Ninety hours in emergency: Leaked patient list reveals dire effects of psychiatrist crisis

Severely ill and distressed patients are waiting three-and-a-half days in a major Sydney emergency department for mental health beds that do not exist, confidential hospital records reveal, in a shocking escalation of the state’s psychiatrist workforce crisis.

Leaked photographs of Westmead Hospital’s emergency department patient lists expose the human toll of NSW’s chronic psychiatrist shortage, as staff warn of the “very real risk” of physical harm to other sick and injured patients when people in the grips of psychosis have nowhere else to go.

A leaked patient list from Westmead Hospital Emergency Department.

Royal Australian and New Zealand College of Psychiatrists NSW chair Dr Pramudie Gunaratne on Thursday said the state’s mental health system was “about to collapse” and accused the government of implementing contingency plans that would put more lives at risk.

“This is incredibly frightening for us and our patients,” Gunaratne said, urging the state government to meet psychiatrists and end the impasse.

A patient with “acute exacerbation of chronic schizophrenia” had waited almost 88 hours in Westmead’s emergency department for a mental health bed on Tuesday, the leaked patient list showed.

A staff member not authorised to speak publicly said this patient was still waiting 90 hours after arriving. Another patient with suicidal plans had been waiting almost 86 hours, and two psychosis patients had waited almost 78 hours and 62 hours, respectively.

“MH NBA” – shorthand for “mental health no bed available” – appears almost uniformly down the list.

Nick Howson, a mental health clinical nurse consultant and the NSW Nurses and Midwives Association Cumberland branch delegate for mental health, said involuntary patients waiting in emergency departments across western Sydney have nowhere else to go.

“This is deeply upsetting and unfair for a section of the population who suffer at the best of times,” Howson said.

“Emergency departments are big, noisy spaces where emotions are heightened. We have mental health [patients] who have spent three-plus days in a holding pattern with no specialised treatment being given.”

Nick Howson, NSW Nurses and Midwives’ Association mental health Cumberland Branch delegate. Credit: Wolter Peeters

Howson said when someone experiencing psychosis in a loud and strange environment, there was a very real risk that person may lash out at themselves or other people.

“You might be there for a broken leg, and there is somebody who is psychotic and suddenly thinks that after three days of having minimal treatment, you’re part of the problem,” he said.

“This is the reason why we have specialised, dedicated acute inpatient units that provide treatment to people who need it. The emergency department is not that space.”

Of the 16 patients waiting more than 24 hours in emergency at the time the leaked photograph was taken on Tuesday, 12 were psychiatric patients. Of those, eight were involuntary patients, meaning they were subject to compulsory assessment and treatment without their consent under the Mental Health Act.

Dr Jackie Huber, chair of the Australia and New Zealand Emergency Psychiatrist Network, at a press conference on Thursday.Credit: Dion Georgopoulos

Other patients who appeared on the leaked lists included patients with an acute coronary syndrome (30 hours), pulmonary embolism (27 hours), a blood platelet disorder (25 hours), Crohn’s disease, a urinary tract infection (24 hours) and colitis (24 hours).

The government and the doctors’ union are not set to front the Industrial Relations Commission over the dispute until March 17, more than six weeks away.

NSW Health is co-ordinating a statewide emergency response while hospitals implement contingency plans such as rationing psychiatric assessments in emergency departments and hospital wards.

At Westmead, mental health patients in the emergency department are being managed by the drug and alcohol toxicology team, who can liaise with a psychiatrist consultant.

Psychiatrist resignations by the numbers

• One-third of the state’s 416 staff specialist positions were vacant before the mass resignations 
• Of the 295 staff specialist psychiatrists working in NSW, 206 submitted their resignations. Of these:
  • 55 have left the system
  • 26 have rescinded their resignations
  • 75 have delayed their departure
  • 50 have taken better-paying visiting medical officer contracts with NSW Health 

Australia and New Zealand Emergency Psychiatry Network chair Dr Jackie Huber said psychiatric patients already faced extreme lengths of stay daily in NSW emergency departments due to decades of underfunding mental health services.

One in 10 mental health patients wait more than 23 hours in emergency departments for a bed, Australian Institute of Health and Welfare data shows.

“This is not something the resigning psychiatrists have caused. This is a chronic and escalating issue,” Huber said.

NSW public hospitals lost 150 mental health beds in the five years between 2016 and 2022, Australian Institute of Health and Welfare data shows.

Meanwhile, the rate of mentally ill people leaving hospitals without getting treatment increased by almost 30 per cent in NSW over the last year, Huber said.

“We worry about very serious self-harm, neglect, misadventure and very occasionally harm to others,” Huber said.

On Thursday, Mental Health Minister Rose Jackson acknowledged emergency departments were under pressure. NSW Health Secretary Susan Pearce said the government was working on arrangements to treat involuntary patients in private hospitals where clinically appropriate.

Pearce rejected the accusation that the mental health system was on the brink of collapse.

“The NSW health system is one of the best health systems anywhere in the world, on any objective measure,” she said.

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