Almost half of psychiatrists report wanting to leave their jobs in the face of the soaring demand for mental health services.
A report by the Association of Salaried Medical Specialists found three quarters of psychiatrists have reported an increase in their caseloads, and on the demands of on-call work in the last three years. Cases are also becoming increasingly complex.
And despite the number of people experiencing psychological distress increasingly significantly in the last decade, the numbers of staff, acute beds and availability of respite care have not increased correspondingly.
Photo: RNZ / Dan Cook
Listen to the full interview with Dr Charlotte Chambers
For the medical specialists at the coalface of this mental health crisis, it presents a stressful and challenging workplace, with no signs of positive change.
Psychiatrists are fed up, Dr Charlotte Chambers, the report's author and the director of policy and research at the Association of Salaried Medical Specialists, told Kathryn Ryan .
“They’ve been putting their own wellbeing on the line for a very long time and they’re also struggling with this sense that they’re not able to provide the best quality care to their patients that they know they could if resourcing was actually concurrent with demand from mental health services.”
She says a lot of psychiatrists are hanging on because they really care for their patients.
“They wouldn’t be in this job for many other reasons, because it’s really gruelling. They have to deal with some of the most unwell patients in New Zealand and are quite literally putting their own wellbeing on the line; they have to deal with violence and really difficult and challenging patients.
“The things that are stopping them from leaving is the fact that they know that, potentially, it’s not going to get any better if they tried to work elsewhere but also because they know, if they leave, then the system is just going to get worse.”
According to the report, in the last three years 76 percent of psychiatrists reported an increase in the size of their case load, 95 percent reported an increase in demand for specialist mental health services, 86 percent reported an increase in the complexity.
“We wanted to look over that three year period because this time in 2018, we had that mental health inquiry and, at the time, they stated that - perhaps rather optimistically – that demand for specialist mental health services would decrease as more attention was paid to community-based care and so forth.
“We really wanted to test that by asking by asking psychiatrists themselves whether they felt that they’d seen any decrease. Part of the problem we have here is that there’s not any solid research into how mental health demand is changing. Asking the psychiatrists themselves is a really important way to fill that research gap.”
Dr Chambers says she was gobsmacked by how many psychiatrists reported an increase in workload.
“There seems to such a gulf between the people working at the front line and the people who are responsible for funding and planning for mental health services.”
Despite a funding boost for mental health services in the previous Budget, Dr Chambers says it’s yet to make a difference on the wards.
“Focussing on the pointy end of this mental health crisis is another way on shining a light on what we already know, which is that our mental health system has not been functioning properly for a long time now.”
She says on-call shifts have been increasing and psychiatrists are using their own annual leave entitlements to safely recover from brutal night shifts.
“The mental distress that these psychiatrists are experiencing is not insignificant. We heard stories where they were starting to dread how difficult their on-call shifts were likely to be, their on for a whole weekend and they’re really concerned as to how safe the care they could offering during that time would be simply because they’re not functioning as well as they could.”
It takes 11 years minimum to train as a psychiatrist and the profession is largely dependent on immigrant medical specialists. Dr Chambers says there might need to be more training places opened up for students in New Zealand to meet the demand.
“We would question if there’s enough oversight as to whether or not the number of trainee places is adequate, particularly if we’re seeing this demand for mental health services continue to increase.
“We have to also understand that this demand for international medical doctors puts us in competition with other countries as well and if, as this report is suggesting, our mental health service is in a pretty dire state, then I think we have to question whether or not it’s going to be an attractive place for these international medical graduates to want to come and work.”