Psychiatrists not trained to treat common conditions despite huge demand

The Royal Australian and New Zealand College of Psychiatrists (RANZCP), which trains and examines doctors hoping to specialize in psychiatry, has been accused of failing to equip students with the skills needed to treat a surge of patients suffering from anxiety, depression and substance abuse disorders.

The college has also been criticized for gagging trainees and other members, failing to provide enough support to harassed or bullied trainees, and disrupting a respected exam without a suitable alternative.

The president of the National Association of Practicing Psychiatrists, Professor Philip Morris, has warned that university trainees are only receiving adequate training in managing the more serious disorders that present themselves at inpatient psychiatric units, such as schizophrenia and bipolar disorder.

He said there was a lack of training to treat “high prevalence” conditions, despite 60% of the work being done in private practice to treat these less acute ailments.

“The college will have to make some changes and they will have to start having training not only in public sector psychiatric units but also in the private practices of community psychiatrists,” said Professor Morris.

“We really need to move to a different training model that gives our trainees a much broader and broader experience and helps them build skills in therapy, especially psychotherapy, which is more intensive and advanced.”

He said a dwindling private workforce would only exacerbate shortages, with some psychiatrists reporting waiting lists of up to six months and many closing their books altogether because they can’t take on more patients.

The concerns are among those highlighted in a report released last month by the Australian Medical Council, which grants accreditation to medical schools across the country.

Since the start of the pandemic, nearly every other medical college — including those that train specialists in emergency medicine, critical care, anesthesia, dermatology, radiology, and rural and remote medicine — have blitzed their accreditation reviews, meeting or meeting “basically” all the standards set by the council.

RANZCP was by far the worst performer, failing to meet 40% of the standards, with 46 conditions placed on its accreditation.

The report noted concerns that the university’s program results “do not adequately reflect the community’s need for non-acute mental health services.”

She also raised issues the college had with handling “bullying, discrimination and harassment” issues and a lack of support for the “welfare and safety” of interns at local sites.

Ironically, less than half (45%) of university respondents said they had access to mental health support services.

The review was also critical of confidentiality agreements the college had forced members of more than 120 committees and other groups to sign, which it called “disproportionately legalistic” and a barrier to transparency.

It is an opinion shared by Professor Morris.

“Preventing committee members from talking to other college members is folly,” he said.

“Why do we need it? It seems to have grown as the college has become more of a corporate, bureaucratic, hierarchical, authoritarian organization.

There was also dissatisfaction with the way the college discontinued Objective Structured Clinical Examination (OSCE) late last year, with concerns raised that alternatives such as workplace assessments would be just as comprehensive, independent and fair.

Sky News Australia first revealed in 2021 that there were fears the mental health crisis would worsen after the college canceled multiple OSCEs during lockdowns, prompting outrage from trainees who were unable to qualify without of them.

A trainee who spoke to Sky News on condition of anonymity said the trainees were not happy with the exams – which tested them on their ability to collect medical histories from a range of different ‘patients’ – they had now been completely eliminated.

“How rigorous is the exam process if you aren’t faced with a real-world scenario?” the intern said.

She also said the interns were “absolutely furious” at the college’s response to the board’s review, which she said felt glossed over the sour results.

NSW Association of Psychiatry Trainees President Dr Maryssa Portelli said that while she could not comment on the review due to her non-disclosure agreement, she welcomed the decision to discontinue the OSCE which “were no longer fit for purpose”.

“The objection has come from mostly private counselors who have moved away from mentoring trainees, or the challenges facing those in the public system,” said Dr. Hatches.

“Medicine is a profession that likes to eat its own young, and psychiatry is (an) no exception.”

RANZCP Chair-elect Dr Elizabeth Moore said workplace assessments are a “more accurate assessment of a professional’s skills and competencies” than exams such as those of the OSCE.

He said “work is well underway” to address the concerns raised by the council report, including “improving cultural safety and educational programmes”.

Do you know more? Please email caroline.marcus@skynews.com.au.