‘Severe and enduring crisis’: senior psychiatrists call for urgent NSW mental health fix

The NSW government’s stopgap strategy of relying on locums and visiting medical officers to care for the most severely mentally ill ‘will almost certainly do more harm than good’

Psychiatrists have warned ‘the mental health system in NSW is deeply entrenched in a severe and enduring crisis’. Picture: Emilia Tortorella

The NSW government’s stopgap strategy of relying on locums and visiting medical officers to care for the most severely mentally ill “will almost certainly do more harm than good” and is out of step with world’s best practice, the nation’s most prominent psychiatrists say as they launch a bid for funds to be quarantined to rebuild crumbling mental health systems.

Psychiatrists Pat McGorry, Ian Hickie, Gordon Parker and Alan Rosen have penned an open letter to NSW Premier Chris Minns warning “the mental health system in NSW is deeply entrenched in a severe and enduring crisis”, and that the situation is now “more precarious than it has ever been” amid mass resignations of specialists in the state.

They warn the crisis in NSW is not primarily about pay or an industrial dispute, but more about systemic problems that have demoralised psychiatrists nationwide over the past decade, described recently by federal Health Minister Mark Butler as “a stain on the nation”. The senior psychiatrists say that while mental health systems around the country are in a dire state, NSW is “near the bottom of the pack”.

“Key indicators include the per capita ratio of mental health workers per population, inpatient suicide rates, inequity of access to specialist care, investment in non-government support and housing services, bed closures, and ineffective integration of clinical and psychosocial services,” the psychiatrists write. “Right now we call on you to hear the voices of those who are often least heard, including some of the most vulnerable individuals and families in our community.”

Victoria-based Professor McGorry, one of the nation’s most prominent and respected psychiatrists, is executive director of Orygen, The National Centre of Excellence in Youth Mental Health. Professor Hickie was one of Australia’s first National Mental Health commissioners and he is co-director of health and policy at the University of Sydney’s Brain and Mind Centre. Professor Rosen was a key figure in the policy of deinstitutionalisation in NSW and was an inaugural deputy commissioner of the Mental Health Commission of NSW between 2012 and 2015. Professor Parker was founder of the Black Dog Institute and is a professor of psychiatry at the University of NSW.

Pat McGorry. Picture: NewsWire / David Crosling

Ian Hickie.

The four doctors have asked for an urgent meeting with Mr Minns as psychiatrist resignations continue to cripple NSW hospitals. Up to 100 have already resigned and scores more will leave their jobs in coming weeks after their attempts to fix a recruitment and retention crisis in public hospitals reached a stalemate. The state is scrambling to employ locums to plug the gaps and is increasingly relying on visiting medical officers. This critically undermines continuity of care for the most complex patients, the psychiatrists say, and it will be a catastrophe for the future workforce if it is no longer majority-staffed by permanent staff specialists.

“NSW is failing many of the most vulnerable people with complex psychiatric disorders in need of public mental health services,” the letter says. “For those people to be best served, the NSW public sector services need to recruit many more high-quality medical graduates and then retain their services throughout their professional training period, and then on an ongoing basis in various roles in the public sector.

“In practice, continuity of care – which is exceptionally important for the most complex patients – is severely compromised by a model that relies on interchangeable visiting medical officers. Similarly, replacement of psychiatrists by nurses and/or psychologists will not address these complex needs.

“Tragedies like the Bondi Junction stabbings in April last year reflect the need to provide much more intensive continuity of mental healthcare and local supported housing for individuals who are most disconnected from traditional office-based services, and ongoing support for their families.

“Your government’s immediate response was commendable, but the longer-term solutions need to be enacted urgently, and at scale, for the health and welfare of those directly impacted, alongside ensuring the safety, wellbeing, social cohesion and mental ‘wealth’ of the whole community.

“All of us have the experience to appreciate that this regrettable situation has been many years in the making – but we believe that the situation now is more precarious than it has ever been. While your government has largely inherited this situation, it certainly has the power and means to address it through both immediate and longer-term structural changes. These changes could make profound differences to our patients, their loved ones, and the public sector clinicians who work tirelessly to support many of those who are most disadvantaged.”

A spokesperson for Mr Minns confirmed the Premier had received the letter and “will respond in due course”.

“The NSW government’s position remains clear: we do not want psychiatrists to leave the system, and urge them to await the Industrial Relations Commission determination on a fair and reasonable outcome,” the spokesperson said.

A five-day hearing has been scheduled in the IRC from March 17 to try to resolve the dispute between NSW psychiatrists and the state government.