Anyone who needs to make their first appointment with a psychiatrist may expect a bit of a wait. Our new research shows Australians are waiting an average 77 days for this initial appointment. But some were waiting for at least eight months.
Authors
- Yuting Zhang
Professor of Health Economics, The University of Melbourne
- Ou Yang
Senior Research Fellow, Melbourne Institute of Applied Economic and Social Research, The University of Melbourne
We also showed people are waiting longer and longer for these appointments over the past decade or so, particularly in regional and remote areas. And telehealth has not reduced this city-country disparity.
Our study is the first of its kind to look at the national picture of wait times for a first appointment with a psychiatrist. Here's why our findings are so concerning.
What we did
We analysed data from the Medicare Benefits Schedule from 2011 to 2022. This allowed us to analyse trends in wait times without accessing individual patients' medical records.
The particular dataset we used allowed us to look at the time from a GP referral to the first appointment with a private psychiatrist.
A first appointment with a psychiatrist is crucial as it may lead to an official diagnosis if there is not one already, or it may map out future treatment options, including whether medicine or hospital admission is needed. Depending on the situation, treatment may start immediately, then be reviewed at subsequent appointments. However, with a delayed initial appointment, there's the risk of delayed diagnosis and treatment, and symptoms worsening.
We focused on wait times for initial outpatient appointments with private psychiatrists, and looked at wait times for face-to-face and telehealth attendances separately.
We did not include wait times to see psychiatrists at public hospitals. And we couldn't see what psychiatry appointments were for, and how urgent it was for a patient to see a psychiatrist at short notice.
What we found
We found wait times for the first psychiatry appointment after a GP referral had increased steadily in the past decade or so, especially since 2020. In 2011, the mean waiting time was 51 days, rising to 77 days by 2022.
Waiting times varied substantially between patients. For example, in 2022, 25% of the wait times for a face-to-face appointment were under ten days. But 95% of wait times were under 258 days. This means the longest wait times were more than 258 days.
For telehealth services in 2022, the equivalent wait times ranged from 11 to 235 days.
Wait times also varied by location. People in regional and remote areas consistently had longer wait times than those living in major cities, for both in-person and telehealth services.
The disparity remained over time, except for in-person services during the early years of the COVID pandemic. This is when rural areas in Australia had fewer lockdowns and less stringent movement restrictions compared to major cities.
Why didn't telehealth help?
Our study did not look at reasons for increasing wait times. However, longer waits do not appear to be due to increased demand, considering the total number of visits has not gone up. For example, we showed the total number of visits for combined in-person and telehealth first appointments was 108,630 in 2020, 111,718 in 2021, and 104,214 in 2022.
But what about telehealth? This has widely been touted as a boon for regional and remote Australians , as it allows them to access psychiatry services without the time and expense of having to travel long distances.
Telehealth took off in 2020 due to COVID. There were 2,066 total first psychiatry visits between 2011 and 2019, increasing to 12,860 in 2020. But in 2022, there were 27,527.
However, we found the number of telehealth visits offset the number of face-to-face visits, and the total visits remained stable in recent years. As telehealth still takes up psychiatrists' time, it did not help to reduce wait times.
What are the implications?
The national rise in wait times over the past decade or so is concerning, especially for high-risk patients with severe mental disorders, such as schizophrenia, severe depression and bipolar disorder. Any delays in treatment for these patients could cause substantial harms to them and others in their communities.
Our results also come at a time of increased pressure on mental health services more broadly including:
long wait times for people with a mental health concern to be admitted from the emergency department to a hospital ward
many public psychiatrists resigning in New South Wales
ongoing national shortages in the mental health workforce
high out-of-pocket costs to see psychiatrists.
Now, more than ever, we need to pay continued attention to access and distribution of psychiatric services across Australia.
Yuting Zhang has received funding from the Australian Research Council (future fellowship project ID FT200100630), Department of Veterans' Affairs, the Victorian Department of Health, and National Health and Medical Research Council. In the past, Professor Zhang has received funding from several US institutes including the US National Institutes of Health, Commonwealth fund, Agency for Healthcare Research and Quality, and Robert Wood Johnson Foundation. She has not received funding from for-profit industry including the private health insurance industry.
Ou Yang does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
