Staff shortage stunts psychiatry services

IN DEMAND: Bendigo Health psychiatric services executive director Phil Tune, Bendigo West MP Maree Edwards and Bendigo Health chairman Bob Cameron tour the parent-infant unit at the new hospital. Picture: DARREN HOWE
IN DEMAND: Bendigo Health psychiatric services executive director Phil Tune, Bendigo West MP Maree Edwards and Bendigo Health chairman Bob Cameron tour the parent-infant unit at the new hospital. Picture: DARREN HOWE

MENTAL health staff recruitment difficulties are affecting Bendigo Health’s capacity to open beds at the new hospital, the head of psychiatry said. 

Associate Professor Phil Tune took the opportunity to highlight some of the challenges faced by the city’s psychiatry services at the invitation of a Bendigo church group. 

“I think we’re very well provisioned with the opening of the new hospital and we’re very grateful for the investment the government has made,” Dr Tune said.

“But it’s about being able to open all of those beds and recruit sufficient staff.”

All but two of the new Bendigo Hospital’s 35 acute adult beds are already open.

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Its parent-infant unit is also operational. But only eight of 20 extended care beds are available. 

“Those beds are a statewide resource,” Dr Tune said.

Though he said there was a “significant shortage” of secure extended care beds in Victoria, staff was also limited.

“There’s a global shortage of mental health nurses,” Dr Tune said. 

“It’s very hard then to adequately staff a unit, even if you’ve got the beds.”

Bendigo Health last year extended its search for mental health nurses to New Zealand and the United Kingdom, resulting in a number of new recruits.

“We’re still undertaking that recruitment process to try and open the rest of our beds, in due course,” Dr Tune said. 

“But we've been able to open a lot of our beds, so there's already been a significant benefit to the community.”

He said the ratio of supply and demand for hospital beds had been better balanced since the new hospital opened in January.

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The average length of stay had also increased to about 10 days.

”There have been times when it’s been as short as seven days,” Dr Tune said. 

There were instances when the psychiatric services executive director said patients were discharged “perhaps a little prematurely than we would otherwise like to.”

“I wouldn’t like to say we’re discharging people who are seriously ill that we think we shouldn’t discharge – it’s not that,” Dr Tune said. 

“That would be unsafe and it would be poor practice. The judgement is, it’s okay for this person to go, but in an ideal world another couple of days would be even better for them.

“When we had many fewer beds it would happen much more often. There’s not a lot of sense that it’s happening now.”

He said hiring psychologists and psychiatrists had been “extraordinarily difficult”.

“It’s actually increasingly difficult to attract psychiatrists to work in the public sector,” Dr Tune said. 

Remuneration and administrative burden were factors he suspected were affecting the appeal of public practice.

It’s very hard to adequately staff a unit, even if you’ve got the beds.

Dr Phil Tune, Bendigo Health

Dr Tune said the combination of the new Mental Health Act, the Mental Health Tribunal, and bodies such as the Mental Health Complaints Commissioner could create “a sense of excessive oversight”.

Work in a hospital environment also involved a patient cohort clinical psychologists might not see in private practice. 

“From our psychiatric services point-of-view, we see 1.1 per cent of the population,” Dr Tune said. 

“It’s a pretty demanding patient group. That sort of work is only going to appeal to a limited number of people.”

As more doctors completed their training in psychiatry in Bendigo, Dr Tune believed it would become easier to attract staff.

“We’ve just had a successful experience of having someone complete their training in Bendigo and apply for a psychiatrist job, and get that job,” he said.

Bendigo Health did not offer a psychiatry training program before Dr Tune joined the organisation. 

“I saw the need to have a local training program because there’s such a shortage of psychiatrists,” he said.

Despite difficulties recruiting to the public sector, Dr Tune said the private sector in Bendigo was also in need of development. 

If people don’t meet the criteria for care by Bendigo Health’s psychiatric services, they have to be cared for in the private system.

“There’s very little private sector so they’ve got to travel to Melbourne or somewhere else,” Dr Tune said.

“The need to develop locally-trained psychiatrists who live in this community who can then work in this community – whether it’s in hospitals or in private practice within our community – is an important need.”

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Ruth Hosking, of the Bendigo Uniting Churches Social Justice Group. The group invited Dr Tune to speak about psychiatric services in Bendigo as part of its annual social justice worship service. Picture: DARREN HOWE

Ruth Hosking, of the Bendigo Uniting Churches Social Justice Group. The group invited Dr Tune to speak about psychiatric services in Bendigo as part of its annual social justice worship service. Picture: DARREN HOWE

He stressed the vitality of access to services for a broad range of mental health issues, including through general practitioners. 

“We talk about the health disadvantages of the Aboriginal community, that they have a 20 per cent reduction in life expectancy,” Dr Tune said. 

“Patients with serious mental illnesses have an identical reduction in life expectancy and we don’t hear about that. That’s a really significant issue.

“The other issue in relation to social justice for our folks is access to housing.”

Ruth Hosking, of the Bendigo Uniting Churches Social Justice Group, thanked Dr Tune for his “informative address" at the group’s annual social justice worship service.

She said group members had been working towards improved outcomes for people experiencing mental ill health for some time. 

“Bendigo Uniting Churches Social Justice Group will continue to pursue these issues along with exploring a community advocacy role for psychiatric care,” Mrs Hosking said. 

The service was held at the Uniting Church at Forest Street on Sunday morning.