The absence of a safety net is not an accident of history. It is a choice politicians and administrators continue to make.
We like to believe that Australia has a safety net – a quiet civilisational promise that if you cannot afford care, the system will step forward and say, we will not let you fall.
It is a comforting belief, which may be why we cling to it even as the evidence slips away.
The Guardian’s recent report on specialist access exposes what those of us in psychiatric care have known for years: the public safety net is not just frayed but, in many places, absent.
Psychiatry is one of the few specialties where the public system often does not provide a service. Entire cities have no outpatient psychiatry clinics. GPs in some regions have nowhere to refer. The only doorway into care is crisis: a police check, an ED cubicle, a person pushed to breaking point.
We would never design cancer care this way. We would never ignore early disease until it becomes metastatic or terminal and then call that an efficient use of resources.
Yet we accept this architecture in psychiatric care, perhaps because psychological pain is still treated as negotiable, something to be endured rather than addressed.
The consequences accumulate. People lose work, relationships and stability while waiting for treatment that never arrives. Families absorb distress that should never be theirs to carry. Clinicians in emergency settings attempt to fill the void left by services that were never funded.
What we call a safety net behaves more like a sieve.
A nation cannot claim universal healthcare while leaving psychiatric treatment largely to the private market and expecting those who cannot pay to survive on improvisation.
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A functioning system would make public outpatient psychiatry a basic expectation. It would build clear referral pathways. It would fund long-term therapeutic work, not only crisis containment. It would see early intervention as ordinary and necessary.
The absence of a safety net is not an accident of history. It is a choice politicians and administrators continue to make.
And repair begins with telling the truth: that the story we tell ourselves about equitable access is only that, a story, preserved because belief is easier than reconstruction.
What might become possible if Australia created a true universal public psychiatric service that reached people before they broke?
Dr Alexandra Goldsworthy is a consultant psychiatrist in South Australia.
This article was first published on Dr Goldsworthy’s LinkedIn feed. Read the original here.