Where is the clinical professor within the structure of regional mental health services?

To the Editor

In a recent Editorial, Henderson et al., (2015) drew attention to the fact that recruitment into academic medicine is declining and the academic psychiatrist should be declared an endangered species. We support their call for further university funding for dedicated career pathways in psychiatry. In addition, we need to revisit health-funding models to ensure that clinical academic positions are adequately funded.

As the Editorial highlights, the decline and indeed possible extinction of academia would be disastrous for psychiatry. The academic mission of research, teaching and clinical excellence has underpinned the quality of healthcare for over a hundred years (Pennington, 2008). The clinical professor is the cornerstone of this tripartite mission in teaching hospitals; and academic leadership remains central to the most prestigious academic health science centres in the world (Pennington, 2008; Goodall, 2011).

With the waning influence of university departments however, there is evidence that clinical academic leadership is already being lost. For instance, Flinders University Medical School was founded in 1974 on the basis of an academic-health partnership, which included a fully integrated teaching hospital with academic leadership of the clinical departments including psychiatry (Pennington, 2008). With the creation of a regional mental health network over the last decade, senior academic psychiatrists were specifically and intentionally sidelined from the leadership team in mental health.

This short-sighted administrative decision severed the links between research, teaching and patient care within the regional mental health network; and replaced the leadership of the clinical professor with an essentially non-medical managerial structure. The increased emphasis on managerial models and the exclusion of academia led to non-aspirational goals, affected the funding base for mental health, reduced the sense of creativity, and contributed to the failed implementation of evidence-based care.

Active and urgent measures are needed to restore the tripartite mission of research, teaching and quality healthcare within regional mental health services across Australia. This requires the return of senior academic psychiatrists to the real decision making forums at state and regional levels.

Senior staff specialists are central to renewed academic-health integration, particularly clinical directors. Ideally, clinical directors within major teaching hospitals should be joint university/health appointments that play a crucial bridging role between academia and mental health services. Clinical directors with strong research track records can improve the performance of health services (Goodall 2011) and provide valuable academic role models for trainees; hence restoring academic-health integration would also strengthen career pathways in psychiatry and increase research output.