- In short: Two psychiatrists say they are left with no choice but to close their Hobart practices when the St Helen's Private Hospital ceases operation in June
- What's next? The Tasmanian government says it is working with other providers to minimise the impact on St Helen's patients
In three weeks' time, psychiatrist Dr Marzena Rybak's career in private practice will come to an abrupt end.
"I'm devastated," Dr Rybak said.
She said she had been left with no choice but to close her practice when St Helen's Private Hospital in Hobart also closed on June 23.
Dr Rybak has worked at the hospital as a consultant psychiatrist for the past 20 years.
"I managed to collect a couple of thousand … patients who I have been seeing all of those years," she said.
Fellow consultant psychiatrist Dr Yvonne Turnier-Shea — who has been at St Helen's for 18 years —said she had also made the "really hard decision" to close her practice.
She said she had 800-1,000 active patients on her books, and another 1,000 who she saw infrequently.
Both doctors said most of their patients were moderately to severely mental unwell. They were not confident there would be enough mental health beds available for them to admit patients needing hospitalisation after June 23.
"Given that I've been looking after a number of severely ill people that intermittently need regular admissions to hospital, I cannot see how I can safely continue the kind of practice that I've been providing," Dr Turnier-Shea said.
"I will have to close my practice and it breaks my heart."
One of their colleagues told the ABC they are also shutting their practice and working interstate while they assess their options.
Owner Healthscope has said it cannot afford the repairs and upgrades the hospital needs to keep operating.
St Helen's has 31 adult mental health beds and an eight-bed mother and baby unit. Dr Rybak said it also had a "very busy outpatient clinic".
It offers electro-convulsive therapy (ECT) and transcranial magnetic stimulation (TMS) — the only approved effective therapies for treatment-resistant depression.
Dr Rybak and Dr Turnier-Shea work with another five psychiatrists, a pain specialist and three psychologists.
"We're running a lot of services from this little practice," Dr Rybak said.
Both doctors also said they had not been invited to be part of any consultation about how the closure would be managed by the government and other providers.
"We as actually the service providers for those patients, we have at no stage been invited into those conversations," Dr Turnier-Shea said.
"Frankly I don't understand this, because, you know, we should be the first people to know what our patients need and what will and will not work".
The state government has said it was working with the St Helen's hospital operator Healthscope and other providers to "minimise the impact on patients" affected by the St Helen's closure.
Health department secretary Kathrine Morgan-Wicks said it was not as simple as just finding beds in the public system to replace those that had been lost.
"There are different services that are provided within those 31 beds [as well as] a mother and baby unit, including various mental health treatment services that we are actually matching up between our Royal and public service provision and private hospital partners."
A new mother and baby unit at the Royal Hobart Hospital has already been announced and the government has said other services offered by the St Helen's Private Hospital "will be absorbed by private providers to ensure patients can continue to receive treatment".
It is also working with the Hobart Clinic and another private provider to establish a TMS service in the public health system.
The Hobart Clinic is working to transition inpatient and day programs from St Helen's to its centres, and ECT services will continue to be provided through the Hobart Day Surgery, with patients under the care of the Hobart Clinic.
Dr Turnier-Shea is worried about the capacity for other providers to "absorb" patients.
"The reality is the services in place aren't any extra services that haven't been there yet," she said.
Mental Health Council of Tasmania Connie Digolis said her organisation had been reassured there would be a smooth transition for St Helen's patients.
"While this service is closing, all steps that we believe can be taken are being taken to ensure that in the short term — especially those specific treatments [TMS and ECT] — are actually still going to be available to people, that patients are being transitioned into ongoing care and that moves towards ensuring that we've perhaps got some better options are actually going to be available in the longer term," she said.
"With closure there comes disruption, but there also comes opportunity, so this is our chance to be looking at where the most contemporary models of care are, how do we ensure that what we replace it with is actually accessible to more people, and we still need to answer those questions around access around the state."
Ms Digolis said more work needed to be done to make mental health more accessible and more affordable for Tasmanians.
While they are closing their practices, Dr Rybak and Dr Turnier-Shea said they both wanted to continue working in mental health.
Dr Rybak said as she was nearing retirement, she had started slowly cutting back on her patient load and had been preparing to transfer patients.
"I was not prepared for such a sudden end to my career," she said.
Dr Rybak will not rule out returning to private practice but she said that would only happen if she has a place to admit patients who need hospitalisation.
When the hospital and consulting rooms close, she will look at other options to figure how she can be "the most useful for the system as a whole".
Dr Turnier-Shea is also considering her options for after the closure.
"As an immediate measure … I will see myself as having to do some locum work, which is not really necessarily something I would be choosing if I wasn't in this position, but at least it's something to give back to patients, assist in psychiatric care in areas where there's high need."
In a statement, the government said it was "fast-tracking" the appointment of St Helen's staff to its casual employment registers.
In a statement a spokesperson said Healthscope "is disappointed to see comments in the media from a small number of psychiatrists who have been operating at St Helen's Private Hospital".
"Healthscope has consulted extensively with psychiatrists about the impact of the closure and what support they need in the future to continue providing care to their patients," they said.
"All psychiatrists have been offered opportunities to continue treating their patients at other nearby facilities.
"Our priority continues to be ensuring a safe transition of ongoing care for all our current patients."
