Former NSW psychiatrist says public mental health system 'on the brink', amid mass exodus from today
Dr Lauren Taylor now lives in Adelaide after leaving what she says was a highly pressurised NSW public mental health system. (Supplied)
With almost 200 of the psychiatrists in NSW's public hospital system set to leave over ongoing frustrations with pay and working conditions, one worker who has already left the system emphasised the need for urgent reform in the sector.
Last November, Lauren Taylor, a consultant psychiatrist with almost 20 years' experience working across the NSW public health sector, relocated to Adelaide.
Part of why was centred around personal reasons but another influence was the strain that came with working inside the state's underfunded public psychiatric sector.
"The pressures of working in the system, combined with my own difficulty in tolerating the conflict associated with the public mental health system pressures were significant as a factor," she said.
Working 16-hour shifts was not unusual for Dr Taylor, neither were days where the patient numbers in her unit doubled, well beyond capacity, nor the demoralisation that followed when her clinical assessment was overridden by non-medical managers.
"It's more than a job. It is a vocation. And it's driven by a wish to provide care and treatment, and the best possible care and treatment. To not be able to do that is really, really difficult."
The mass exodus of psychiatrists will put extra pressure on an already stretched NSW public mental health system. (ABC News: Luke Bowden)
For 12 months, Dr Taylor wrestled with the thought of leaving, before making her decision in November.
The transition has been difficult, she said.
"The loss of almost my professional identity and shared experience and learning — I mean, my colleagues are my closest friends as well."
She believes the sector in South Australia is more sustainable for workers and supportive for patients in comparison to NSW.
"There's just a sense of stability, of groundedness. And that is what is necessary in order to care for people who are so sick that they have lost their bearings in terms of reality," she said.
"Providing care for those people in a system that is also in crisis requires extraordinary individual efforts."
'An untenable workplace'
As announced on Tuesday afternoon, the Industrial Relations Commission will hold arbitration hearings over five days regarding the wage dispute between NSW's staff specialist psychiatrists and the state government.
The decision for the proceedings, which are expected to commence on March 17, follows an application made by the government hours before 181 of those psychiatrists were set to resign.
As of January 20, 25 of those staff specialists had rescinded their resignations, while another 81 have deferred their resignations until February 1.
The announcement of the planned resignations first came in October, where the call was made to spur improved working conditions, including a 25 per cent pay rise for clinicians.
According to Australian Salaried Medical Officers' Federation (ASMOF) estimates, staff specialists psychiatrists earn almost 30 per cent more in other states compared to NSW.
In response, Premier Chris Minns described the 25 per cent pay rise as unaffordable.
NSW Health has offered a 10.5 per cent wage increase over three years, equating to a 3.5 per cent rise a year.
On Monday, Mental Health Minister Rose Jackson announced a further 10 per cent "onerous duties allowance" that psychiatrists will be able to access "immediately".
NSW Minister for Mental Health Rose Jackson announced a further 10 per cent "onerous duties allowance". (ABC News: Nick Dole)
A staff specialist psychiatrist's base salary starts at $186,241 a year, according to the NSW government.
That figure increases over five levels to $251, 618 per year for a senior level psychiatrist.
The state government said about 50 per cent of public sector psychiatrists are on a senior salary.
Per capita spending on specialised mental health services
The push from psychiatrists also stemmed from attempting to improve the sector's underfunding and service gaps, alongside widespread vacancies.
Federal government data shows the number of psychiatrists in NSW per 100,000 people is the second lowest in the country after Western Australia, with funding largely stagnating over the 10 years to 2022.
The repercussions of an underfunded mental healthcare system in NSW has been previously flagged by the Royal Australian and New Zealand College of Psychiatrists (RANZCP).
In 2023, the college released a report citing how workers were under duress and felt unable to meet the needs of those seeking support.
Vacancies and the reliance of medical specialists on temporary contracts, are a compounding factor on this existing burnout.
Figures provided by the RANZCP show that just under one-third of the state's local staff specialist roles are vacant.
Speaking at the time, RANZCP NSW chair Pramudie Gunaratne said it was demoralising for psychiatrists dedicated to the public sector being unable to provide care because of how under-resourced the system is.
"I'm just devastated that I'll have to put in my resignation because the system isn't working and we can't hold it up any longer," Daniel, a psychiatrist at The Children's Hospital at Westmead, told ABC Radio Sydney on Monday.
"We were already overrun by an increasing number of patient presentations, with no increase in funding, but also not the ability to fill one-third of the position that we had available," Ricky White, a psychiatrist whose resignation was processed last week said.
"So increasingly I felt it was like an untenable workplace to continue working in a safe and effective manner for the population I care so much about."
Concerns for long-term implications
NSW Health said that the state's Local Health Districts have suspended these resignations until January 29, after reaching a mutual agreement with ASMOF and the RANZCP.
But while there is a temporary stalemate, concern remains for what will happen if psychiatrists do leave the sector in droves, and what it will mean for other public services like emergency health care and the criminal justice system.
In a statement, the NSW faculty chair of the Australiasian College of Emergency Medicine Rhys Ross-Browne said emergency departments "cannot compensate for a shortage of mental health services" in either a hospital or the community.
NSW Police Commissioner Karen Webb told ABC Radio Sydney "we are trained, but we're not clinicians, so we can deal with people in a crisis, but it's better that they're dealt with by people that are trained."
Speaking on Tuesday, Ms Jackson urged psychiatrists to not resign, and to not use mass resignations as a negotiation tactic.
"Work through the process that's set up, that's clear, established and transparent."
Dr Taylor contends that any argument not centred around the sector and its need for reform misses the bigger point.
She said, during her time working in NSW, it felt as if the system was on the precipice of collapsing.
"There's a sense that it was right on the edge of something really critically horrific going wrong," she said.
"It's getting to the point where literally you cannot sustain doing it because of fatigue and a deep exhaustion. It's not necessarily a choice. It's 'If I don't do this, my health will suffer'."