Judges, doctors warn of ‘unacceptable risk’ to public safety

Doctors deeply concerned for the welfare of their severely mentally ill patients who have committed violent acts have issued a dire warning that the disintegration of the psychiatric workforce poses an unacceptable risk to public safety.

Sydney courts are also braced for the impact of a severe psychiatrist shortage on the criminal justice system as the dispute between the NSW government and more than 200 resigning psychiatrists is set to drag on for months.

Deputy Chief Magistrate Sharon Freund is concerned about the effect of the mass resignations on the legal system.Credit: Janie Barrett

The president of the Royal Australian and New Zealand College of Psychiatrists wrote to Premier Chris Minns on Wednesday night, warning that “inadequately treated behaviourally disturbed patients may be of risk to healthcare workers and other patients”.

“We also fear that vulnerable people requiring hospitalisation will, wrongly, find themselves in the criminal justice system for acts committed while experiencing a mental health crisis,” college president Elizabeth Moore wrote. “Such outcomes are devastating for patients and their families.”

Magistrates and prison advocates have foreshadowed the critical knock-on effects for mentally ill people accused of crimes if forensic hospitals cannot take them.

Deputy Chief Magistrate Sharon Freund told Downing Centre on Wednesday the resignations of more than 200 psychiatrists was “going to impact the courts going forward” after hearing of the struggle an accused man faced attempting to access mental health support.

“We are talking about acutely unwell people not getting the physical and mental help they need,” Freund said.

In a local court on Tuesday, a magistrate sent a man with severe psychosis to jail instead of granting a recommendation to divert him to a forensic hospital because he may not see a psychiatrist due to the mass resignations.

Most of NSW’s roughly 500 forensic patients have been found not criminally responsible for serious crimes, including homicide, attempted homicide and serious sexual assault, due to their mental health or cognitive impairment.

Dr Elizabeth Moore, president of the Royal Australian and New Zealand College of Psychiatrists (RANZCP).

Roughly 250 are in the community under the supervision of the Mental Health Review Tribunal, and about 130 are detained in the forensic hospital at Malabar. Others are in medium-secure forensic units or jail waiting for a forensic bed.

Thirty forensic psychiatrists submitted their resignations – almost two-thirds of the workforce.

Resigned forensic psychiatrist Dr Ian Korbel said it would be indefensible if forensic patients left to languish without vital psychiatric care were to harm someone as the state government delayed finding a solution to the crisis and had abrogated responsibility to the Industrial Relations Commission.

“We know that when our patients don’t get adequate care, there is a risk for violence,” Korbel said. “Undoubtedly, there will be less community care as we lose more psychiatrists.”

Korbel said he was worried about staff being assaulted when emergency departments are overflowing with patients not getting the care they need.

He described a recent case of a young mother who killed her child and had been recovering well from her mental illness in a forensic unit before being released with woefully inadequate support.

“She will go from being in an institution and seeing a psychiatrist at least once a week and a registrar twice a week to seeing a community psychiatrist once every three months,” he said. “It’s an unacceptable level of risk that we are putting on her, and society.”

A forensic psychiatry registrar not authorised to speak publicly said the vast majority of mentally ill patients posed no physical threat to others, but a small subgroup of patients posed a “very real risk”.

“I cannot believe, less than a year after [the Bondi Junction Westfield stabbing], that this isn’t being taken more seriously,” the registrar said.

Christina Matthews, a former medical director at a NSW hospital and forensic psychiatrist, said the hardest part of her former job was helping patients deal with the grief and trauma of overcoming their mental illness to discover they have hurt or killed someone when they weren’t in their right mind. “This is what staff do every day.”

Claude Robinson, a former prisoner who runs Rainbow Lodge, a home in inner Sydney for men released from prison, used the example of Matthew John Whitehall, 40. In 2016, Whitehall stayed at a home Robinson managed after leaving the forensic hospital at Long Bay, but had to be discharged after Robinson feared he would “kill someone” at the home.

“He was removed by police who just put him on the street,” Robinson said.

Months later, Whitehall stabbed 38-year-old Paul Antaw outside a refuge hostel in Woolloomooloo.

When prisoner advocate Renee McNab was jailed at Silverwater Correctional Centre, she thought she would be able to continue the medication she had been prescribed to manage her bipolar.

Instead, she was stripped of daily medication for one month until she could get an appointment with the prison’s mental health service. She suffered a manic episode and became suicidal.

“How many more suicides or suicide attempts in custody are we going to end up seeing because of the lack of resources and services?”

Minister for Mental Health Rose Jackson said the resignations were yet to have a significant impact on justice, health or forensic mental health services, but the government had a “comprehensive mitigation and contingency plan” in place.

“Our clear priority is community safety and minimising the impact of these resignations on service delivery,” Jackson said in a statement.

The government and resigning psychiatrists will next appear before the IRC on March 17.

With Perry Duffin

If you, or someone you know, needs support you can call Lifeline on 13 11 14 or Beyond Blue on 1300 224 636.

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