Dear Premier, don’t play politics with our fragile mental healthcare
Public sector psychiatrists who offer a critical service are quitting and it seems like you just don’t care. They should be able to work in safe conditions.
NSW Premier Chris Minns is making me sick. His approach to funding the state’s fragile mental health system is myopic, dangerous and cruelly political. It has precipitated a crisis that is destroying public mental health care in NSW. It cannot stand.
After I gave birth to my babies, my mind took me to some dark and terrifying places. Very few people know about this and I am deeply uncomfortable sharing it. However, a service that has been there for me in a time of distress is in grave jeopardy and I feel compelled to use my voice.
For the past nine months I have been receiving care from the Perinatal Infant Mental Health Service. It’s a free service that helps parents with a serious or complex mental health issue.
The service is critical to the wellbeing of many parents but also to whole families, neighbourhoods, workplaces and society at large. Such is the ripple effect of patient health.
PIMHS particularly supports pregnant women and women with young babies.
It has supported me immensely through the tumult of my motherhood journey and helped me to live a full family, social and work life.
During my appointment with my specialist perinatal psychiatrist this week, I found out that it was to be my last with her. Not because I no longer need her expert care. Neither is it because she does not want to keep caring for me. She has committed her career to working in the public sector and sincerely wishes to continue doing so.
My doctor finished up at PIMHS this week because she, with more than 200 of her colleagues across the public sector en masse, resigned. They have taken a desperate last stand against poor work conditions that have contributed to one-third of their positions being unfilled for close to a year.
She does not know where she will go next. Perhaps it will be interstate, where her counterparts are paid substantially more, draining the ranks in NSW further.
It could be the private sector, where she can easily command even more pay.
But that’s not an outcome that should satisfy us as a community either. We should reject any further entrenching of a two-tiered and inequitable system of healthcare. We should demand a system that serves us all, based on our needs, whoever we are.
In many ways I am fortunate.
Other women have much more severe conditions than mine. Some face admission to hospital or involuntary treatment and the devastating separation from their babies while they receive care.
Women in rural and remote parts of the state are often left languishing without access to public or private services. While I have the ability to access a psychiatrist privately, most women have no choice. Either they access a publicly funded service or they live untreated.
No one doubts the difficulty of the job laid before the government, including simultaneous wage negotiations across the public sector. But the Minns government must separate the issues and the politics – it must put the needs of people first.
Public sector psychiatrists are among the most specialised and critical professionals we have. Even though they could earn double the pay in private practice, they serve in the public system driven by a sense of public duty.
Their service is to us, the citizens of NSW, in our most drastic moments of need. They cannot, and should not, be expected to serve if the conditions make it unsafe or impossible to do so.
Public sector psychiatrists provide a niche service that needs careful attention, not least because collective resignations were always a viable option for them. They have received a craven political response that has compared them to nurses and train drivers and highlighted their annual rates of pay, presumably in the cynical hope that voters would consider them generously paid.
This approach fails to appreciate that these publicly minded professionals can and will walk away from a dangerously understaffed system. In choosing this path, the Minns government seems to be relying on a belief that the people of NSW will have limited compassion for their neighbours in times of need.
I hope it is wrong. Our public mental healthcare system is critical infrastructure for the wellbeing and prosperity of our state. And a comprehensive and properly funded mental health system will surely be a saving to government in the long run.
Access to public psychiatric services can help to break the cycle of poverty and marginalisation that often traps the mentally unwell.
Services for pregnant women and women in the post-partum phase, in particular, are in need of expansion and deeper commitment from government, not shutdowns and irresponsible spending on short-term solutions. The inability to attract and retain sufficient psychiatric staff to ensure safe workplaces comes off the back of decades of neglect by government.
Public psychiatrists, perhaps understandably, are refusing to continue to prop up a broken system.
The government will now overpay casuals – sometimes three times as much as staff psychiatrists – to do less work and provide poorer continuity of care. This is no way out of the crisis. We will see dire impacts on patient care and community wellbeing.
Patients at public hospitals, the mentally unwell receiving community-based support and those seeing psychiatric doctors in our prisons and forensic hospitals will be without critical care. This poses real risks to community safety.
How we treat our sick is a mark of how humane we are as a society. We should be spending far more on our public sector mental health services so people can live with dignity and to their full potential.
The government has invested in police pay at record levels. This has created friction in other negotiations and has not been overlooked by the nurses union. Presumably the politics justified it – the same politics that now are bringing about the destruction of our public mental health system.
Mr Minns, your politics are failing us. Beware lest they destroy you.
Felicity Graham is a Sydney-based human rights barrister and mother of two.
