NSW Government ignored warnings since 2018: Mental health system unravels as psychiatrists quit en masse

The New South Wales Labor government’s plan to “redesign” the state’s mental health system, while excluding psychiatrists, has sparked intense criticism from political opponents who warn of potential risks to patient care delivery.

Dr Amanda Cohn, spokesperson for Health from Greens NSW, voiced serious concerns during last week’s Legislative Council meeting, stating, “I am terrified about what is going to happen to the next generation of psychiatrists in this State because of the mistakes being made by the Minns Labor Government right now.”

Dr Cohn emphasised the critical role of staff specialist psychiatrists in supervising psychiatric registrars, asserting, “A psychiatrist cannot be replaced by a peer worker. It would be completely inappropriate. If they cannot ring a consultant and have that level of supervision, they cannot deliver care safely or progress through their training.”

Highlighting the impact on services, Dr Cohn pointed to the Concord Centre for Mental Health at Concord Hospital, one of the state’s largest mental health facilities, which now faces significant staffing challenges. Its 173 psychiatric beds are being staffed by less than a dozen part-time specialist psychiatrists following the resignations, boosted by some support from locums.

Over the past 30 years, expenditure on mental health services has grown from $3.4 billion to $12.2 billion, an increase of 258%. The increase has been in an almost-straight line, despite various state and federal governments being in office, and despite varying policy initiatives, many inquiries and five successive National Mental Health Strategies.

“Despite this enormous expenditure,” said the report from the Australian National University, “there is evidence that a substantial proportion of people with the most chronic severe mental health conditions – schizophrenia, bipolar disorder and severe depressive disorders – do not receive adequate care, if they receive care at all.”

It is critical to note that the issue has been brewing since 2018, when an upper House inquiry into the mental health system first raised alarms. A recent report by the Royal Australian and New Zealand College of Psychiatrists (RANZCP) also highlighted systemic flaws, describing the NSW mental health care system as “fractured” and inadequately integrated, with dire consequences ranging from increased suicide rates to individuals ending up in the criminal justice system.

“The real sense is that, without urgent investment and attention to workforce issues, the system risks irreversible decline,” the RANZCP report warned.

Budget constraints have been cited as the primary reason for the NSW government’s failure to address the crisis adequately. In response to the resignations, NSW Health opted to hire temporary contractors, with a third of resigning psychiatrists rehired as visiting medical officers, a move criticised for escalating instability and costs within the hospital system.

The RANZCP is urging the NSW Government to rapidly resolve the crisis to ensure a sustainable and well-resourced public mental health system. The College emphasised the potential consequences of psychiatrist shortages, warning that increased strain on emergency departments and other health providers which are already at capacity, could lead some patients into the judicial system due to lack of timely access to mental health care.

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