Children in adult wards, 27-hour emergency waits: the mental health crisis in NSW

Long wait times, a shortage of hospital beds and rising demand for adolescent care have left NSW mental health services in a “constant state of crisis”, the sector says as it begs the Minns government for an urgent review of funding.

The NSW Mental Health Alliance, a group that includes the peak bodies representing psychiatrists and carers, believes the state must follow Victoria and Queensland and introduce a payroll tax levy to raise more cash, as they struggle under the pressure of a mental illness epidemic.

While a 2023 Australian Institute of Health and Welfare report found mental health issues represent 15 per cent of NSW’s total burden of disease, spending on mental health represented only 6.5 per cent of the state’s total health budget last year.

“The fact is the NSW mental health system is critically underfunded and on the brink of collapse,” said Professor Samuel Harvey, executive director of the Black Dog Institute, a member of the alliance.

“Across the state, we are seeing mental health services stretched to their limits, the mental health workforce is burnt out, and people who need help are falling through the cracks.”

According to the most recent data from the Productivity Commission, NSW funding for mental health services is being outpaced by money provided in other states and territories.

During the five years to 2020-21, NSW’s total mental health expenditure increased 7.92 per cent to $2.17 billion, while Victoria’s increased 32 per cent to $1.96 billion.

Between 2013-14 and 2020-21, NSW government per capita spending on mental health services rose by $17.76 to $267.85, while Victoria’s spending increased by $63.70 to $298.57.

State governments are responsible for funding mental health units in hospitals, as well as community-based outpatient teams. They also provide funding for mental health organisations and administering other non-hospital initiatives, such as the NSW “safe havens” program.

The alliance is particularly concerned about funding and resources for children’s and adolescents’ mental health services.

Between January and October in 2023, 208 young people were treated in adult mental health units in NSW, according to questions on notice published following a budget estimates hearing late last year.

The incidents represented 8 per cent of total episodes of care for minors during the period. While most of the patients involved were aged 16 and 17, there were 27 instances of children aged 13 to 15 being placed in an adult unit.

It was revealed last month that a $7.5 million plan to build a four-bed dedicated adolescent mental health unit at Northern Beaches Hospital had been abandoned, replaced with a $500,000 safe haven at Brookvale Community Health Centre, a mental health first responder program and a liaison service.

Sydney is also at risk of losing 70 private psychiatric beds after it was revealed this week that Wesley Mission intended to close its hospitals in Ashfield and Kogarah.

Sarah, who is using a pseudonym to protect her child’s identity, waited 27 hours with her suicidal teenager in a major Sydney emergency department in 2021.

“We didn’t even see a psychiatrist,” she said. “If you are admitted to emergency for appendicitis or a broken arm, you will see a doctor.”

They were triaged by an apologetic mental health nurse, who told them there were no mental health beds available anywhere in the city that day.

Sarah waited more than 24 hours with her suicidal son in emergency.Credit: Rhett Wyman

“Their hands are tied as well,” Sarah said of those working in the sector. “But you know that unless you are advocating for your child and present and able to fight for them, they won’t be able to access help.”

In another incident, her then 15-year-old was admitted to an adult psychiatric ward because no paediatric beds were available.

“They were exposed in an environment that was completely inappropriate for them,” she said.

The alliance is asking the state government to allocate funding proportionate to the burden of disease by pursuing a new mental health funding revenue stream, such as the payroll tax levies recently introduced in Victoria and Queensland.

Since 2022, the Victorian government has imposed a 0.5 per cent mental health and wellbeing surcharge on employers with taxable wages of more than $10 million, and 1 per cent on employers with taxable wages of more than $100 million. The additional levy raised $912 million in 2023-24.

NSW Mental Health Minister Rose Jackson said she “completely agreed” that more needed to be done to protect the mental health of people in NSW, particularly youth, and that the state government valued and respected the advocacy of the alliance.

“That’s why we’re looking at various ways to adequately meet the mental health needs of our vulnerable communities,” Jackson said.

She said a short-term “gaps analysis” of shortages in the sector was due to be finalised shortly, with actions to follow.

“Throughout 2024, NSW Health will undertake a more thorough analysis to understand exactly what investment is required to comprehensively meet the mental health needs of people in NSW,” she added.

“The alliance will play a vital role in this process; from this point we will be able to understand and explore what revenue or funding stream is required to bridge the gaps in our system.”

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