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The Forum > Article Comments > Real and immediate pressures on psychiatry services and those who work in them > Comments

Real and immediate pressures on psychiatry services and those who work in them : Comments

By Peter Baume, published 21/1/2015

The only way to avoid risk completely is to lock people up alone for a long time - and that kind of risk-averse behaviour has its own problems.

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An excellent summation of the situation. But the main problem is the neo-liberal attitude to government income and expenditure.

I, like you and one of the Roy and HG duo, was in the audience of John Ralston Saul's talk in 1999 at University of NSW. Modern Monetary Theory (MMT) now really explains the situation of a currency issuing (Sovereign) government. Australia is nowhere near at full employment and the SG could use an effective Loans Council to fund the substantial improvements that you see as necessary, among the many other things that could be achieved.

Australia's principal problem is the current account situation. In years to come, under present policies, Australia will not be able to afford the import of all our white and electronic goods and transport needs such as cars, buses, trucks and rail rolling stock. From memory you were a wet liberal and we need people who understand the options available. One interesting book I suggest is Professor Mariana Mazzucato's, The Entrepreneurial State.

The other thing worth understanding is the concept of fiscal space as explained by Dr Stephanie Kelton (now Chief Economic Adviser to the minority in the US Senate) in her address in late 2013 to the Toronto, Canada, Fields Institute.
Posted by Foyle, Wednesday, 21 January 2015 8:05:17 AM
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Thanks for an interesting piece on a topic that tends to be swept under the table.

Psychiatry is the profession that is left to pick up the pieces when human psychology interacts with the environment to produce bad outcomes for individuals. It seems to me that there is a lot of scope within psychiatry, just as within other branches of medicine, for a greater focus on prevention. I've previously mentioned the work of Seligman, Csikszentimihalyi, et al in developing what they call Positive Psychology, which seems to me to offer some possibility of a preventative approach if implemented purposefully and broadly.

Foyle, this isn't the thread to do it, but I'd love to have a discussion about MMT and some of the implications of fiat currencies.

On reflection, perhaps this IS the thread, some of those implications could easily send people around the bend :).
Posted by Craig Minns, Wednesday, 21 January 2015 8:34:03 AM
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Seriously impoverished Cuba has one of the best public health systems in the world, and conducted out of even older facilities that have seen far better days.

And some of your patients have incurable conditions that make them violent or worse and at the drop of a hat, for no particular reason, aside from incurable insanity, say?
And a permanent threat to the community that always ends badly, with tears and endless recriminations!

I think there has to be a case for frontal lobotomies, that turn these people into virtual mindless robots, who follow instructions to the virtual letter? (take one with food three times a day Dinny)

Well that seems to be the case in the available reports I've seen?

In a nutshell, what you're asking for Peter is more money that a shrinking base of taxpayers are expected to pay!

Perhaps we could get an increase in the granny killing GST, and bump off a few more grannies, who are a huge burden on the public health system anyway?

You've obviously thought this through Peter?

Satirical truisms aside, if we could just end endemic tax avoidance by foreigners and nationals alike, and assist that outcome by closing down onshore tax havens, we might be able to double the health budget?

Even now, with a direct funding model and almost absolute regional autonomy, it might be possible to increase the coalface budgets by as much as 30%; the estimated cost to us, of double handling, fee extracting, centralizing, collating (in triplicate) state administrations?

And which state administration currently handling our public health and education funds; is going to recommend their exclusion from the funding process?

And you seem to think there's a problem that exists between private and public health Peter?

What do you want from the private sector, more pro bono assistance perhaps?
Well they rarely exceed a 60% capacity?

However, that might reduce the number of multimillionaires in private medicine, and really, given our rep for meanness on the part of our better off, you might expect more generosity from the Cubans!?
Rhrosty.
Posted by Rhrosty, Wednesday, 21 January 2015 10:47:46 AM
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It really is time that public servants, like those people who staff psychiatric facilities, parole boards, judges & the like, remembered who pays their salaries, & what they are employed to do.

Their primary, secondary & last duty is to the public, to keep them safe from any who might harm them.

It is not to conduct experiments in curing the incurable. If while completing their primary duty of protecting their employers from harm they can help the inmates under their care, great, but letting dangerous people out on leave has no place in that care.

It is time responsibility is sheeted home to these public servants, & they suffer real long term penalties when their doubtful experiments go wrong, & members of the public are harmed or killed.

A psychiatrist, parole board or judge who lets a dangerous person out who then kills, is as guilty of killing as the inmate they allowed out. Until this is brought home to fools in high places, with suitable real penalties, we will continue this Russian roulette with public lives.
Posted by Hasbeen, Wednesday, 21 January 2015 11:34:10 AM
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Dear Allah,

13 out of the 72 virgins I received are ugly, 5 have freckles, 4 are lame, 15 are frowning at me and 2 refuse to wash the floor. At least once a day when I call a virgin, she fails to arrive immediately because parking in heaven has become an issue.

What a lousy job - you could do better, Allah.

Sincerely, your Martyr.
Posted by Yuyutsu, Wednesday, 21 January 2015 1:31:05 PM
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Peter Baume is very familiar with the problems that have plagued our public psychiatric facilities, because nearly all of them have existed for decades, despite massive expenditure (or because of it) on multiple consultancies, reports, inquiries and a royal commission or two. What i've witnessed during 31years working in victorian psychiatry (public and private) and as a carer for an intermittently involuntarily admitted mentally ill family member, amounts to little more than the proverbial shuffling of the deck chairs on the Titanic. Fancy words don't compensate for the chronic underfunding of public psychiatric facilities that while definitely prettier and more comfortable, remain staffed overwhelmingly by nursing and allied health staff and precious few consultant psychiatrists. Successive governments' oft stated agenda of replacing peak professionals in psychiatry with "cheaper substitutes" has seen mass deskilling of public psychiatry in step with the exodus of psychiatrists unwilling to have clinical decisions overidden by cost considerations and artificial length of stay ceilings. A psychiatric nurse's reply to me informing her of the wishes of a professor of psychiatry to admit a floridly psychotic patient is typical of the malaise afflicting public psychiatry, at least in the two states where i have worked. She told me, "we don't have to listen to professor x, or any other psychiatrist. We decide who will be admitted and who won't". The failures of public psychiatry cannot be addressed without researching those mentally ill patients who are poorly managed under a community care model (or not managed at all) and their often distraught, exhausted carers. Pruning psychiatrists from the public psychiatric tree, has been an absurd, fiscally driven, ill-considered experiment with the lives and well-being of the neediest and sickest of victorians and it's time to depart this false fašaded mirage and call the enterprise exactly what it has been - building sand-castles in the air.
Posted by OZSHRINK, Tuesday, 27 January 2015 6:07:24 PM
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