Sydney ambulance worker’s comments point to growing mental health crisis in Australia

A health worker’s recent comments to the World Socialist Web Site point to a broader crisis in mental health, where available services are stretched thin and access is subject to socio-economic and geographic inequality.

An ambulance in Sydney in 2020 [Photo by Helitak430 via Wikimedia Commons / CC BY-SA 4.0]

The Sydney ambulance worker said the number of mental health cases they were seeing was “exploding. At any one time there will be several active jobs categorised as mental health cases. They would generally be acute jobs, needing a time-sensitive response with people in real distress. I’ve seen it steadily increase over 20 years.

“There aren’t long-term solutions for people, they are sent back out to live in their home or into whatever challenging situation they are in. There is community care, but I get the distinct impression that they are overwhelmed.

“We get a sense of, ‘we know this person,’ we are familiar with them as someone we see frequently.”

The mental health system is “under-resourced and reactive. There are local initiatives, but they seem to be overstretched. People end up sitting in emergency departments (ED) for hours and hours and hours on end until they get frustrated and leave.

“There just doesn’t seem to be any good system that is able to take people in and give them meaningful care and let them leave with a good plan. They get in, wait for ages, are very quickly seen and sent out again or they leave in frustration.”

Emergency departments in public hospitals have become the entry point for mental health care, placing an ever-increasing strain on their wait times. Many people are forced to attend EDs where no payment is required rather than a doctor.

Since the EDs are so stretched, only the most acutely psychotic or suicidal cases will get a bed. The rest will be discharged back home or to the street to a roundabout of further illness.

Australian Bureau of Statistics (ABS) data, collected between 2020 and 2022, show that nearly 40 percent of young people aged 16 to 24—a total of more than one million—had experienced a mental health disorder in the preceding 12 months, up from 26 percent in 2007.

The report also revealed that 42 percent of the 19.8 million people aged 16‒85 had experienced a mental disorder some time in their life. Anxiety disorders, such as post traumatic stress disorder, were the most commonly reported mental health condition.

But many of these people are finding it increasingly difficult to get the support and treatment that they need.

According to the Australian Psychologists Society, one in three psychologists are unable to take new clients and 65 percent reported worsening wait times, now averaging 55 days. Support services are typically only available nine to five, Monday to Friday.

Throughout the country, the inequitable rationing of access to mental health services has become entrenched. A 2023 report by the NSW branch of the Royal Australian and New Zealand College of Psychiatrists (RANZCP), “Mental health on the brink,” is replete with examples of the operation of a two-tier system.

One community mental health worker working in a regional setting said: “It’s virtually impossible for low-income patients to access private psychs.… Community mental health are under resourced and cannot cope with the amount of people in need, leaving them to fend for themselves as far as obtaining adequate clinical mental health care. They end up falling through the cracks.”

A city psychiatrist spoke of the “significant divide between public and private psychiatric services. Most people need what private services offer (subacute services, treatment for high prevalence conditions, preventative treatment), as they can’t access this within the public sector. However, most struggle to access private services due to cost or scarcity.”

A number of clinicians denounced the limitation of government-subsidised counselling to ten sessions. One city doctor said: “Mental health problems are mostly chronic and cyclical, and 10 sessions of partly funded psychological sessions per calendar year is inadequate for good health outcomes.”

A regional psychologist added: “Complex mental health clients… are often in need of comprehensive assessment and appropriate medication support for acute symptoms. There is significant inequity for clients in this area. Similarly, clients who cannot afford to pay the gap fee (or ongoing full fee after 10 sessions) for a psychologist are often left without any treatment options for complex mental health issues.”

Temporarily doubled to 20 in the early stages of the COVID pandemic in 2020, the allotment of subsidised counselling sessions was slashed back to 10 in the Albanese federal Labor government’s 2023 budget. Health Minister Mark Butler claimed this was because “tens of thousands of Australians have missed out on spots due to the increased demand.”

In other words, Butler was saying that the health system is so broken that it can’t provide 20 sessions per person, and the only answer is to slash the allotment.

One consequence of the growing crisis is that health professionals are being driven into the ground as they battle to provide public mental health care on a shoestring budget.

In a February 2024 paper by RANZCP, “Burnout and Moral Injury: Australian psychiatry at its limits,” 73.88 per cent of psychiatrists surveyed said they had experienced symptoms of burnout in the past three years.

The dire situation in mental health care, which parallels the broader breakdown of the public health system, is the product of decades of funding cuts and privatisation, in a bipartisan, union-enforced assault on social services.

Labor governments, in office federally and throughout the mainland, are now deepening these attacks as part of their pro-business, pro-war austerity program.

Labor’s 2024–25 federal budget includes no measures to build the mental health workforce and address the chronic shortage of clinicians. Overall, it contains just $361 million in new mental health funding over four years, a drop in the ocean compared with what is needed.

Even the pro-business Productivity Commission has called for a far greater injection of funds into mental health care, estimating that an additional $2.4 billion each year is needed. The Productivity Commission did not raise this out of any concern for people struggling with mental health issues, but because it believes mental illness is costing the Australian economy $18 billion a year in lost productivity.

Cuts to spending on mental health, and public health more broadly, are a symptom of a capitalist system that is incapable of satisfying the needs of the population. The crying need for services in this area indicates the necessity for a fight on a socialist program to end this bankrupt system.