Re: Mental Health, Alcohol and Other Drugs Workforce Strategic Framework

Transcription

1 29 August 2018 Mr David Axworthy Assistant Commissioner Planning Policy and Strategy Mental Health Commission GPO Box X2299 Perth Business Centre WA 6847 By to: Dear Mr Axworthy Re: Mental Health, Alcohol and Other Drugs Workforce Strategic Framework The Western Australian Branch of the Royal Australian and New Zealand College of Psychiatrists (RANZCP WA Branch) welcomes the opportunity to provide feedback regarding the consultation draft of the Western Australian Mental Health Commission s Mental health, alcohol and other drug workforce strategic framework (the Strategic Framework). The RANZCP WA Branch supports the Mental Health Commission s aim to develop a guide for the planning and development of the mental health and alcohol and other drug workforce. The RANZCP is a membership organisation that prepares doctors to be medical specialists in the field of psychiatry, supports and enhances clinical practice, advocates for people affected by mental illness and advises governments on mental health care. The RANZCP has almost 6000 members including more than 4000 qualified psychiatrists and around 1500 members who are training to qualify as psychiatrists. The RANZCP WA Branch represents over 450 members, more than 340 of whom are qualified psychiatrists. It is the view of the RANZCP WA Branch that further work would need to be undertaken in order to develop the existing draft into a comprehensive workforce Strategic Framework. The RANZCP WA Branch commends the Mental Health Commission in consulting extensively with the non-government sector regarding the workforce requirements. However we have concerns about the appropriateness of the Strategic Framework regarding the broader mental health workforce and consider the omission of workforce representatives or professional bodies from the Workforce Strategy Advisory Group to have been a significant contributing factor in the less than comprehensive consideration of workforce development issues associated with clinical services in particular. The significance of safety and quality, extensive training and planning required for the specialist workforce, health and wellbeing issues, service integration and the value placed on the workforce are some of the issues the RANZCP WA Branch would like to see addressed Graylands Hospital, Private Bag 1 Claremont WA 6910 Australia T F ranzcp.wa@ranzcp.org ABN

2 in more detail. The RANZCP WA Branch is concerned that policies are being developed for the mental health sector with limited involvement from the clinical workforce and would hope to see this addressed in future policy development. Given the multidisciplinary nature of the teams working in mental health, the RANZCP WA Branch notes that it is important that the views of a range of professional associations representing specialist mental health workers are sought and that the capacity of such organisations or individuals to provide detailed responses is considered in designing consultation methodology. In response to the draft Strategic Framework, the RANZCP WA Branch has made the following recommendations: Recommendation one: That safety and quality be included as principles underpinning the Strategic Framework. Recommendation two: That Principle 4 be revised to read The mental health workforce is recognised as a distinct, valued and essential partner in care whose engagement in the coproduction of mental health planning and development issues is actively sought and supported. Recommendation three: Urgently address the under-representation of the views of the mental health workforce in the development of the Strategic Framework through a forum to consult professional bodies and other workforce representatives, and ensure that the workforce is formally engaged in the future. Recommendation four: Include system integration, rural and remote workforce, Aboriginal work force and specialist workforce shortages as priority areas. Recommendation five: Commission a detailed analysis of specialist clinical workforce development issues and an accompanying plan for implementation that is costed, funded and has commitment from key stakeholders. Please see the attached submission for recommendations regarding the Strategic Framework and workforce development more broadly. The RANZCP WA Branch would welcome the opportunity for further consultation, and if you would like to discuss any of the issues raised in the submission, please contact Zoe Carter, RANZCP WA Branch Policy Officer via zoe.carter@ranzcp.org or by phone on (08) Yours sincerely Dr Elizabeth Moore Chair, RANZCP Western Australian Branch

3 Government of Western Australia: Mental Health Commission Mental Health, Alcohol and Other Drug Workforce Strategic Framework: August 2018 inform and influence mental health policy in Australia 309 La Trobe Street, Melbourne VIC 3000 Australia T F ranzcp@ranzcp.org ABN

4 About the Royal Australian and New Zealand College of Psychiatrists The Royal Australian and New Zealand College of Psychiatrists (RANZCP) is a membership organisation that prepares doctors to be medical specialists in the field of psychiatry, supports and enhances clinical practice, advocates for people affected by mental illness and advises governments on mental health care. The RANZCP is the peak body representing psychiatrists in Australia and New Zealand and as a bi-national college has strong ties with associations in the Asia and Pacific region. The RANZCP has more than 6000 members including more than 4000 qualified psychiatrists and over 1500 members who are training to qualify as psychiatrists. Psychiatrists are clinical leaders in the provision of mental health care in the community and use a range of evidence-based treatments to support a person in their journey of recovery. Introduction The RANZCP Western Australian Branch (RANZCP WA Branch) welcomes the opportunity to provide feedback on the consultation draft of the Western Australian Mental Health Commission s Mental health, alcohol and other drug workforce strategic framework (the Strategic Framework). The RANZCP WA Branch supports the Mental Health Commission s aim to develop a guide for the planning and development of the mental health and alcohol and other drug workforce. The RANZCP WA Branch commends the Mental Health Commission in consulting extensively with the non-government sector regarding the workforce requirements. We have concerns about the appropriateness of the Strategic Framework regarding the broader mental health workforce and consider the omission of workforce representatives or professional bodies from the Workforce Strategy Advisory Group to have been a significant contributing factor in the less than comprehensive consideration of workforce development issues associated with clinical services in particular. It is the view of the RANZCP WA Branch that further work would need to be undertaken in order to develop the existing draft into a comprehensive workforce Strategic Framework. We make the following recommendations regarding the Strategic Framework and workforce development more broadly: Recommendation one: That safety and quality be included as principles underpinning the Strategic Framework. Recommendation two: That Principle 4 be revised to read The mental health workforce is recognised as a distinct, valued and essential partner in care whose engagement in the co-production of mental health planning and development issues is actively sought and supported. Recommendation three: Urgently address the under-representation of the views of the mental health workforce in the development of the Strategic Framework through a forum to consult professional bodies and other workforce representatives, and ensure that the workforce is formally engaged in the future. Recommendation four: Include system integration, rural and remote workforce, Aboriginal workforce and specialist workforce shortages as priority areas. Recommendation five: Commission a detailed analysis of specialist clinical workforce development issues and an accompanying plan for implementation that is costed, funded and has commitment from key stakeholders. WA Branch submission Page 2 of 11

5 Although outside the scope of the draft, the RANZCP WA Branch also notes that the current governance structure for mental health in WA means that it is difficult to assess the extent to which the Strategic Framework can, or will, influence workforce development in practice. Appropriateness and clarity of principles and priorities The RANZCP WA Branch has considered the appropriateness of the draft principles and priorities in the Strategic Framework in the context of the Better Choices. Better Lives. Western Australian Mental Health, Alcohol and other drug services plan (WA Mental Health Commission, 2015) which identifies a need for the Commission to: Develop and commence implementation of a comprehensive mental health, alcohol and other drug workforce that includes key priorities and strategies to build the right number and appropriately skilled mix of staff and clarifies roles and responsibilities of commissioning agencies and services providers. The challenges inherent in the complex governance of the mental health system in Western Australia are evident in this framework although many organisations are identified as having a role in workforce development and planning, the capacity of the document to guide the workforce development activities is contingent on the extent to which the principles and priority areas align with the funding, accreditation and regulatory frameworks within which the operational activities of service providers are determined. The RANZCP WA Branch supports the view of the Mascie-Taylor Review that the complexity of governance in mental health in Western Australia poses a direct risk to ensuring the safety and quality of services (Mascie-Taylor, 2017). As the mental health system is charged with the care of some of the most vulnerable patients in the health-care system, resolution of responsibility for the overarching system is of critical importance. The frequent yet asynchronous review and restructure cycle in the Western Australian health, mental health and drug and alcohol sectors results in volatility in the roles and responsibilities key stakeholders are prepared to undertake as their organisational priorities realign. The Strategic Framework is an important opportunity to clarify the roles and responsibilities for workforce development in a way that is cognisant of not only the complexity of the intersections and interdependencies between jurisdictions in the sector but acknowledges and plans for the dynamic nature of those relationships in order to maintain system cohesion. This volatility is of particular concern to the RANZCP WA Branch as upcoming critical shortfalls in the numbers of required specialists have been identified and yet the timeframes and placement requirements for the development of the specialist medical workforce require long-term system approaches. The description of the roles and responsibilities of varying stakeholders in Western Australia is a helpful addition to the Strategic Framework; however, the RANZCP WA Branch suggests that it may enhance the clarity and utility of the document to prioritise detailing the functional roles required to effectively deliver on the workforce Strategic Framework, and subsequently map the responsibilities of current stakeholders against those rather than vice versa. This will allow better oversight of where gaps are in the implementation of an integrated and strategic approach to workforce planning and development, thus affording an opportunity to address those concerns. Likewise the alignment to other documents such as the Fifth National Mental Health and Suicide Prevention Plan (2017) and the National Mental Health Workforce Strategy (2011) are helpful. The WA Branch submission Page 3 of 11

6 usefulness of including such documents could be further enhanced through identification of the direct overlaps, and where the WA policy has been developed to address issues unique to Western Australia. Principles Safety and quality Priority Seven of the Fifth National Plan, Making safety and quality central to mental health service delivery, identifies safety and quality as the cornerstones of Australia s health system, and explains that a quality health system provides the right care to consumers, improves health outcomes to consumers and optimises value. Many of the principles articulated in the Strategic Framework would be considered components of safe and quality service but if prioritised over safety and quality could result in unintended unhelpful consequences and poor outcomes. Principle three Equity, respect for diversity, cultural inclusivity and cultural security are of paramount importance is one example where the principles are central to the development of safe and quality services, but if considered paramount would imply that skills and experience that may be essential to provision of a safe service are not to be prioritised. The RANZCP WA Branch concurs with the Fifth National Plan that safety and quality need to be central to mental health services, and considers that they must be foundational principles in the development of the workforce. Safety and quality are particularly relevant in workforce development regarding decisions such as the appropriate ratio of staff to consumers, mix of skills and experience, accessibility of training and peer support, and the availability of good leadership and supervision. As the capacity of the State (or private individuals) to fund growth in the workforce is not infinite, the quest to deliver services more efficiently and make best use of resources is an inevitable feature of the service provision landscape. Safety and quality are principles that need to be considered when balancing care needs with resourcing. In both the government and private sectors, being compliant, and demonstrating compliance, with safety and quality standards is a substantial component of the work required of psychiatrists and other members of the professional workforce. There are many mechanisms for ensuring compliance with a legislation and standards including national service accreditation via the Australian Commission on Safety and Quality in Health Care (ACSQHC), practitioner standards through the Australian Health Practitioner Regulation Agency (AHPRA), audits conducted by the Office of the Chief Psychiatrist, Mental Health Tribunal proceedings, ongoing quality improvement projects in health services, inspections conducted by the Mental Health Advocacy service, Coronial inquests, critical incident reviews and complaint processes. These processes underscore the significance of safety and quality in the mental health sector, and are indicative of the need to ensure that workforce development is appropriate to reaching and maintaining appropriate standards. The RANZCP WA Branch supports robust safety and quality processes but notes that challenges for psychiatrists and other professionals arise when the tasks associated with compliance become disproportionate to the time available for clinical work. This may be due to the sheer number of bodies with oversight of the work of clinicians requiring separate reporting, the ongoing issues associated with the quality of WA s IT infrastructure (including a mix of paper and digital record systems) or reductions in administrative and project support for mental health. RANZCP WA Branch members have expressed WA Branch submission Page 4 of 11

7 their concern that the complexity of the requirements, coupled with the redundancy of some documentation presents its own inherent risks. Employees across the health system are passionate about providing excellence in patient care and genuinely invested in delivering best-practice services. Supporting clinical services with adequately staffed and efficient administrative systems, workable models and robust policy and planning resources means that the clinical skills and expertise of mental health professionals can be directed to consumercentred care, rather than layers of duplicated documentation. Workforce safety Due to workforce shortages, and lack of locum cover, we are not able to have a good leadership and presence in our services. We are also taking less and less study, professional development and conference leave, because we are not getting locums, and this further contributes to stress. RANZCP WA Branch member One aspect of safety and quality that the RANZCP WA Branch would like to see given greater emphasis in the Strategic Framework is the consideration of the health, safety and wellbeing of the workforce. The Interim Report of the Sustainable Health Review made recommendations for a Direction to Create and Support the right Culture including system-wide employee reporting (Sustainable Health Review Panel, 2018). The development of system-wide core values and metrics for workforce health and safety could be of benefit in this regard. As demonstrated in the quote above, RANZCP WA Branch hears from members about a range of workplace concerns. Some of the elements that the RANZCP WA Branch would like to see considered regarding the safety of the mental health workplace include adequate staffing levels (numbers and skills mix), access to leave cover, access to ongoing professional development, adequate time for peer review and support, cultivation of good clinical leadership and inclusion in decision making about service development and design. Not only is the health and wellbeing of individual workers and workforce sustainability impacted by work pressures, being able to take the time to access training and support has a direct impact on the quality of care. RANZCP Position Statement 61: Minimising the use of seclusion and restraint in people with mental illness (RANZCP, 2016) identifies lack of skills and knowledge as barriers to reduction of seclusion and restraint. Where the workforce is not adequately configured for safety, even greater access to training and development is required to address shortfalls. In their recent article in Australasian Psychiatry on neuro-reciprocity and vicarious trauma in psychiatrists, Isobel and Angus-Leppa (2018) identified that there is a need for an implementation of trauma-informed approaches on a system-wide level noting that workplaces can mitigate or exacerbate trauma responses in staff and patients through numerous mechanisms. They concluded: The reciprocal nature of trauma and therapeutic relationships suggests that awareness and prevention of VT [Vicarious Trauma] is crucial for both treatment efficacy and clinician wellbeing. (Isobel and Angus-Leppa, 2018) In addition to consideration of vicarious trauma, the RANZCP WA Branch considers that the impact of traumatic workplace incidents for staff in mental health and for staff working in related areas such as WA Branch submission Page 5 of 11

8 hospital emergency departments and emergency services (particularly where support from specialist mental health staff is not available) in Western Australia is particularly worthy of further research and consideration. Valuing the workforce While organisations responsible for service provision and some sector peak bodies are well represented, the mental health workforce has not been formally engaged as a collaborating partner in the development stages of the Workforce Strategy. The RANZCP WA Branch notes with concern the lack of inclusion of representatives from the mental health workforce in advisory groups and decision-making bodies in the Western Australian mental health sector generally, and on the Workforce Strategy Advisory Group in particular. The RANZCP WA Branch suggests that including professional bodies and/or workforce representatives as distinct to services in the formative stages of policy development would be a useful standard practice. The RANZCP WA notes variations with the Strategic Framework in Principle 4, with: All workers, including clinicians, are offered the opportunity to be involved in addressing workforce planning and development issues appearing in the Strategic Framework s Executive summary (p3), which varies from the version (preferred by the RANZCP WA Branch) on page 27: All workers, including clinicians, are actively involved in workforce planning and development issues. The RANZCP WA Branch suggests amending further to include both acknowledgement of the value of the workforce and greater emphasis on ensuring consultation occurs: The mental health workforce is recognised as a distinct, valued and essential partner in care whose engagement in the co-production of mental health planning and development issues is actively sought. While appreciative that there was some discussion with representatives from the RANZCP WA Branch ahead of the release of the Strategic Framework, we would like to see the mental health policy makers actively engaging with the workforce in the development of strategies such as this. It is also important to acknowledge that there is a distinction between the feedback that clinicians are able to provide when representing their employer, and that which is possible as a representative of their profession or as an individual in the workforce. It does not always follow that the views of service providers are shared by the workforce on an operational level. In addition to their professional expertise, workforce representatives provide valuable insight on what high-level aspirations might look like when translated into practice in the context of the service provision environments that are available. It is also important to note that it is easy to overestimate the capacity of the workforce to respond to callouts for consultation. At a state level, many professional bodies are not resourced with policy support to research and respond to consultation, relying instead on the work of volunteer boards and committees. Responses through workplaces represent the views of service providers, and may not represent the experience of the workforce. This may be of significance around issues such as the level of staffing required to provide a safe level of care or the clinical implications of a new policy. WA Branch submission Page 6 of 11

9 The RANZCP WA Branch suggests that it would be beneficial for the Mental Health Commission to review if the views of important groups within the workforce such as mental health nurses, allied health staff (including psychologists, occupational therapists, physiotherapists, pharmacists, exercise physiologists and social workers), Aboriginal health workers, medical officers, addiction specialists, people working in rural and remote areas, emergency department and emergency services staff, community mental health workers, crisis line workers have been able to respond to the draft, and consider strategies to address shortfalls. Further consultation The RANZCP Branch has attempted to draw attention to some of the issues of concern but would like to reiterate that it is our view that considered consultation with the (multidisciplinary) workforce is necessary. For this reason, the RANZCP WA Branch recommends that a specific forum including clinicians and representative of professional bodies is held to more broadly consider workforce issues. Priorities System integration Ensuring appropriate care across sectors, where there is mix of Commonwealth and State funding models will require specific coordination and implementation of already identified gaps in service. Across Health Service Boards there is a growing difficulty with specialist mental health seen as discrete services rather than components of an integrated system, which makes innovative, state-wide models of care difficult to achieve without agreed clear direction and a comprehensive workforce plan. This also poses particular problems in workforce development for highly specialised professionals such as psychiatrists, where training, development and practice may need to take place in multiple services and is therefore best considered on a state-wide basis. While Tier four services require a raft of highly specialised clinicians to deliver the specialised interventions, these services also play a critical role in leading, providing upskilling to other service tiers and facilitating integrated services across both geographical areas and other disciplines. If these services aren t resourced for building capacity via education and training support or consultation for other service levels, it may mean that consumers are not able to be safely supported in less acute models. For example, in order to provide support in the community setting through outreach to GP clinics FTE is required however may not be available if an area health service does not deem it core business for a specialised mental health service. Rural and remote workforce There is no better example of workforce problems than rural WA. Four out of seven regions with no Clinical Director, positions unfilled other than by FIFO locums in one regions since 2014, unfilled training positions in rural placements, and not to mention the terrible inequity of resourcing the further from West Perth you go. RANZCP WA Branch Member As acknowledged in current hearings for the Senate Committee Inquiry into accessibility and quality of mental health services in rural and remote Australia, there is an urgent need for better mental health services in rural and remote areas. The training models and pathways, access to leave cover and unique challenges of working in rural and remote require different strategies to those employed in the WA Branch submission Page 7 of 11

10 metropolitan area. In the view of the RANZCP WA Branch the issues are significant and require identification as a priority area that is a whole of system responsibility. Some of the issues that could be considered regarding the rural workforce in further consultation include: training models and placements availability/role/ support of overseas trained doctors supernumerary positions in metro areas, adequate FTE to cover training sessions consideration of leave cover integrated models with GPs and other mental health workers telepsychiatry opportunities for peer review and support. Specialist workforce While we appreciate that the Strategic Framework is a high-level document, in order to address the existing shortfalls and looming crisis in the specialist workforce, the RANZCP WA Branch would have expected to see a strategic framework provide guidance as to how, and by whom, the looming shortfall in psychiatry and other specialist workforces across the mental health system will be addressed. Subspecialty shortages have been noted as far back as the Stokes Review in 2012 yet practical implementation is lagging. This issue has become more urgent as the devolution of the WA Department of Health has increased the number of organisations who may need to play a role in a component of developing workforce that may have systems outcomes not necessarily shared by the individual health service provider. With regard to workforce development for psychiatrists there are some key issues: identified critical workforce shortage by 2025 (WA Department of Health, 2017) given training takes 10+ years, shortfalls need urgent attention shortage of training places in consultation liaison psychiatry creating training bottlenecks The RANZCP WA Branch has significant concerns about emerging workforce shortages in sub-speciality areas including: forensic psychiatry consultation liaison psychiatry addiction psychiatry eating disorders child and adolescent psychiatry. Many RANZCP WA Branch members have also expressed concern about the lack of services for people with intellectual disability or autism, and identified that it is virtually impossible to develop expertise in this area in Western Australia as a result of a lack of services and therefore training places. Neuropsychiatry is similarly requiring further development. WA Branch submission Page 8 of 11

11 Headlines such as Paedophiles and dangerous rapists have WA psychiatrists at breaking point (Clarke, 2017) have brought to light the current issues being experienced in the Courts with the lack of forensic psychiatrists available for forensic court reports. The article is illustrative of how the impact of the workforce shortages can have significant implications across multiple sectors. Although the number of psychiatrists required may actually be quite small, the high degree of specialisation required means that the loss of one or two such psychiatrists can have significant consequences. It s also important to note that specialists play a broader role than one-on-one clinical consultation with consumers and their carers for acute and/or complex care. Consultation support on complex clinical issues and clinical leadership are important components of the role of psychiatrists. Further detail on the role of psychiatrists is available in RANZCP Position Statement 80: The role of the Psychiatrist in Australia and New Zealand (2013). Robust support from multidisciplinary teams provides excellent and cost-effective care and the RANZCP WA Branch would like to see greater detail in the Strategic Framework around support for both multidisciplinary models and consideration of the role of standardised clinical teams. Further consultation with the RANZCP WA Branch and other WA professional bodies is recommended in this regard. The RANZCP WA Branch will continue to offer support for emerging disciplines and models of practice where they are supported by evidence of appropriate safety and quality outcomes and are used to complement, rather than replace, the existing workforce. The levels of past and future staff levels illustrated in the Strategic Framework does indicate increases are needed in all disciplines. What is not as clear is how those increases will be supported, and the anticipated consequences if they are not. The RANZCP WA Branch notes the work commissioned by the Victorian Department of Health and Human Services resulting in the report Psychiatry Attraction, Recruitment and Retention Needs Analysis Project (RANZCP, 2017). The RANZCP WA Branch suggests that more detailed analysis of the requirements of the specialist workforce is required to inform workforce development and therefore recommends the commissioning of such analysis for relevant disciplines, and importantly, a plan for implementation that is costed, funded and has commitment from key stakeholders. Aboriginal Workforce and models of care The RANZCP WA Branch considers that the development of culturally secure models of care, development of the Aboriginal health workforce and development of training pathways in other specialist areas of the mental health workforce should be noted as a priority area. Conclusion In conclusion, the RANZCP WA Branch would like to reiterate our support for the substantial time and effort that has been put into developing this draft Strategic Framework. We support further consultation in the form of dedicated clinical fora in order to develop a more comprehensive consideration of the workforce issues in the clinical mental health workforce. Transparency around modelling will maximise the capacity of these groups to provide relevant and timely advice as how best to meet future needs within a consumer centric framework. WA Branch submission Page 9 of 11

12 References Clarke T (2017) Paedophiles and dangerous rapists have WA psychiatrists at breaking point. Available at: thewest.com.au/news/crime/paedophiles-and-dangerous-rapists-have-wa-psychiatrists-at-breakingpoint-ng-b z (accessed 28 August 2018). Department of Health (2017) The fifth national mental health and suicide prevention plan. Available at: %20Prevention%20Plan.pdf (accessed 1 July 2018). Isobel S, Angus-Leppa G (2018) Neuro-reciprocity and vicarious trauma in psychiatrists Australasian Psychiatry 26: Mascie-Taylor, H (2017) Review of Safety and Quality in the WA health system a strategy for continuous improvement, Available at ww2.health.wa.gov.au/~/media/files/corporate/general%20documents/review%20of%20safety%20a nd%20quality/review-of-safety-and-quality.pdf (accessed 1 July 2018) Mental Health Act 2014 (WA). Mental Health Workforce Advisory Committee (2011) National Mental Health Workforce Strategy. Available at: (accessed 28 August 2018). National Mental Health Commission (2016) Equally Well Consensus Statement: Improving the physical and wellbeing of people living with mental illness in Australia, Sydney: NMHC. Reid, M (2004) A healthy future for Western Australians: Report of the Health Reform Committee, Perth: Western Australian Government Department of Health. Available at: (accessed 23 October 2017). Repper, J, Carter T. (2011) A review of the literature on peer support in mental health services. Journal of Mental Health. 20(4): Royal Australian and New Zealand College of Psychiatrists Victorian Branch (2014) Service model for consultation-liaison psychiatry in Victoria. Available at: Wor.aspx (accessed 23 October 2017). Royal Australian and New Zealand College of Psychiatrists (2016) The economic cost of serious mental illness and co-morbidities in Australia and New Zealand. Melbourne, Australia: RANZCP. Royal Australian and New Zealand College of Psychiatrists (2016) Position Statement 61: Minimising the use of seclusion and restraint in people with mental illness. Melbourne, Australia: RANZCP. Available at: (accessed 28 August 2018). WA Branch submission Page 10 of 11

13 Royal Australian and New Zealand College of Psychiatrists (2016) Position Statement 80: The role of the psychiatrist in Australia and New Zealand. Melbourne, Australia: RANZCP. Available at: Psychiatrist.aspxhttps:// 80-PPC-Role-of-the-Psychiatrist.aspx (accessed 28 August 2018). Royal Australian and New Zealand College of Psychiatrists (2017) Psychiatry Attraction, Recruitment and Retention Needs Analysis Project. Melbourne, Australia: RANZCP. RANZCP Victorian Branch (2017) Response to Safer Care Victoria on clinician engagement. Available at: ranzcp.org/files/resources/submissions/ltr-vic-safer-care-victoria-scoping-paper_clinicia.aspx. Stokes, (2012) Review of the admission or referral to and the discharge and transfer practices of public mental health facilities/services in Western Australia. Available at: (accessed 23 October 2017). Sustainable Health Review Panel (2018) Sustainable Health Review: Interim Report to the Western Australian Government. Available at: ww2.health.wa.gov.au/~/media/files/corporate/general%20documents/sustainable%20health%20r eview/sustainable-health-review-interim-report.pdf (accessed 28 August 2018). Western Australian Mental Health Commission (2015), Better Choices. Better Lives. Western Australian Mental Health, Alcohol and Other Drug Services Plan , Perth: Western Australian Mental Health Commission. Western Australian Department of Premier and Cabinet (2017) Service Priority Review Blueprint for reform final report available at: Reform-recs-and-actions.pdf (accessed 16 August 2017). WA Department of Health (2017) Medical Workforce Report 2015/16. Medical Workforce Branch, Office of the Chief Medical Officer, Department of Health, Western Australia. WA Branch submission Page 11 of 11