Psychiatrists are fleeing the public system in record numbers

As many as one in four public sector psychiatry positions are vacant in some states as despairing doctors are forced to discharge patients from psychiatric wards weeks before they are recovered.

The psychiatry workforce only meets 56 per cent of the national demand for psychiatrists in mental health services, ­according to The Royal Australia and New Zealand College of Psychiatry. Picture: iStock

As many as one in four public sector psychiatry positions are ­vacant in some states as despairing doctors are forced to discharge patients from psychiatric wards weeks before they are fully recovered from spells of psychotic ­illnesses.

The escalating workforce crisis is seeing state governments forced to spend hundreds of millions of dollars every year paying locum psychiatrists to plug the gaps in staffing in critically overloaded inpatient units in public hospitals around the country.

The Australian can reveal that one in four staff specialist psychiatry positions overall in public hospitals in NSW – where schizophrenic Joel Cauchi recently killed six people in a mass stabbing at Westfield Bondi Junction – are currently unfilled, with the ­figure far higher in some health districts.

Of about 100 staff specialist ­positions, 40 are currently routinely being filled by locums who are being paid between $2500 and $3000 a day.

The situation is just as bad in the ACT, which in March 2024 ­recorded a public sector psychiatry workforce shortage of 26.5 per cent.

Of the 55.65 full-time equivalent psychiatrist positions funded, in March 2024 40 were filled, but 18 per cent of those positions were filled by locums and more than 8 per cent of positions were left completely unstaffed. Medical staff salary funding has not increased in more than five years.

Other states are also experiencing critical shortages as burnout hits overworked public hospital staff who are leaving en masse for the private sector, where they can earn double the salary or more.

Based on a large-scale survey of the profession, The Royal Australia and New Zealand College of Psychiatry estimates that 30 per cent of NSW’s psychiatrists are considering leaving the profession in the next five years and 43 per cent of the workforce intend to retire in the next decade.

The current psychiatry workforce only meets 56 per cent of the national demand for psychiatrists in mental health services, ­according to the College. Mental health patients make up as many as half of the patients who use ­ambulances to arrive at emergency departments.

Overall emergency department presentations have doubled over the past two decades, with mental health making up a significant part of the increased burden.

RANZCP president Elizabeth Moore said there was an overwhelming view across the profession that the workforce crisis was negatively affecting patient care. That situation was exacerbated by severely inadequate support in the community for people with chronic mental illness, who were frequently homeless and made up about a quarter of the population in the nation’s prisons.

RANZCP president Elizabeth Moore. Picture: RANZCP

“Sometimes you have people who can’t get into hospital ­because there are other people in the hospital who can’t be discharged because there’s nowhere for them to go,” Dr Moore said.

“Psychiatrists want to do the best by their patients, but they are feeling so pressured, they feel they’re unable to give the best care. They’re still giving adequate care but it’s not the best care. Then that leads to people wanting to leave the workforce.”

One senior psychiatrist in NSW said the situation had never been worse in mental health inpatient units, where people were ­admitted or discharged based on risk rather than the actual state of their health.

People are being pushed out of hospital weeks before they are fully well, and end up being rapidly re-admitted in a revolving-door situation.

“It’s never been anything like this,” the psychiatrist said.

“On the ground it’s very difficult to maintain one’s strength and morale as a clinician. The other big change is that there’s just a culture or perhaps an exaggeration of the culture of just churning patients through.

“There are loads of patients with treatable conditions that don’t get treated. Or if they do get treated they get discharged too soon and they come back.”

Canberra psychiatrist Jeffrey Looi, the president of the ACT branch of the Australian Salaried Medical Officers Federation and the Psychiatrist Federal Council Representative for the Australian Medical Association, said the steep decline in the public sector psychiatry workforce had left hospitals in a state of being “just not functional”.

“Without adequate staffing levels and being able to hire enough staff, it becomes unsafe for patients,” Professor Looi said. “It’s dangerous for patients. We cannot make up the shortfall that we’re going to face for the foreseeable future.”

RANZCP Queensland division chair Brett Emmerson. Picture: Supplied

RANZCP Queensland branch spokesman Brett Emmerson said the staffing shortage was also ­severe in Queensland, especially in rural areas.

“Certainly, since Covid, the number of people needing care has gone up,” Dr Emmerson said. “So the units are always 100 per cent full, and you are forced to discharge your least sickest patient or least risky patient to get a more risky or a second patient a bed.

“Caseloads have gone up, ­severity has gone up. And the number of staff dealing with all of this has fallen.”

The college has asked the federal government to invest $23.9m to expand the Psychiatry Workforce Program to support 45 extra rural trainee and training supervisor posts, spend $6m to attract doctors to the psychiatry training program, and introduce a psychiatry MBS “complex care” item for assessment, support, and management of people with complex mental health presentations and/or circumstances. They also want the MBS rebate for psychiatry ­lifted from 85 to 100 per cent.