The division between care for physical health compared to mental illness is akin to apartheid, experts say following the release of an AMA report.
People with serious mental health problems are given “third-world care” in public hospitals in an apartheid-style system, and GPs and hospital emergency departments are being left to deal with impossible situations, according to leading psychiatrist and mental health campaigner Professor Patrick McGorry.
Professor McGorry’s scathing comments came in response to a new AMA report that shows Australia’s public hospital mental health system has reached record high waiting times and historically low bed capacity, as the number of patients with severe mental illness seeking help in emergency departments soars.
The AMA’s Public Hospital Report Card: Mental Health Edition 2025 shows that patients with mental health conditions wait an average of seven hours before receiving care in hospital emergency departments.
Long waits in EDs are making patients’ symptoms worse and can lead to agitation, distress or violence, AMA president Dr Danielle McMullen said in the report.
Professor McGorry, executive director of Orygen and professor of youth mental health at the University of Melbourne, told TMR that people with severe mental health problems were being neglected by governments at every level.
“The neglect is incredible,” Professor McGorry said.
“For example, the federal government only spends four or five billion a year on the whole of mental health care, and they’re spending $52 billion on the NDIS for a fraction of the number of people.
“The asymmetry of funding is incredible.”
Things are continuing to worsen, he said.
“We had a Royal Commission in Victoria, which was supposed to fix everything, but it’s actually done nothing. And New South Wales, as you know, was imploded with a psychiatrist strike.
“Danielle McMullen’s introduction is very, very clear. People with severe forms of mental illness in particular are being seriously let down by state and federal governments.
“We had the deinstitutionalisation of the 1990s, and the [bed numbers] have just continued to shrink despite the population growth.
“It’s not just all about beds,” said Professor McGorry.
“They not only didn’t fix or replace the clinical care of patients with a new model properly, they completely abandoned all the social care, somewhere for people to live and social forms of therapy which are needed to help people recover.
Professor McGorry said cancer patients in Australia received incredible quality of care backed by the latest scientific evidence.
“And you see the way the people with mental illness are treated. They don’t even bother to provide the latest scientific evidence. It’s all about risk management. It’s extremely frustrating.
“And like Danielle says, the GPs and the EDs are left to deal with an impossible situation.
“The solutions are clear,” Professor McGorry said. “It’s not like it’s a wicked problem.”
The key was to strengthen primary care as with headspace, and to build a backup system for primary care and stronger specialist community mental health services, he said.
“And at the same time, the states have got to build more beds and more sub-acute beds, and fund their community mental health systems, and they’ve got to attract people to come and work in the field, because it’s very difficult to attract and retain people when you’re working in a chronically crisis-ridden situation,” he said.
“People burn out, they’re not supported, and they’ve got an impossible job, so you’ve got to turn that around and attract a whole new generation of motivated professionals. But that means it’s got to be a reasonable place to work.
“All those things are doable, but it needs political will, it needs money, and it needs great leadership.”
Professor McGorry said he had observed how mental health patients were treated in emergency departments.
“They’re treated very badly in a crisis,” he said.
“It’s like an apartheid. If you’ve got a physical problem, you get a certain level of care. If you’ve got a serious mental health problem, it’s third world.
“I’m not blaming the clinicians – [the system is] not designed to deal with that.”
While more beds would be part of the solution, social assistance played a key role, he said.
Professor McGorry said many people with mental illness have ended up in the prison system simply because there was nowhere else to go.
“People haven’t got anywhere to live. In themental hospitals, whatever their faults, at least there was a roof over people’s heads and food.
“A lot of the mentally ill are in jail, especially men, because that’s the only way that they can survive.
“They’ve offended because of the neglect and their illness, and they’ve ended up in prison, and the care in the prisons is terrible.
“It’s a scandal. I don’t use that word lightly, because I’ve tried my whole career trying to fix it, worked with governments to try to fix it, but honestly, it’s a scandal.”
According to the AMA report card, there are just 27 specialised mental health beds per 100,000 people in mental health wards – a figure that hasn’t changed since 2024 and which remains the lowest capacity on record.
“This reflects a concerning decline in system capability at a time when the demand for mental healthcare is at an all-time high,” AMA president Dr Danielle McMullen said in the report.
The average time to see a doctor in emergency departments has soared, along with the number of people needing emergency mental health care.
The report shows that the number of patients with mental illness triaged as an “emergency” (with care required within 10 minutes) has more doubled in the past 15 years from nine to 23 per 10,0000, while those triaged as “urgent” (to be seen within 30 minutes) has increased from 37 to 60 per 10,000.
And in 2023–24, 53% of mental health-related presentations came via an emergency services vehicle, compared to 27% of all emergency presentations.
“These figures clearly demonstrate the needs of patients with severe mental illness are increasingly unmet by community and primary care services,” the authors said.
“As a result, many are turning to their local EDs as a last resort – often when their condition has reached a critical point.”
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Dr McMullen said wait times for patients with mental illness were the longest on record and there had been no improvement since last year’s report.
“This means very unwell people are waiting for an unacceptably long time in completely inappropriate settings, with bright lights and noise, potentially further exacerbating their symptoms,” Dr McMullen said.
“An increasing number of patients are presenting to health services in acute mental health crisis, requiring urgent intervention and coordinated care. For many of these patients, a hospital admission is required and the journey through the ED is a daunting and overwhelming experience.
“Patients are facing long waits in bright, noisy environments that often lead to increased agitation and distress. Sadly, this can lead to either verbal or physical assaults on staff, with violence in public hospitals continuing to rise.”
Dr McMullen said the report highlights the “logjams” in the system. There were several contributing factors, she said: exit block, a shortage of inpatient mental health unit beds, a lack of investment in community and primary mental healthcare, and a lack of interoperable electronic patient records which causes time-consuming administration.
“In my practice I see the significant burden of mental illness – from patients with early, mild symptoms, to patients with chronic and complex conditions. I see firsthand how important it is to have a connected and well-functioning mental health system.
“We need to properly resource general practice, psychiatry and community mental health services with acute care teams to provide best practice care and take the pressure off emergency departments.
“Growing demand and under-resourcing is leading to clinically unacceptable long waiting lists for these services.”
RANZCP president Dr Astha Tomar said that while governments have not been completely ignoring the need for investment in mental health, “they have been trying their best but it’s just not enough”.
“Some governments have invested a little bit more than others, and some have done a little bit more than their previous years, but this piecemeal approach is not getting us anywhere,” she told TMR.
It was unacceptable that a person who went to an emergency department for severe mental health issues could not access the same quality, timely care as someone for a physical problem, she said.
“When there’s a big gap between how mental health care is being provided – whether it’s bed-based services or in the community – if it is not the same as it would be for a physical health issue in the same hospital, in the same state, in the same service, then we have to wonder why. The need is there. The communities are asking for it.
“There is not a single government, either state or federal, that can say what they’re doing is good enough. Then when are they going to do what is needed of them? What are they waiting for?”
Dr Tomar said investment was needed “across the whole of the continuum”.
“It can’t just be prevention versus early intervention versus long term care versus acute care versus public versus private. It has to be the whole-of-system approach. For any Australian, they shouldn’t have to rely on the private health system.”
Even people who had private health insurance couldn’t be guaranteed that they would receive timely, adequate quality and evidence-based mental health care, she said.
“It is completely unacceptable that we have effective treatments and people are not able to get it now, whether that is adequate medication, adequate psychotherapy, adequate psychosocial support.
“It is very clear that the demand is not being met, and that demand is not just for anxiety and depression, we’re also talking about severe postnatal depression, severe obsessive compulsive disorders, post-traumatic stress disorder, veterans and ambulance officers. People who do need that timely care are not getting it.”
Dr Tomar said for many people with severe mental illness, their ability to seek care and support was limited. “There are people out there who are stuck in their houses, in the rooms, they haven’t gone out, they haven’t spoken to anyone. Those are invisible people at this point.”
It was unacceptable that someone in a high level of distress had to go to an emergency department “because they have no choice left anymore”, and then have to wait for seven hours, she said.
“And healthcare workers are doing their best to be able to provide that care.”
Dr Tomar said psychiatrists and other mental health professionals received extensive training in effective treatments but ended up working in systems that were “completely broken”.
“Apart from a crisis response, the system has a very limited ability to deliver that evidence-based care.
“That is the biggest cause of burnout in psychiatrists, in healthcare workers, where they can see the demand, they have the expertise, the experience, the drive and the passion to deliver that care, but there is no system which enables them to do so.”
Australian Association of Psychologists Inc executive director Tegan Carrison said while the AMA rightly points to exit block, bed shortages and triage delays, “the upstream issue is that people cannot access timely, affordable psychological care”.
Ms Carrison called for Medicare rebates to be increased to $150 per psychology session and the number of sessions to be restored to 20.
“These two elements should be seen at the very least as a preventative measure. For every patient sitting in an ED for seven hours in a state of distress, there is someone in the community who was deterred by out-of-pocket costs or limited to just 10 sessions.”
Another report from the Australasian College for Emergency Medicine (ACEM), also shows rising numbers of mental health-related presentations to emergency departments.
According to that report, people of Aboriginal and Torres Strait Islander descent and people over 65 face excessively long waits for admission, and 10% of patients with a mental health diagnosis waited more than 23 hours for an inpatient bed in 2023-24.
“The consequences of this are profound – for people who wait too long or do not receive appropriate care, for families and communities who carry the weight of crisis, and for staff working under relentless pressure,” said ACEM President Dr Stephen Gourley.
“Without meaningful investment in community-based mental health services, the system will remain reactive, costly and unsustainable.”
A third report, this time from Australians for Mental Health, says more people are seeking mental health support but still face barriers to accessing help.
“These trends are unfolding alongside broader concerns relating to decreasing social cohesion, rising rates of loneliness, and the aftershocks of the covid pandemic,” the authors say in the Mental Health Compass.
“Added to this are cost-of-living pressures, wage stagnation, housing insecurity, and insecure work – all of which are contributing to increased stress, anxiety and depression, particularly among young people.
“Beyond these immediate pressures, the existential threat of climate change and a growing sense that decision-makers are not listening is shaping peopleʼs confidence in the future.”
The authors surveyed more than 3000 adults and found that 88% believed mental health was just as important as physical health, and 72% believed mental ill-health was a major issue affecting many Australians.
They also found that 59% agreed the nation was facing a mental health crisis that needed to be urgently addressed, but 41% believed that not every challenge is a mental health issue and that it shouldn’t be called a “crisis”.
And 43% believed that the mental health system was difficult to navigate, while 40% were concerned they could not afford to pay for mental health support if they needed it.
“Australians understandably come from many different backgrounds, and have many different experiences which influence their views on mental health, but we need to help everyone understand that we are undeniably experiencing a mental health crisis in this country right now,” executive director of Australians for Mental Health Chris Gambian said.
