Strain takes toll on psychiatrists

A massive cash injection is needed if the Government hopes to combat a national shortage of psychiatrists, the Mental Health Foundation says.

A report issued this week by the Health Ministry's Clinical Training Agency says that by international standards New Zealand is short 118 psychiatrists.

But the ministry says the shortage is worldwide, and the issue is finding suitable staff, not money.

Foundation clinical spokesman Peter McGeorge said yesterday that clinical psychiatrists in many parts of the country had extremely high caseloads and were under huge pressure because of the shortage.

It created poor working conditions in many areas, which in turn made recruiting staff more difficult, he said.

The biggest shortages were in regional areas where psychiatrists had to work long hours and sometimes had caseloads of up to 150 patients - about 50-70 more than was advised.

The report, which evaluates training needs for the health workforce, says the World Health Organisation (WHO) recommends a ratio of one psychiatrist per 10,000 people, but New Zealand has just 282 practising psychiatrists - a ratio of about one per 14,000.

The WHO also recommends a ratio of one child and adolescent psychiatrist per 50,000 people, but New Zealand has just 25 specialists in this area - a ratio of one per 156,000.

Dr McGeorge said that easing the shortage would contribute towards reducing failures in the mental health system, which in some cases had resulted in deaths of patients or their family members in the past few years.

But he estimated it would cost an additional $21 million a year to pay for the extra 118 psychiatrists needed to bring New Zealand up to WHO-recommended levels, an amount district health boards would probably not be willing to pay.

"But if we are serious about getting up to the benchmark I believe it would bring benefits in the long term."

Improvements would also require an increase in the numbers of other mental health professionals, such as nurses and psychologists.


Dr McGeorge, who is also mental health services clinical director for the Capital and Coast District Health Board, said the situation was better than it was a few years ago.

Overall, mental health funding had almost doubled in the past few years.

But huge pressure remained in areas that had to cater for uncapped patient numbers, such as child and adolescent, general and to some extent forensic (criminal) psychiatry.

"In those areas the stress has been fairly enormous. I know that it's a pretty hard political pill to chew on, but the reality is that if there was another 118 psychiatrists in New Zealand it would make a huge difference to those services."

Dr McGeorge said that better use of existing positions included evaluating what work now performed by psychiatrists could be safely delegated to senior nurses and psychologists under supervision.

The Ministry of Health says there is "unlimited money" available to train psychiatric registrars - if hospitals can find them.

Its director of mental health, Dr David Chaplow, said everyone who wanted to be a psychiatrist who met the selection requirements would get ministry funding.

The shortage was a worldwide issue. The Medical Council was helping with the recruitment of overseas-trained psychiatrists by granting temporary registration while they completed their New Zealand registration requirements.

Falling short

The World Health Organisation recommends a ratio of one psychiatrist per 10,000 people. NZ has about one per 14,000.

The organisation also recommends a ratio of one child and adolescent psychiatrist per 50,000 people. NZ has one per 156,000.

System failures

High-profile cases where psychiatric care has failed include that of:

* Mark Burton, who killed his mother, Paddy, in Queenstown in March 2001.

* Lachlan Jones, who killed his flatmate, Malcolm Beggs, in Auckland in August 1999.

* Leslie Parr, who decapitated his partner, Hutt Valley woman Fiona Maulolo, in April 1997.

- NZPA