The Impact of Mental Health Reform on General Hospital Psychiatry: Unintended Consequences

Over the last decade, there have been substantial changes in the funding of mental health services in Australia. For example, during the period 1992- 1996, there was a 22% decrease in expenditure on stand alone psychiatric hospitals; a 16% increase on spending on acute psychiatric units in general hospitals and a 54% increase in community based expenditure [1]. The implementation of the National Mental Health Strategy has generated considerable discussion at the level of broad policy direction, the impact of such budgetary changes and changes to psychiatrists work practices [2-4]. However, there has been less comment from the 'coal face' as to the impact of these changes, particularly from the perspective of those involved with clinical care and teaching in the setting of general hospital psychiatric clinics.