00:00One of the most important things in mental health care is the therapeutic relationship
00:06between the clinician, in this case the psychologist, and the patient.
00:11And there's obviously going to be massive disruption for thousands of people on that
00:14front.
00:15It's unclear what the pathways to new care will actually be here.
00:23Maybe some of them will continue, maybe through telehealth it seems to be hinted at by Ramsey.
00:29But telehealth is a poor substitute for face-to-face care.
00:33It's often necessary as better than nothing, but it's not ideal.
00:39And of course this disruption puts patients at risk of relapse, of their conditions worsening,
00:46and of course then long delays in getting access to other forms of care.
00:51Ramsey says that this decision reflected in part growing demand for support that is easy
00:58to access and flexible, as well as rising costs, uneven demand, and operational complexities.
01:05What do you make of that?
01:06Well there's no doubt there's been a very big increase in need for care in mental health.
01:13We published a Lancet Commission last year in the teenage and young adult area, the youth
01:18mental health crisis, basically a 50% increase in need for care over the last 15 years.
01:24The federal government is responding to that by emphasizing this in their reform package
01:30in the election.
01:31So there'll be $700 million put into strengthening and building new dimensions to the youth mental
01:38health system, which is very, very welcome.
01:41But this needs to go a lot further, not just for young people, but also for older adults.
01:47There is a strengthening of that too in the election commitments, but these are salary based
01:53models, team based models based on evidence.
01:56And they're going to be available in more outer metro and rural and regional areas.
02:02A lot of the people working in the Ramsey system and the private medicine system, private psychology
02:07system, are located in affluent suburbs.
02:10And so people are really missing out in these other parts of Australia.
02:13So a private model, a subsidised private model won't work for those parts of Australia.
02:18And we need a much more salary based, team based model, which is much better for patients
02:23anyway.
02:24Yeah, well, you've just said there that there is a need for more access to mental health facilities.
02:31We know that there are already significant wait times.
02:34So why would there be a need financially for Ramsey to be closing clinics?
02:41Yes, that's a fantastic question, actually.
02:44The only thing I can think of that might partly explain is they do have to rent premises.
02:49So the cost of the facilities, the cost of reception, and all the things that go with
02:54that might be part of the explanation.
02:57They probably think they can get away with a much cheaper model, which is telehealth.
03:02And it's a devolved model and the responsibility for the kind of fabric is put back onto the
03:07practitioner.
03:08That's the only dimension that I can think of.
03:12But you'd have to ask Ramsey what the commercial drivers were for this decision.
03:16But it seems like a purely commercial decision, which has really not really thought about the
03:21needs of the community or the patients.
03:24What kind of an impact do you expect this could have on the public system?
03:29Well, the sort of patients that see private psychologists, especially in middle class and
03:34affluent areas, are a different population from the people with more serious forms of
03:39mental illness who depend on the public mental health system, which is extremely hard to
03:43access because it's so underfunded and struggling in so many parts of Australia.
03:49So but there would be some overlap.
03:52And if some of these people do have more serious conditions or deteriorate because of this
03:56disruption, they could well find themselves in emergency departments and in the public
04:00mental health system.
04:01But the real likely effect mainly is to add to other waiting lists and to disrupt and cause
04:10a significant impairment in the conditions of these patients, unless it's been thought
04:15through.
04:16Now, maybe Ramsey have got a plan, but I just don't know.
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