These NSW doctors warned of a fractured system and now half have quit

Half the psychiatrists working in the state’s chronically understaffed services submitted their resignations, as the Bondi Junction stabbing inquest throws into stark relief the potentially devastating consequences of a fractured mental health system.

Of the state’s 295 staff specialist psychiatrists, 145 have sent letters of resignation to their union, the Australian Salaried Medical Officers’ Federation NSW, as pay negotiations with the NSW government falter.

Dr Pramudie Gunaratne, the chair of the NSW Branch of the Royal Australian and New Zealand College of Psychiatrists, said the staff shortage has serious implications for the most vulnerable patients.Credit: Louise Kennerley

The state’s public mental health system, which has capacity to employ 416 full-time staff specialist psychiatrists, is buckling under immense pressure as hospitals fail to fill an unprecedented 121 vacant positions due to a protracted recruitment and retention crisis.

NSW Health staff specialists, including psychiatrists, are seeking a 30 per cent pay rise and increased penalty rates to compete with Victorian and Queensland salaries and to prevent an exodus of doctors across the borders.

“This is not about a pay rise,” said Dr Pramudie Gunaratne, chair of the NSW branch of the Royal Australian and New Zealand College of Psychiatrists. “These psychiatrists are saying that if they can’t provide safe or high-quality care for patients because they are so chronically understaffed, they can’t continue to support a broken system.

“If public psychiatrists were interested in lining their own pockets, there are so many other places they would work,” Gunaratne said, referring to private practice, particularly with the rise of lucrative telehealth consultations and in-demand ADHD assessments.

“Public psychiatrists care for people with the most severe mental health needs [including] people with schizophrenia, drug-induced psychosis and acute crisis where there is a life-threatening risk to themselves or others.”

The resignations come as the inquest into the Westfield Bondi Junction tragedy heard that the killer Joel Cauchi’s mental health had deteriorated in the years before the attack in April.

The mother of Jade Young, one of Cauchi’s victims, has implored politicians to address the gaps in mental health care.

Gunaratne said the Bondi Junction attack was a tragedy on all fronts.

“With shortages of psychiatrists, people will inevitably fall between the cracks and not get the treatment that keeps them well,” she said.

The shortage meant admissions to mental health units would become restricted to only the most acutely unwell patients who have reached potentially avoidable crisis points, Gunaratne said.

“We have seen a big increase in demand for psychiatric health services while we’re seeing understaffing where one psychiatrist might be taking the role of three of four psychiatrists, and huge wait times in emergency departments when there aren’t psychiatrists available to assess people,” she said.

Higher-paid visiting medical officers or locums who work in a unit sporadically are filling the gaps, disrupting patient continuity of care.

ASMOF NSW had agreed to refrain from facilitating such action before the next Industrial Relations Commission hearing on December 19. The letters have not been sent on to NSW Health.

Sharon Grocott and her husband Rohan use their retirement savings to pay the private psychiatric bills for their daughter, Amber, 26, who was diagnosed with schizophrenia, including $300 for weekly 30-minute consultations.

Sharon Grocott (middle), with her daughters Amber (left) and Gemma (right).

“The public system is where complex patients like Amber should be treated, but the system has let us down,” said Grocott, chief executive of mental health advocacy organisation WayAhead.

Each time Amber presented at an emergency department, she waited 12 to 14 hours. During her multiple admissions to public mental health units, she never saw the same psychiatrist twice, Grocott said.

“Every time we went, we would have to repeat our story. Every time, we would get a different opinion: a different view on diagnosis and treatments,” she said.

Amber’s father retired early to care for his daughter, who also has a mild intellectual disability.

“We shouldn’t be trying to support a loved one who is acutely unwell,” Grocott said.

“Amber will inevitably have to be admitted to the public system again, and I’m really worried about the treatment and care she will get.”

The resignation tactic is similar to that used by paramedics, who won a 25 per cent pay rise in December.

Several staff specialists not authorised to speak publicly said their resignations were not an empty threat. They describe burnout and their moral unease over offering treatment in a fragmented system that risked exacerbating their patients’ symptoms.

Minister for Mental Health Rose Jackson commissioned a gap analysis and a more detailed analysis of service demand, which is due by the end of the year.

“We recognise that NSW psychiatrists deliver world-class care, and we are acutely aware of the pressures placed on this workforce,” Jackson said.

“We take these issues seriously and want to see a resolution.”

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