Policy, Structural Change and Quality of Psychiatric Services in Australia: The Views of Psychiatrists

Abstract

Objective: Given that 10 years have elapsed since the implementation of Australia's National Mental Health Strategy, the aim of the paper was to ascertain the views of the country's psychiatrists about changes in mental health services. Methods: A survey was mailed to all Fellows of the Royal Australian and New Zealand College of Psychiatrists living in Australia; 1039 out of 2059 (50%) returned the questionnaire. Results: Private care has not changed much in the last 5 years, but the quality in public psychiatric services has deteriorated. While 67% of private practitioners, 46% of psychiatrists with mixed practice, 39% of exclusively public psychiatrists and 27% of academics believed public practice had deteriorated, only 18% of psychiatrist administrators believed that to be the case. Daily or weekly problems admitting patients to hospital was reported by 40% of psychiatrists working in the public system. Public psychiatrists believed that they now treat more patients who are more disturbed, more acute and more demanding. However, they see their patients less often, provide less psychotherapy and use more medication. Administrative demands have increased. Conclusions: According to psychiatrists, implementation of the National Mental Health Strategy has not yet resulted in better psychiatric care in the public health system.