Too many chiefs hampering psychiatric sector: study

While the share of expenses per patient on management and administration in the public psychiatric sector has increased, the share spent on nursing care has decreased.

A study of expenditure trends in the public psychiatric sector raises questions about the highly controversial period of deinstitutionalisation and accompanying rise of managerialism of the 1990s. 

It has found that the share of expenses per patient on management and administration has increased – while the share spent per patient for nursing has decreased.

La Trobe health economist, Ruth Williams, said the research compared data from 1992-93 when the process began, with 2005-06 when deinstitutionalisation was well in place. She said that, ironically, the new era of managerialism had argued for programs to cut back administrative and managerial expenses.

“Our study finds the opposite happened,” said Williams who carried out the research with Dr Darrel Doessel from Griffith University.

“It reveals statistically significant trends which suggest there are too many chiefs and not enough Indians. It also strongly indicates the need for greater managerial accountability in this sector, and finds evidence of unmet demand.”

The work by the two researchers is concerned with a wide range of mental health issues.

They argue government policy on suicide – and in Australia’s mental health sector in general – is not based firmly enough on economics research.

“Some pockets of underdevelopment and misery in our society are overlooked by the economics profession,” Williams said.

“For the scandals and crises in mental health to end, we need contributions not just from clinicians, accountants, and psychological researchers.”

She said it was difficult for economists to be heard above all those other voices.

There is also a message to the economics profession that mental health is trivial: ‘that they should focus on conventional topics like recessions, trade, banking, finance and tourism’.

But economic ‘diagnoses’ of the various problems in the sector need to be provided. The researchers argue this is now possible and that sufficient collections of data exist.

For example, one of their studies deals with the conventional ‘headcount’ measure for suicide using a 100 years of Australian mortality data.

“We apply a measure of suicide that takes account of its societal importance as a cause of death – and the time span data enables us to comment on some “big societal trends”’.

Other research highlights what Williams and Doessel describe as the problem of “the worried well”. They use mental health services while the needs of severely mental ill people remain under-resourced, she said.

“Some Australians attract mental health resources that could be used for people in much greater need. Shifting resources to address severe issues, like child and adolescent service delivery, is one great need.”

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