It's good to know the money is there, but spend it on primary care and protecting the staff we have.
The Federal Government’s Head to Health program it will create 10 new “pop-up” clinics at a cost of $10.6 million, it was announced today.
The announcement included a commitment for these clinics, available only for those with mental health conditions that have arisen as a direct result of the covid pandemic, to be up and running in four weeks. The clinics will be run by dedicated mental health professionals, but no medical professionals. The brief is to take calls and redirect people to the appropriate mental health services, and not to provide direct crisis management.
As a psychiatrist who has worked at the front line of acute mental health services since the pandemic began, I am somewhat impressed that such an initiative could attract such funding and be rolled out in such a short time.
Nobody would argue that there is a growing mental health pandemic following the pandemic caused by covid. Just as we have seen with the banking of ambulances at emergency departments, a lot of the ever-increasing demand on mental health services has come about because the system was decimated in the first place. So, yes, funding is extremely important, and so is addressing workforce shortages.
But is the creation of pop-up clinics the answer when it comes to the best way to use this funding and addition to the mental health workforce?
I am concerned that the newly created workforce to service the pop-up clinics will consist of our dedicated mental health professionals, who are given an opportunity to leave their posts in a very overburdened mental health system.
It is difficult to comprehend that there is an oversupply of mental health professionals right now that can start work almost immediately, when most psychologists and psychiatrists have closed their books to new patients for months. It may become way more attractive for many of our invaluable clinicians to move away from the frontline and into such clinics, which are offering a sophisticated mental health call centre and drop-in service.
After 20 years of service in the psychiatry space, I am constantly disappointed at the dumbing-down of my profession. I can’t fathom a chest pain or an oncology pop-up clinic.
I do wonder what the general public make of our skills and expertise in psychiatry.
The fact that medical professionals are not part of this model of care puts immediate limits on its capacity to offer much more than a chat and a referral. Many who are experiencing mental health consequences as a result of the covid pandemic are very depressed, often suicidal, have problems with substance misuse or have developed a clinical disorder such as anorexia nervosa. None of this could be adequately triaged in a pop-up clinic, and that could just add more confusion and hurdles to find appropriate care.
The answer is really to simplify what is a very complicated mental health system, which often differs from state to state, not add another layer of complexity.
For anybody unsure if they have a mental health condition, or unsure where to get help, the answer has always been the same: general practitioners are the backbone of our primary health care system, they always have been, and are something our nation should continue to invest in and be proud of. GPs offer everything a pop-up clinic will offer. They understand how to navigate the mental health system, and provide interim assessment and treatment, often managing great degrees of complexity and risk.
It’s a no-brainer that if indeed federal funding is available, it should be directed to the primary care sector in the form of incentives and increases to MBS item numbers. In the space of four weeks this would have a dramatic impact, with a workforce that already exists.
Another simple add-on would be the creation of an MBS item number for secondary consultations with psychiatrists, to support the work the GP does with the patient, and getting around the workforce shortage seen in psychiatry. For example, a patient on a waiting list to see a psychiatrist could be managed by the GP with the support of the psychiatrist, utilising a new MBS item number funded by Medicare.
As appealing as it sounds that people are directed to the appropriate services when presenting to these pop-up clinics, the obvious next question to explore is: where are these services? Non-governmental organisations (NGOs) have done a lot of heavy lifting and offer an incredible array of programs and services that often cater to culturally specific concerns, or specific mental health conditions. But most cannot actively manage symptoms of a mental health presentation, mitigate risk or offer ongoing treatment.
In Victoria, there are no public services outside metro Melbourne for the treatment of eating disorders. Very few beds are left for mothers experiencing severe post-natal depression. People experiencing a florid episode of psychosis are more likely to come to the attention of the police and transported to an emergency department in a divisional van rather than in an ambulance. And the only pathway to an acute psychiatry ward is still via the emergency department – overburdened, overwhelmed and the worst possible place for a patient who is terrified and vulnerable.
So given this is reality, how much value would a pop-up clinic offer? The only benefit I can derive is that finally there is attention on the need to invest in mental health care immediately. This needs to exist in the form of funding and investment in workforce recruitment and retention. Initiatives that protect the finite workforce we already have, knowing that there will be attrition due to burnout is a much more sensible way to go. Thinking logically, if emergency departments are completely overwhelmed by patients with covid, why not invest in clinical mental health teams that work in emergency departments, that can assess and triage people with mental health presentations at the point of contact? These teams currently exist in a very piecemeal way, and often not at all in regional hospitals. These clinicians know how to assess risk and refer on.
And even more rudimentary than that, use this funding to support those completely exhausted and demoralised with tangible solutions such as a casual workforce to let so many step down and take leave.
There does seem to be a full circle appearing here. The frontline workers in the mental health space who are experiencing their own mental health problems as a direct result of the pandemic would fit the brief of the ideal patient for a pop-up clinic service. This does seem rather hypocritical and counter-intuitive. The last thing we need is a duplication of services; more importantly, we need to invest in the services we already have, filling gaps in areas such as eating disorder services, boosting the capacity of the general practice sector and being clever about recruitment and retention.
And now that the federal government has declared its hand that funding exists, let’s not squander it.
Dr Helen Schultz is a consultant psychiatrist specialising in doctor mental health