31 August 2017 Mr Trevor Hunt Manager, Mental Health and Drugs Workforce Portfolio Strategy and Reform Department of Health and Human Services 50 Lonsdale Street MELBOURNE VIC 3000 Dear Mr Hunt Re: Final report to DHHS on the Victorian Psychiatry Workforce The Victorian Branch of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) wishes to present the Victorian Department of Health and Human Services (DHHS) with the report Psychiatry Attraction, Recruitment and Retention Needs Analysis Project. The DHHS approached the RANZCP in 2015 to undertake a project that would contribute to psychiatry workforce planning and development for Victoria’s public mental health sector. The project objectives, activities and deliverables were to: 1. Undertake a research and consultation exercise to identify factors and challenges influencing the psychiatry workforce. 2. Develop recommendations for future short-, medium- and long-term project work to address challenges faced by psychiatry in Victoria, with a particular focus on attraction, recruitment and retention to rural settings and to public mental health settings. 3. Produce a final report on methods, findings and proposals for possible future work that addresses attraction, recruitment and retention issues for psychiatry. The final report outlines the methods and findings from an extensive review of literature and data sources, together with more than 40 key informant interviews with psychiatrists working across Victoria. The report concludes that Victoria’s Approved Mental Health Services (AMHS) struggle to perform their role, with barely the capacity to care for Victorians during periods when they are severely mentally ill. Along with population and demographic changes over recent decades, public mental health services have experienced a reduction of funding in real terms to cope with these changes. This has created a shortage and a maldistribution of the psychiatry workforce across metropolitan, regional and rural Victoria, which means that needs for mental health services are no longer being met. The findings of the report reveal that challenges besetting Victoria’s psychiatry workforce are multifaceted and stem from a range of causes. Identification of these issues, however, has enabled the formulation of a comprehensive and detailed suite of recommendations to address them. 309 La Trobe Street, Melbourne VIC 3000 Australia T +61 3 9640 0646 F +61 3 9642 5652 [email protected] www.ranzcp.org ABN 68 000 439 047 Of the 55 recommendations in the final report, the RANZCP Victorian Branch has prioritised the following 10 broad recommendations: 1. Develop and implement urgent safety measures to address the unacceptable threats of aggression, violence and occupational safety risks experienced by psychiatrists and trainees. 2. Improve employment conditions for psychiatrists and trainees (including incentives and leave cover), as well as conditions for training and supervision. 3. Pilot and evaluate clinical models that meet acute clinical demand 7 days per week. 4. Improve workplace conditions for rural and outer metropolitan psychiatrists (including professional isolation) and develop a model to attract psychiatrists into rural and outer metropolitan practices. 5. Rectify the maldistribution of the psychiatry workforce, including in communities of need, as well as the significant shortages in some subspecialties like consultation–liaison psychiatry, child and adolescent psychiatry and psychiatry of old age. 6. Establish ongoing funding for a Director of Training Specialist International Medical Graduate (DOT-SIMG) position. 7. Improve contractual conditions for psychiatrists working in Aboriginal mental health services and explore incentives to recruit and retain consultant psychiatrists to Aboriginal outreach mental health services. 8. Undertake a pilot of psychotherapy services in the public sector to determine the impact on patient outcomes, re-admissions and health care costs. 9. Address the lack of clinical academic positions to improve recruitment and retention in subspecialties, specifically in forensic psychiatry and addiction psychiatry. 10. Undertake a comprehensive review of the current funding model for addiction psychiatry services, recognising that the current model does not support clinical service delivery by psychiatrists and fails to provide adequate training opportunities in addiction psychiatry/medicine. The RANZCP Victorian Branch also encourages the DHHS to advocate for the continuation of Specialist Training Program funding, and to also make a proposal to the Commonwealth Government to increase the Medicare rebate to 100% of schedule fees in socio-economically disadvantaged District of Workforce Shortage areas rather than attempting to attract SIMGs who are subject to the 10-year moratorium to work there. Thank you for the opportunity and funding to undertake this crucial project, which has been led by the Victorian Branch Committee and oversighted by the RANZCP Board. The RANZCP Victorian Branch Committee would also like to thank the many psychiatrists and trainees who contributed their experience and insights. We look forward to working with the DHHS to implement recommendations to address the identified workforce issues. To further discuss the final report and recommendations, I can be contacted via Rosie Forster, Executive Manager, Practice, Policy and Partnerships via [email protected] or by phone on (03) 9601 4943. Yours sincerely Associate Professor Richard Newton Chair, Victorian Branch Committee Victorian Psychiatry Attraction, Recruitment, and Retention Needs Analysis Project Report Report: Victorian Psychiatry Workforce Executive Summary August 2017 RANZCP Board Authorising Committee RANZCP Victorian Branch Committee Responsible Department RANZCP Practice, Policy and Partnerships RPT PPP Victorian Psychiatry Attraction, Recruitment, and Retention Document Code Needs Analysis Project Report Victorian Psychiatry Attraction, Recruitment, and Retention Needs Analysis Project Report – Exec Summary Report acknowledgements: This project was undertaken by the Royal Australian and New Zealand College of Psychiatrists (RANZCP), Victorian Branch, in consultation with psychiatrists across Victoria and with project support from the RANZCP’s Practice, Policy and Partnerships Department. The Psychiatry Attraction, Recruitment, and Retention Needs Analysis Project was supported by the Victorian Government. Although the project was supported by the Victorian Government, the content contained herein does not necessarily represent the view or policies of the Victorian Government. The RANZCP is solely responsible for the content of, and views expressed in, any material associated with this report. The RANZCP wishes to thank in particular the: Victorian Branch Committee Victorian Branch Committee members who were project advisors, being Dr Mahendra Perera and Dr Nader Yakoub Psychiatrists and trainees interviewed for the report. Copyright disclaimer © Copyright 2017 Royal Australian and New Zealand College of Psychiatrists (RANZCP) This documentation is copyright. All rights reserved. All persons wanting to reproduce this document or part thereof must obtain permission from the RANZCP. Victorian Psychiatry Attraction, Recruitment, and Retention Needs Analysis Project Report– Exec Summary Page 2 of 13 Table of Contents Executive Summary .............................................................................................................. 4 Key findings ....................................................................................................................... 5 Adult psychiatry.............................................................................................................. 8 Addiction psychiatry ....................................................................................................... 8 Consultation–liaison psychiatry (CLP) ............................................................................ 8 Forensic psychiatry ........................................................................................................ 8 Child and adolescent psychiatry (CAP) .......................................................................... 8 Old age psychiatry ......................................................................................................... 8 Psychotherapy ............................................................................................................... 8 Aboriginal outreach MHS ............................................................................................... 8 Perinatal psychiatry ........................................................................................................ 8 Trainee workforce .......................................................................................................... 9 Trainee workforce: Commonwealth-funded Specialist Training Program (STP) ............. 9 Specialist International Medical Graduate (SIMG) workforce.......................................... 9 Private psychiatry sector ................................................................................................ 9 Recommendations........................................................................................................... 10 Adult psychiatry............................................................................................................ 10 Addiction psychiatry ....................................................................................................