Without doctors, hospital patients left in locked wards

Extremely unwell patients held against their will at the state’s biggest psychiatric hospital are waiting for days to see a specialist as the government offers more than $3000 a day for doctors to fill roster holes.

Cumberland Hospital staff have accused the NSW government of failing to prepare for the damaging effects of the state’s public psychiatrists resigning en masse, which they say has left acutely psychotic and psychologically disturbed patients in locked wards without enough doctors to care for them.

Patients under involuntary treatment orders are left waiting days to see a psychiatrist at Cumberland Hospital. Credit: Marija Ercegovac, Adobe Stock

Mental Health Minister Rose Jackson said hospital contingency plans, such as hiring visiting and locum doctors, were delivering care “as well as can be expected”, but current and resigned staff say the system is not coping.

“I am here on the ground each day. Patient care is being significantly compromised,” a current staff member, not authorised to speak publicly, said.

When Cumberland closed its 20-bed acute unit and 20-bed rehab unit in January, moving patients to other wards, several patients had no treating psychiatrist, even when remaining specialists took on the maximum number of patients they could safely treat, the staff member said.

Psychiatrists at Cumberland told NSW Health they could not take more patients, but more admissions came daily from nearby Westmead Hospital, resigned Cumberland psychiatrist Dr Anu Kataria said.

The result was that patients, many involuntarily admitted under the Mental Health Act, were not reviewed by a psychiatrist – the only specialist who can prescribe medication and discharge patients – for up to a week, Kataria said.

“This is absolutely terrible and completely unacceptable,” she said.

Roughly 54 per cent of mental health admissions in NSW include “involuntary” care, which must be done by the least restrictive means possible under the Mental Health Act.

The staff member who spoke on condition of anonymity said the delays had led to agitated patients becoming violent, punching and kicking staff.

Ward closures have also left sub-acute patients, who are typically young or elderly with more mild mental health issues, sharing wards with extremely psychologically disturbed patients with histories of violence.

In a statement, a Western Sydney Local Health District spokesperson said new models of care were “being explored” at Cumberland, and some beds were “reallocated” in response to the resignations.

There has been no reported increase in aggression towards staff, and “all consumers admitted to mental health services are admitted under the care of a psychiatrist to an appropriate clinical environment”, they said.

Western Sydney emergency departments had 94 mental health presentations last weekend. Last week, 84 “admitted” patients were waiting in emergency for a bed on a ward.

Mental health staff say they have been left on hold for more than an hour calling NSW Health’s Mental Health Line to find a service that can take their patients.

Part of the government’s contingency planning is paying for public patients to be treated at private hospitals. NSW Health Secretary Susan Pearce said it was working on arrangements to “gazette” private facilities to admit involuntary patients.

Greens health spokesperson Amanda Cohn urged the government to rule out admitting involuntary patients to private facilities, as is done in some other states, warning the possibility of profit motives influencing patient assessments was a significant risk to human rights.

A contractor agreement seen by The Sydney Morning Herald shows psychiatrists at Ramsay private facilities are paid a weekly fee of $1400 per public patient admitted. These psychiatrists are expected to be available seven days a week but only required to see patients twice a week (once in person).

Doctor recruitment agencies are advertising more than 70 psychiatrist locum jobs to fill vacancies in NSW, offering $2500 to $3050 per day for two- to 11-month stints. Nine job ads are for Cumberland Hospital, all with the highest rate.

Modelling by senior psychiatrist Dr Kathryn Drew, first published in The Guardian, projected NSW Health could save $35 million a year by giving staff specialists a 25 per cent pay rise – which they have requested as a special levy – instead of paying locum contractors.

NSW Health has offered staff specialists a 3.5 per cent increase per year for three years, including mandatory superannuation indexation, plus a 10 per cent “onerous duties allowance”. Staff specialists received a 4.5 per cent increase last year.

Jackson said 29 psychiatrists had withdrawn their resignations, 105 had deferred their departure beyond this week, and 71 had taken – higher-paid – visiting medical officer contracts.

“The mental-health system is under strain,” Jackson said. “We recognise there are recruitment and retention challenges … but a 25 per cent pay increase in one year alone is not reasonable.”

Jackson has repeatedly said she wants to work with psychiatrists to resolve their legitimate issues, and urged them to remain at work until the matter goes before the Industrial Relations Commission on March 17.

The Morning Edition newsletter is our guide to the day’s most important and interesting stories, analysis and insights. Sign up here.