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From Schwartz Media, I’m Ruby Jones, this is 7am.

Lockdowns and ongoing concern about the pandemic have led to a significant spike in the number of Australians experiencing mental health issues.

But when many people try to seek treatment they are faced with a complicated, under-resourced and expensive system.

Today, senior reporter for The Saturday Paper Rick Morton on the real causes of Australia’s spiralling mental health crisis and the recent bungle that made it worse.

It’s Thursday, February 24.

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RUBY:

Rick, the last two years have obviously been a pretty difficult time for a lot of people, and I think that has translated into mental health challenges for many of us as well. And so I thought that a good place to start this conversation would just be, I guess, quite a simple question, which is if you were a person who wanted support or help with your mental health right now, what would you find?

RICK:

Well, the chances are if you're looking as a new patient and you've developed a mental health condition, it would be close to impossible to get help right now.

Archival tape -- News:

“Psychologists like Tracey Hunter have no space for new clients. She's been forced to turn patients away and she isn't the only one.”

RICK:

You know, right now, the wait times to see a mental health professional can be over nine months. And that's a huge problem because one in five Australians are reporting very high levels of mental stress related to the pandemic.

Archival tape -- News:

“Lifeline took more than 89000 calls. Just last week, 48 per cent of callers mentioned Coronavirus, 16 per cent discussed the Melbourne lockdown.”

RICK:

And a third of Victorians reported feeling depressed or anxious in a recent survey. And obviously, that's got a lot to do with the long lockdowns in the state. But even now, when restrictions are largely eased, there's a kind of pervasive sense of uncertainty and anxiety. People are really struggling.

Archival tape -- News:

“Scripts for anti-depressants are up. An extra 34000 boxes of tablets have been filled.”

RICK:

And really, there was already a mental health crisis in this country before COVID. That's well documented.

Archival tape -- News:

“The two year Mental Health Royal Commission revealed the system is chronically underfunded and often can't reach the people who need it.”

RICK:

The pandemic clearly has exacerbated it, but there isn't enough in place to help people there wasn't before. There certainly is it now and now. Of course, the federal government has tried to do a little bit of catch up by introducing some measures that will help some people. You know, for example, it's extended financial subsidies for people trying to seek mental health care. But really, all that has done is expose how deeply under-resourced the current system is.

RUBY:

OK, so it's not a great state of affairs, Rick. We have a lot of people who want help, and it seems like getting that help is difficult. Before we get into the reasons why that is though, and whether it might change, could you actually just step me through how mental health care services are accessed in Australia? How does it work?

RICK:

I'm so familiar with this. So most people in Australia who access psychology or psychiatry services do so with private providers and in private clinics, but they are eligible for government subsidies. The Medicare rebate and those subsidies are really important because the cost of a mental health care professional, even when it's covered under Medicare, can be, you know, $100 to hundreds of dollars per appointment.

Now, to claim these rebates, you must have a referral in the form of a mental health care plan from your general practitioner. Now that mental health care plan used to give you access to 10 subsidised sessions a year, and even then you'd get six upfront and then you had to go back to the GP to get the other four. But that has now doubled to 20 sessions per year for those impacted by the pandemic.

But while that sounds like a sensible system on the surface and it is helpful to people who already have a psychologist, for example, there's a couple of big problems with it. Firstly, even with the subsidy, it can still be very expensive to see that psychologist. And secondly, trying to find one who doesn't have a months-long wait list is really bloody hard.

RUBY:

Hm so it sounds like there are two problems here, Rick. Let's talk about the cost first. How significant is it?

RICK:

So across all mental health services, Australians paid $217 million in gate fees in that financial year, or an average of $36 for every single service rendered.

Now the gap fee is the difference between what clinics charge and what the government pays you essentially - what the government subsidies. So it's basically the out-of-pocket cost for the patient.

Now in psychiatry, the gap fees charged in 2018-19 were $101 million or $54 for each service on average. Now, the important thing to realise here is that the average obscures the individual picture and for many people who are unable to secure a bulk billed appointment, the fees can be in the hundreds of dollars per service.

So it's kind of funny in a dark, dark kind of way. You know, in Australia, we're proud of what we describe as a universal health care system. But when it comes to mental health, we're paying out of pocket more than $300 million each year.

RUBY:

OK. And so Rick what does that mean, then on an individual level, for people who are seeking help, is the cost of doing that stopping them?

RICK:

Yeah, in some, in some cases, it's either delaying them or stopping them from even trying because they just know it's a fruitless exercise.

So the Productivity Commission's report on government services that was released earlier this year has the most recent data on this, which found that 13 percent of people across Australia with a mental health condition delayed seeing or did not see any professional for that mental illness.

So the situation was most alarming for those who needed to see a psychiatrist with eighteen point two percent. That's almost one in five being deterred due to cost.

So a lot of people drop off and don't get help. Purely for that reason, the cost is prohibitive.

But then there are. All the others who can pay, but still can't get an appointment because the wait times have blown out so much.

And there are some bigger problems here with the training and the pipeline of trained professionals, particularly psychiatrists, but psychologists as well.

And they could have been at least scores more in the system right now were it not for a pretty huge technical bungle late last year.

RUBY:

We'll be back after this.

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RUBY:

Rick, right now, if you're lucky enough to be able to access mental health services, it could still cost you hundreds of dollars in out-of-pocket fees. But a lot of people aren't even able to get that appointment. So why is that? Is this to do with there not being enough psychologists or psychiatrists? What is going on?

RICK:

Well, that's that's more or less exactly right. You know, all across Australia, people in need of care are reporting wait times of nine months or more for psychologists and well in excess of a year or even two years for some psychiatric appointments.

And it's a massive problem that the government hasn't done anything to solve. Now, expanding subsidies is all well and good for people already in the system, but it doesn't help people who can't get an appointment.

And really, what it comes down to is that this is a workforce issue. The workforce is not growing at anywhere near the level that it needs to. And of all the mental health professions, psychiatrists are growing by far the least.

And psychiatrists are also the hardest to train because they take the longest. Like any other doctor, they have to do a medical degree which takes years and years and years. And then they have to go through years of psychiatric training through the college, through placements, rotations, internships and all the rest of it to specialise in psychiatric medicine, which means that they are able to prescribe the medication and treat complex and serious mental illnesses.

But without the psychiatrist, we're in a pretty difficult spot.

And there have been recent mistakes that have actually made things worse at the worst possible time.

RUBY:

OK, so tell me about that, Rick. What sort of mistakes?

RICK:

So just before Christmas, the Royal Australian and New Zealand College of Psychiatrists cancelled a critical exam midway through the day of assessment.

There were about 270 junior doctors and registrars who were due to sit that exam. Many of them were ready for the final accreditation that that exam would have given them.

But it was technically because the audio visual link failed and they had to do an audio visual exam because they couldn't sit face to face due to COVID, but they didn't test the audio visual platform. The whole thing collapsed. They had to cancel everything, and this was critical because the registrars had been preparing for months and months and months to sit this exam. And for many of them, this was the final hurdle before they could start practising as a fully fledged psychiatrist.

Archival tape -- Nick O'Connor:

“Look, nothing I can say is going to make it right. But you know, beware of that is the level of the distress and in my heart truly goes out to all of you.”

RICK:

And the college was scrambling - and they’re still playing catch up now as we speak four months later.

Archival tape -- Nick O'Connor:

“For the record, Nick O'Connor, board member, chair of the Education Committee Some sort of central to all of this. And just want to give my most sincere apology for how things have gone.”

RICK:

And I was listening to Dr Nick O'Connor. He told a podcast in December that, you know, this means that workforce issues are predicted to get worse.

Archival tape -- Nick O'Connor:

“I think that the exam crisis has made salient a number of issues that have been bubbling under the surface for a long time.”

RICK:

And he said, you know, the issue of how many qualified psychiatrists the college is graduating each year is a continuing concern for us because the Commonwealth Workforce Group has projected significant shortfalls of psychiatrists.

So things were already bad. The pipeline is slow and this exam was a critical failure.

RUBY:

Yeah okay, so it sounds like this issue over the exam, it might contribute to the problem, which is that there are not enough people who are qualified to help. That's on top of other issues around cost and accessibility. But you said earlier that this problem dates back to before the pandemic, that it's a long term issue. So what is the underlying problem when you take a step back and you look at the state of Australia's mental health care system?

RICK:

Now the simple answer to this, although I believe it is much more complex, is it's about funding, of course.

So mental health funding has scarcely kept pace. So back in 1992, when the National Mental Health Strategy was first launched, the proportion of total health funding that mental health represented was seven point twenty five percent. It's not a bad total for 1992. Not quite two decades later in 2020. It was 7.5 per cent. So that's barely risen.

Now, national per capita spending on mental health has fallen in the year 2019-20. And states such as New South Wales, Victoria, Western Australia, Tasmania and South Australia - cross-party, bipartisan, every state that is the Northern Territory and the ACT by the looks of it - were all spending less per capita on mental health than they have in previous years, so there's been a fall.

Now there is some change afoot. There is a new national agreement on mental health and suicide prevention, which will in effect be the sixth national mental health strategy since 1992.

So this intergovernmental agreement between the Commonwealth states and territories with input from the Australian Local Government Association is expected to be released next month. But it's still four months late. And this is just a headline document, really. It's expected that it will contain precious little detail about who will actually fund what and whether that money will eventually actually end up in a budget that we can pinpoint and say great - that's where the money is.

Now none of this means much at all without the actual psychologists, psychiatrists, GP's and mental health care nurses to do the work. You know, if everything goes right, it will still be years before there are enough trained professionals in this space and in the right places to meet surging demand for the services. That's what this really boils down to.

You know, speaking to people who GP's trying to refer desperate people for help and public mental health teams can't help them. Private psychiatrists either not taking new clients at all, or they're telling people to come back in six months. We're talking about suicidal people, by the way. And this is not the fault of the psychiatrist. There are only 24 hours in a day. It's the same for them as it is for you and me.

We need more of them, and the pipeline is slow. It takes years to do it properly, and that's that's what it boils down to. And you need proper strategic thinking to fix that and you need to do it now.

RUBY:

Rick, thank you so much for your time.

RICK:

Thanks, Ruby. Thanks for having me.

RUBY:

Also in the news today
In a speech on Wednesday, US president Joe Biden outlined the first round of sanctions imposed on Russia after Russian forces entered two seperatist regions in Ukraine earlier this week.

Archival tape -- Joe Biden:

“Russia is now undeniably moved against Ukraine by declaring these independent states”

RUBY:

President Biden said that ‘Russia is poised to go much further’ after Vladimir Putin gave a speech on recognising the two regions of Luhansk and Donetsk as independent states.

Archival tape -- Joe Biden:

“So today I'm announcing the first tranche of sanctions to impose cost on Russia in response to their actions yesterday.”

RUBY:

Biden said the economic sanctions would target two major Russian financial institutions and Russian oligarchs.

European countries have followed suit imposing their own sanctions on Russia - including Germany halting the Russian-German Nord Stream 2 gas pipeline approval.

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The Australian government has also introduced sanctions including travel bans on Russian individuals.
In a press conference on Wednesday Prime Minister Scott Morrison said “The invasion of Ukraine has effectively already begun” and that “Australia has always stood up to bullies.”

I’m Ruby Jones. This is 7am, see you tomorrow.