By Max Maddison and Nick Newling
NSW Premier Chris Minns has accused the Royal College of Psychiatrists of contributing to the state’s mental health crisis by restricting the supply of trained professionals as he flags a greater reliance on counsellors and psychologists as part of the solution to a mass resignation of specialists.
But the college, which wrote to the premier after his remarks on Monday, said the comments suggested the government was “unfamiliar” with how accreditation in psychiatry functions, and said not having enough specialists would have “disastrous” consequences for the public health system.
Resigning public psychiatrist Prachi Brahmbhatt says she could earn $200,000 more working in the public health system interstate.Credit: Wolter Peeters
With about two-thirds of the state’s 295 public psychiatrists on the brink of leaving the health system this week, Mental Health Minister Rose Jackson said the government was urgently seeking a hearing at the Industrial Relations Commission to arbitrate a pay deal.
The government has refused to meet the psychiatrists’ demand of a 25 per cent, one-year pay increase. The government offered 10.5 per cent over three years.
Most psychiatrists have pencilled in Tuesday as the date of their resignation, with the remainder over the rest of the year. Some psychiatrists had retracted their notices, though, while others had pushed them out by months.
NSW Health declined to say how many psychiatrists would resign in coming days.
The premier said any conversation about reform of the mental health sector needed to include “how restrictive” the Royal Australian and New Zealand College of Psychiatrists (RANZCP) was in admitting new psychiatrists to public roles or general practice.
“There’s a very low number of Australian kids that work their way through medical school that can go through the Royal College and be certified ... and as a result, we can only recruit from a very narrow pool, a very shallow pool,” he said.
“And when you’re restricting the amount of supply, that puts enormous pressure on the government and means that we’re in a situation we’re in.”
Figures provided by the RANZCP show 29 per cent of staff specialist psychiatry positions are vacant, demonstrating the acute workforce shortage facing the public health system.
Mental Health Minister Rose Jackson says an urgent hearing at the Industrial Relations Commission has been sought.Credit: Steven Siewert
RANZCP president Dr Elizabeth Moore told the Herald the letter to the premier had laid out the respective roles of the college, health services and governments in determining the number of training places supported in a jurisdiction.
“The RANZCP does not fund training places within health services or determine the number of positions available,” she said. “The number of training positions across NSW is determined by the level of available funding from governments and the capacity of health services to offer suitable training experiences.”
The premier said the medium-term contingency for dealing with a reduced number of psychiatrists would be giving a “greater role” to “counsellors, psychologists, mental health nurses, clinical nurses” in the assessment and treatment of patients.
“We can’t be in a situation where every 12 months we’ve got some kind of specialist who decides to resign,” he said. “In the end, you can see where these ends up: the state goes broke.”
Jackson said the system reform work highlighted by the premier was “already under way” and had substantial support from mental health stakeholders, including ensuring psychiatrists at the pinnacle of the public health system “are only dealing with the most complex cases”.
Moore said psychiatrists were the only specialist mental professionals trained as medical doctors, and the solution could not entail asking other practitioners to work outside their experience or scope of practice.
“Without enough psychiatrists in the public health system, we risk fragmenting care and leaving patients without access to the full spectrum of support they require,” she said. “The consequences could be disastrous.”
Prachi Brahmbhatt, a senior psychiatrist and clinical director, has resigned and plans to move interstate, where she can remain in public health to advocate for patients priced out of the private system. Her move will also earn her at least $200,000 more per year.
Brahmbhatt said that the government’s plan to backfill resigning psychiatrist slots with psychologists “signifies his lack of understanding of the critical role psychiatrists play in the mental health sector”.
“What 13 years of specialist training actually provides … one profession doesn’t just replace another profession,” she said. “That’s like saying ‘hey, we don’t have enough electricians, so we’ll just get some plumbers to fix it’.”
Jackson said she was not “interested in the blame game”, adding the issues in the mental health system had accumulated over many years under the previous government.
“I’m not sure that it’s fair to articulate any one part of the system that is to blame for that,” she said.
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clarification
This article has been updated to say about two-thirds of the state’s 295 public psychiatrists are resigning.