The Australian mental health system has reached a crisis point where psychiatrists and other mental health professionals are leaving the sector in droves due to burnout and inadequate support, leaving patients to wait for long to receive care or delay their treatment and risk further deterioration. 

A news report recently revealed that one in four psychiatry positions in public health institutions are vacant in some states. The National Association of Practising Psychiatrists has affirmed this, adding that the "workforce crisis is negatively affecting patient care, with psychiatrists feeling pressured to discharge patients prematurely, leading to rapid readmissions and a revolving-door situation in mental health inpatient units." This is also what nine in 10 psychiatrists recently polled by the Royal Australian and New Zealand College of Psychiatrists thought about the ongoing staff shortage in the mental health sector.

The impact is more pronounced in rural and regional areas where there are only around one to five psychiatrists per 100,000 population. 

The Australian government claims it has been committed to addressing the supply and demand crisis in the sector by pursuing reforms and making significant investments in both workforce training and retention and filling gaps in and raising mental healthcare access. 

In its latest 2024-2025 Budget, for example, the Ministry of Health and Aged Care announced a funding of A$588 million over eight years to establish a new national digital service to provide support for people in temporary distress. Patterned after the Talking Therapies model in the United Kingdom, the mobile application-based "low-intensity" mental health service targets to serve about 150,000 Australians each year, some of whom had sought support from their GPs or were enrolled in programmes meant for diagnosed clinical cases.

The government seems to be also keen on utilising telehealth in addressing accessibility issues in mental healthcare. The Australian Private Hospitals Association (APHA) has recently shared that it was advised that the 2024-2025 Budget also introduces temporary Medicare Benefit Schedule (MBS) items for the admission and some subsequent teleconsultation of inpatients in private hospitals. It will be implemented initially over the next two years starting in November.

The organisation campaigned for this addition to the MBS for about a year. APHA CEO Michael Roff further discussed this upcoming telehealth trial with Healthcare IT News. He also shed light on issues hampering technological innovation among private hospitals and what he hopes the government could do more for the sector amid the ongoing crisis in the country's mental health system.

Q. I take note of your organisation's enthusiasm for the government's upcoming trial funding for psychiatric teleconsultations. Can you describe the use of private practices/practitioners of telehealth – do they seem to prefer it over in-person consultations and does it somehow help alleviate their burnout and improve the prospect of them staying in the business?

A. A temporary telehealth item for inpatient services was provided during COVID-19 where psychiatrists were unable to attend a hospital in person due to infection control concerns or lockdowns. They found this system worked well as hospitals generally had professional standard video conferencing equipment and a trained psychiatric nurse was present with the patient. This is opposed to outpatient telehealth consultations where the patient may be in a shopping mall on a mobile phone, i.e., an environment not conducive to the best clinical care.

This particular trial is for inpatient consultations, so it will go some way to alleviating pressure on psychiatrists, particularly when a consultation is required out of hours. We are hearing from our members that while we are waiting on more details, the response from many psychiatrists has been positive.

Q. Besides telehealth, what other technologies are being tested/implemented across private hospitals to complement their services amid staff shortages and growing demand for care? Can you identify which technologies (e.g. AI, chatbots, workflows on the cloud) are proving helpful for the sector? Also, how is your organisation promoting the uptake and utilisation of these technologies?

A. Private hospitals are always examining innovative approaches to care where it benefits patients. However, the main barrier to innovation in the private hospital space is the payment model and many large private health insurance organisations are moving into the provider space. This means they do not fund private hospital innovation but create their own programs that only allow their members can participate. Hospitals also need to be cognisant of patient privacy and cyber security issues.

Q. Can you describe the relationship of the private hospital system with the broader mental health system over the years? 

A. Private psychiatric hospitals care for people with moderate to severe and complex mental health conditions. They treat Australians suffering the full range of mental health disorders including severe depression, severe anxiety, eating disorders, addiction and post-traumatic stress. In Australia, 45% of adult psychiatric beds are in private hospitals.

Private hospitals are frequently contracted to treat public patients when the public hospitals are full or a patient needs a service that the public hospital is not set up to provide. Private hospitals also provide care through intensive day programs and outreach care. Private psychiatric hospitals care for more than 40,000 Australians with mental health concerns every year.

Q. How is the private hospital sector in Australia figuring itself in the middle of the ongoing mental health crisis? Besides campaigning for the addition of psychiatry MBS items (ie admission and teleconsultation of patients in private hospitals), what are other initiatives the sector is taking to help address the crisis?

A. There have been four mental health hospital closures in just the past six months, so we know it is a challenging time in the sector. APHA has long been calling for a minimum private health insurance default benefit for private hospitals to provide ambulatory care outreach programs that would provide greater access to patients, no matter who their insurer is. This would allow private hospitals the flexibility to create programs tailored to the benefit of their own patient cohort.

We also want to see the rules loosened up for overseas-trained psychiatrists so that they work across any private hospital and access the MBS. Currently, for the first ten years of practice in Australia, they can only claim the MBS when treating patients in hospitals in areas declared as a "district of workforce shortage." Right now, all private psychiatric hospitals are experiencing workforce shortage.

Q. How is the sector being supported by the Australian government in pursuing these initiatives? What improvements do you wish to see in the government's partnership with the sector?

A. APHA works closely with governments and departments at state and federal levels and will continue to do so. We have been advocating for a reduction in costly regulatory burden, especially where this is caused by duplication between different levels of government. There is now increased government focus on super-profits being made by health insurance companies while they fail to compensate hospitals for the true costs of providing high quality care.

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Interview responses have been edited for brevity's sake.