Public Sector Psychiatry

In short, psychotherapy within the public mental health system is being shifted away from psychiatry. Through changes to Medicare rebates, psychiatrists are being encouraged to adopt a medical consultant model of practice, favouring assessment and planning of management over treatment, which is to be farmed out to GPs, nurse practitioners, psychologists and other workers. The good things about this are:

• More money for private psychiatrists to see low SES pts.
• Encouragement of private psychiatrists who have closed their books, to take on new pts, reducingwaiting lists.

The, er, crap things are:

• Longitudinal care beyond periodic review is discouraged.
• Psychotherapy by psychiatrists becomes even less accessible to low SES pts

Now, you can argue that as medical specialists, we have a duty to the society that footed at least part of the bill for our training, to utilise said training in a way which addresses the greatest possible proportion of psychiatric burden of disease, vast tracts of which lie unaccessed in low SES pts who are not doing the naked-high-street-machete act and therefore don’t qualify for local AMHS treatment.

But you can also argue that as medical specialists, we should be free to offer the right therapy (or combination thereof) to the right patient at the right time, regardless of SES. Local AMHS are overwhelmed with calls for help from the non-machete folk, most of whom need more or other than medication. Splitting specialist-directed treatment between GPs and talking therapists of various disciplines might be ‘good enough’ for some patients, but we all know it won’t work for a significant minority, especially where personality disorder is concerned.

This is where our responder quiz comes in – in addition to psychotherapy training issues, your future capacity and right to practise psychotherapy is what’s at stake.