A new report card from the Australian Medical Association has found Australia’s health system and its public hospitals are failing people with poor mental health — a vulnerable and ‘overlooked’ group of patients, who are suffering as a result.
The AMA’s Public Hospital Report Card – Mental Health Edition, published 7 November 2022, found that due to the hospital logjam, patients with poor mental health often wait longer compared to any other patient group presenting to an ED.
The report showed a big drop in the number of available public hospital beds for mental health patients, as increasing numbers of more severely ill patients present to emergency departments after exhausting all other avenues for help.
AMA President Professor Steve Robson said the report card, the latest from the AMA’s Clear the Hospital Logjam campaign, shows that while the number of patients presenting with poor mental health has almost doubled to 121 per 10,000 Australians, up from 69 in 2004, the number of beds has failed to keep pace with demand.
“As this report card shows, from 1992 to 2020, Australia recorded a significant reduction in mental health beds, from 45.5 to 27.5 per 100,000 population – an almost 40 per cent decrease of available mental health public hospital beds,” Professor Robson noted.
“While this form of de-institutionalisation of mental health was needed and welcomed at the time, planning, funding, or staffing for primary care or specialised community mental healthcare has been inadequate to meet the growing need.
“Put another way, while the Australian population increased by 7,745,219, the number of public hospital mental health beds decreased by 587; a population increase by 43% was met with a 7.7% decrease in the overall number of mental health beds available.”
The data also revealed a rising reliance on ambulances to reach EDs, with every second mental health patient (just over 52%) arriving by ambulance in 2020–21 compared to only one in three people for all other conditions.
On arrival, those needing admission were waiting an average of 12 hours in Queensland to 28 hours in Tasmania before they are admitted to hospital for treatment.
AMA President Professor Steve Robson said the findings were ‘unacceptable’ and showed systemic issues in the public hospital system needing urgent attention.
“We’ve been calling out the logjam in our public hospitals for months and this new report shows vulnerable patients with mental ill health are often waiting longer than other patients in the emergency department,” Professor Robson said.
The AMA’s Emergency Medicine Representative, Dr Sarah Whitelaw, said that an increasing number of patients were presenting to EDs with severe mental health problems that needed intensive mental health care after admission.
“This is causing real anguish — imagine someone severely distressed and ill waiting 28 hours — more than entire day in an emergency department before being admitted to the mental health unit bed that they really need,” Dr Whitelaw said.
“All hospital staff, who are doing their best under the relentless pressure, are devastated at the impact on their patients and their loved ones and are experiencing their own burn out.
“There are also very real and increasing risks to patients and staff from violence and aggression that results from unwell patients having to wait so many hours in a cubicle that, despite our best efforts, can be very loud and stressful with bright lights and lots of people constantly moving around.
“We absolutely need to make sure these patients get to their safe, appropriate mental health unit as soon as possible to start the rest of the treatment that they need, not leave them waiting in an emergency department longer than any other group of patients.”
The AMA is calling for:
- Reform of hospital funding including removing the 6.5% cap on activity growth and 50–50 shared funding between states and the Commonwealth
- More mental health beds, matched with medical and allied health staffing in public hospitals
- The modernisation of Medicare to support GP-led collaborative primary care
- An increase in the mental health community service capacity through expanded medical and allied health staffing
- An urgent plan to increase our mental health workforce numbers in public and private sectors
- Future mental health care policy guided by the professional mental health community
- Funding and strategies to address the mental health crisis in public hospitals involving public hospital doctors, GPs, psychiatrists, and other mental health professionals.