out clear timescales around screening, shortlisting, interviews, interview feedback, selection, offers, reference checks, inductions etc.
  • Partner with a specialist medical recruitment consultancy with local and international presence who have a track record of delivering on such specialist projects. Working together in managing the process tightly from end to end will avoid the high level of candidates currently withdrawing their applications due to a lack of communication. In some cases, applicants are currently waiting up to 3 months for feedback on interviews, and in some instances no feedback at all. Candidates that endure this experience will seek opportunities elsewhere, resulting in Victorian services missing out on suitable candidates.

There is no silver bullet solution for these challenges ahead, however action needs to be taken immediately to help in addressing the needs of people with a mental illness across Victoria.