This was published 4 months ago
Burnout, shortages: Killing spree puts psychiatry struggles in spotlight
A killing spree at a Sydney shopping centre that left five women and one man dead has raised concerns over the nation’s mental health sector and its capacity to support people experiencing complex disorders.
Forty-year-old Queensland man Joel Cauchi stabbed nearly 18 people, including a baby, at a Westfield in Bondi Junction before he was shot dead by a police officer.
NSW Police Commissioner Karen Webb said Cauchi deliberately targeted women.
“It’s obvious to detectives that it seems to be an area of interest that the offender focused on women and avoided the men,” Webb said.
The mental health of the offender – described as a drifter who had been living in a vehicle and at hostels around south-east Queensland in the past few years – has also been raised as a motivating factor.
Cauchi’s family said he was diagnosed with schizophrenia at 17, and had battled with mental health issues since he was a teenager.
Queensland Health confirmed Cauchi had been treated more than a decade ago, and his care was transferred to a psychiatrist in the private sector in 2012.
Queensland Police confirmed Cauchi had been in contact with the police in the past few years, and police were aware he suffered from mental health issues.
No further information had been presented relating to Cauchi’s current diagnosis or treatment.
The case has shifted attention to the mental health sector more broadly and the challenges facing those delivering support, as well as those needing help.
On ABC Radio on Monday, Prime Minister Anthony Albanese was asked whether he thought there was enough funding for mental health.
“We could always do more, but we have had substantial investment in mental health including in our last budget into mental health and suicide prevention systems,” Albanese said.
Some in the psychiatry sector have been calling on the government to increase support, saying staff shortages have led to burnout and poor patient care.
A nationwide survey by the Royal Australian and New Zealand College of Psychiatrists released in February revealed 91 per cent of Queensland’s psychiatrists felt workforce shortages were negatively impacting patient care and almost eight out of 10 practitioners surveyed reported that shortages were contributing to burnout.
Thirty per cent of Queensland respondents said they were considering leaving the profession in the next five years.
Prime Minister Anthony Albanese and NSW Premier Chris Minns lay flowers with others at Bondi Junction Westfield yesterday.Credit: Dion Georgopoulos
Queensland RANZCP chair Professor Brett Emmerson said the findings underscored the severity of the workforce shortage in Queensland’s mental health system.
“A lot has changed, particularly throughout [and after] COVID,” Emmerson said.
“We’ve seen an increase in case complexity ... [and] we’ve seen an exodus of psychiatrists from the public sector.
“Most psychiatrists are feeling overworked, under-resourced and are reporting burnout symptoms.”
Psychiatrists and psychologists treat mental illness but only psychiatrists can prescribe medication.
Psychiatrists are also better placed to treat and diagnose people with complex mental health conditions and mood disorders, including severe depression, bipolar disorder, schizophrenia, eating disorders, ADHD, OCD and PTSD, and monitor progression or resistance to medication.
“We’re not in competition with psychology, there’s not enough of us in both groups,” Emmerson said.
“But there is some diagnosing and specialty treatments that only psychiatrists can do ... [especially] conditions that require medication.”
I just think we have to be really careful not to increase the stigma that’s already associated with having a mental illness.
Professor Brett Emmerson, RANZCP
Even with a mental health treatment plan or Medicare subsidies, psychiatric support is prohibitively expensive for many people, especially rough sleepers.
Initial consultation and assessment can cost upwards of $600, with an out-of-pocket gap of about $200-$300. Even after a Medicare rebate, standard consultations can cost more than $200.
Individuals also need to be well enough to reach out for support and attend appointments, and many find themselves facing excessively long wait times.
“[In Queensland] for a general outpatient appointment in either public or private, unless you are suicidal, you’d be looking at six to 12 months, sometimes even longer,” Emmerson said.
Brisbane Times contacted 28 psychiatrists in the Brisbane area. Of those reached, six were not seeing new patients, five were seeing new patients from about June onwards and two were now accepting referrals.
RANZCP’s Queensland branch estimated that community mental health teams required about 3000 additional staff throughout the state to manage vulnerable people living with mental illness.
According to the organisation, Queensland has the lowest number of acute psychiatric beds per capita in Australia and psychiatric inpatient units in Queensland hospital continued to operate at over 100 per cent occupancy.
Queensland Health agreed the shortage of qualified professionals was an ongoing issue.
“Which is why recruiting, retaining and developing a strong mental health workforce remains a priority,” a department spokesperson said.
Queensland Health agreed the shortage of qualified professionals in the mental health sector is an ongoing issue.Credit: Dan Peled
Mental health organisation SANE estimated about 800,000 Australians experienced complex mental health issues (about 3 per cent of the population).
Most individuals living with complex mental health disorders are not associated with criminality. People living with complex mental illness are far more likely to be victims than perpetrators of violence.
If you or anyone you know needs help, call Lifeline on 13 11 14 (and see lifeline.org.au) or Beyond Blue on1300 22 4636 (and see beyondblue.org.au).