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Psychiatry ‘At the Coal-Face’

The practice of psychiatry confronts the individual clinician, as well as the administrator with responsibility for psychiatry services, with many dilemmas. Who needs psychiatric services, what do they need and who can provide them? There has been criticism that the clinician in private psychiatric practice provides for the upper class and well-to-do, and perhaps especially for fellow professionals. Yet any such claims must be balanced by the provision of public sector mental health services for, more than in any other specialist discipline, psychiatrists work in public facilities to provide care for those without ready access to private health care systems. Thus, according to our manpower estimates, more than fifty per cent of members of the Royal Australian and New Zealand College of Psychiatrists are so employed. Nevertheless, it behoves us to consider if indeed, either as individuals or as a profession, we provide for the most needy individuals with mental health problems. Do we have individual professional codes to guide us for their care, and have policies of our health care systems been developed to meet their needs? If we do not, then this is an important issue for us to address both as individuals and as a College, for it is the core of our professioal role as psychiatrists. It is useful to consider what may be the greatest need in terms of mental health problems in terms of psychic distress and suffering and how we should address this need. This, I have chosen to call psychiatry ‘at the coal-face’, at the dirty, tough, difficult edge of existence, where battles of survival are fought and lost and mental health must encompass these realities. This title is of symbolic significance as well, because many of the problems and issues I will outline are condensed in