The latest psychiatric staffing workforce census from the Royal College of Psychiatrists highlights that one in ten consultant psychiatrist posts remain unfilled. These findings would appear to echo the results of a recent review by the Care Quality Commission into the provision of mental health services. That study found that young people were having to deal with longer and longer waiting times and were encountering unequal access to mental health services.
Health commissioners are supposed to be serious about establishing parity of esteem for mental health services with physical health in the UK yet anyone seeking help for their mental health in the NHS will know that this aim might appear like a distant dream. In spite of recent announcements for increased funding for mental health services, there is an ongoing shameful slow track in this sector for those seeking help where waiting times are shocking or immediate treatment is non-existent.
Professor Wendy Burn, from the Royal College of Psychiatrists, has been doing the media rounds over the weekend and has called the current waiting times a scandal when compared to the urgency when needing to see a cancer specialist. She is absolutely right to highlight the disparity of care and she is also right in seeking greater funding for mental health service provision in the NHS.
However, the uncomfortable truth for us in the West, particularly the UK, is that the bigger scandal over decades has been how rich developed countries such as the UK have consistently targeted low income countries to recruit medics, including psychiatric staff, to fill vacant posts in the NHS. There has been a form of brain drain of medics to the UK from parts of the world that are in even greater need of psychiatric services such as huge parts of Africa, the Indian sub-continent and places such as the Philippines. The numbers of doctors migrating into the four major destination countries (the UK is one, but also includes the USA, Canada and Australia) has steadily increased over the 10 years from 2004 (Siyam & Poz, 2014).
Whilst one in ten vacancies in the UK might seem like a scandal to us compared to physical health provision just consider this one statistic: there are currently approximately 250 psychiatrists practising in Nigeria, a West African country with a population of over 175 million. In the UK, the ratio of psychiatrists to the population served increased from 5.9/100000 in 2003 to 7.6/100000 in 2013. In Africa the equivalent ratio remained extremely low, just 0.1/100000 in 2014. One can only wonder how the local populations in these parts of the world have coped with this level of service provision. Just consider where someone goes when suffering a mental health crisis in such an environment, or the impact on their families for that matter.
The UK has in the past, through recruitment tools such as the International Fellowship Scheme, targeted low income countries for healthcare professionals and significant appointments were made to psychiatric posts (Goldberg, 2004 – The NHS International Fellowship Scheme for Consultant Psychiatrists. Newsletter of the Faculty of General and Community Psychiatry, 6 (Spring), 5-6.). Psychiatry had been a major beneficiary of the scheme, and had recruited more consultants than all the other specialties combined. According to the World Health Organisation (Atlas country profiles of mental health resources. Geneva: WHO, 2001), India, with a population of over one billion, had fewer than 3000 psychiatrists. This compares unfavourably with the UK with a difference of about 27 times. Despite this massive inequality, the NHS previously launched a scheme to recruit senior psychiatrists and other medical specialists from India and other developing countries.
The Department of Health claim that the UK has gradually engaged in more ethical recruitment of medics from source countries but the hard reality is that historical aggressive recruitment of such doctors has badly affected the provision of mental health services in the local populations of these source countries.
The global disparity in healthcare provision between rich and poor countries will not be easy to resolve and there are no quick fix solutions. Perhaps all countries, rich and poor, need to attract more doctors into psychiatry training, that’s for starters. Ways need to be found to address professional isolation, and to improve training and career prospects within the countries where doctors are migrating from. Gureje et al, 2009 showed that these issues are some of the key factors presently driving the emigration of mental health professionals. Ultimately, the partnerships between institutions in developed and developing countries are required to encourage doctors to return to their own countries where they are vitally needed.
See also
Will additional funding for NHS mental health services work?