Nevertheless, the central issue inability to permanently recruit for these areas continues unresolved. Those who venture to serve in underserviced areas soon become overburdened and disenchanted with the workload and the system s failure to provide backup for them. Even in large centres where psychiatrists numbers seem to be adequate, relative shortages in terms of access to specialized services such as forensics, psychopharmacology, or psychogeriatrics are common. It is unacceptable that anyone has to wait for weeks, and often months, to obtain a consultation in such specialized areas. Attracting psychiatrists to work with the severely and chronically mentally ill continues to be a challenge, and there are ongoing, significant shortages of addiction psychiatrists.
Hospitals continue to be unable to recruit for inpatient psychiatric services.
Inpatient psychiatry has become unattractive, not only because of the ever-continuing pressures on fewer psychiatric beds but also because of pressure to shorten the length of stay. There is, in addition, ever-increasing harassment rooted in the extensive and complex legal issues arising from the Mental Health Act. Particular ethnic and cultural populations in large cities have no access to psychiatrists who can speak the patient s language and who are familiar with the patient s culture. Obviously, many reasons have contributed to this state of affairs. As we now recognize, it is clear that free-market forces are not capable of dealing with many of these shortages and inequities in distribution.