More questions than answers
The Mental Health and Addiction inquiry report has laudable aims but lacks detail about implementation and side-lines those who work in the sector, says Lyndon Keene, Director of Policy and Research at the Association of Salaried Medical Specialists (ASMS)
Published in ASMS magazine The Specialist on page 17-18, Mr Keene’s analysis of the report can be read here: https://www.asms.org.nz/wp-content/uploads/2019/04/The-Specialist-Issue-118.pdf
Mr Keene takes issue with the inquiry panel’s decision to be (in the panel’s words) “guided by the needs of people and communities rather than the preferences of the various groups accustomed to the way the system is structured and services are delivered at present”.
Excluding workforce views might account, in part, for a lack of substance about how to deliver the recommendations. Mr Keene says notwithstanding the exclusion of workforce views, the conclusions are reasonable and will find consensus. An emphasis on wellbeing and community, prevention, expanded access to services, and more treatment options are laudable, if rather familiar, aims. The lack of specifics about how to achieve the desired outcomes allows the Government much wriggle-room.
The practicalities of what will change, and how, are no closer to being answered than before the panel was convened, Mr Keene writes.
While the report talks about a “workforce crisis” there is little recognition of issues in the psychiatrist workforce. Indeed, the report incorrectly states there was “a large jump in the number of registered psychiatrists in 2018”.
Trainee numbers have risen in recent years but are lower than in the early 2000s. There is a heavy reliance on international medical graduates (60% of the workforce).
In 2018 there were 492 full-time equivalent psychiatrists employed by DHBs, compared with 482 in 2017. Caution is needed interpreting the figures because it could reflect an increase in registrations of doctors, including non-specialist medical officers, who were already practising.
District health board workforce figures do not show a large jump in full-time-equivalent psychiatrists.
The report calls for psychiatrists to provide more support for community-based workers. ASMS has long advocated for integrated services and patient-centred care. This approach requires a well-resourced specialist workforce.
Ultimately, it’s the Government – whose official response to the report is expected soon – which determines if the recommendations are transformed into actions.
“The extent to which the Government supports a well-resourced [Mental Health] Commission with teeth will be an early test of its commitment to addressing our mental health crisis,” Mr Keene writes.