Years of unresolved staff shortages and under-resourcing drove more than half of all psychiatrists working in public mental health in Australia’s largest state to resign last week.
The mass resignations encompass more than 180 of the nearly 300 psychiatrists in New South Wales, employed in psychiatric hospitals and wards, community mental health services, and justice mental health services.
Their resignations took effect on 21 January.
The loss of so many professionals from a workforce that already had a nearly 30% vacancy rate is likely to cause the public mental health system to collapse, psychiatrist Kathryn Drew, MD, a director of mental health medical services in a regional health district in the state, told Medscape Medical News. Drew is among those who resigned.
“There will be devastation throughout the system. There will undoubtedly be beds closed,” Drew said. The development will have ramifications for emergency departments, as psychiatric patients will have to remain in the emergency department until psychiatric beds become available.
Salary dispute
The core issue is that staff specialist psychiatrists in New South Wales, a state with a population of nearly 8.5m people, claim they are paid around 30% less than their counterparts in other states, which has made recruiting and retaining psychiatrists in the public mental health system difficult.
Those entering the profession are instead choosing private practice, staff positions interstate, or working as locums at a much higher pay rate.
In the Australian healthcare system, the federal government covers the cost of public healthcare through Medicare, but states and territories are responsible for managing public hospitals and staff and services, including community and mental health.
The Royal Australian and New Zealand College of Psychiatrists and the Australian Salaried Medical Officers’ Federation (the doctors’ union) have been meeting with the state government for 16 months to try to resolve the issue. The psychiatrists have asked for an immediate 25% increase in salary to address the imbalance, and the state government responded by offering 10.5% over three years.
In her own health district, Drew has been unable to fill staff positions and has instead had to rely on locums, who are paid around two to three times more than staff specialists. She said that of the 12 vacant positions in the district, nine are filled with locums.
“We are trying to provide care but are not able to provide comprehensive, multidisciplinary, integrated, wraparound services to people with severe mental illness, either in the inpatient unit or in the community,” Drew said.
Patient care affected
The reliance on a transient locum workforce severely affects the quality and continuity of patient care, said Giancarlo de Vera, CEO of BEING – Mental Health Consumers, an organisation that represents the interests of individuals experiencing mental health issues in New South Wales. “If you’ve got a relationship with your treating professionals, you'll get better care,” De Vera said.
The patients using public psychiatric care tend to be unable to afford the higher cost of private psychiatric care, said neuropsychiatrist Pramudie Gunaratne, MD, research fellow at the University of New South Wales in Sydney and chair of the New South Wales state branch of the Royal Australian and New Zealand College of Psychiatrists.
“By the nature of severe, serious mental illness, these are people who sometimes will end up in situations where they are much more marginalised or vulnerable, so it’s a patient group that really needs our care,” Gunaratne told Medscape.
The shortage of public psychiatrists is a national issue, Gunaratne said, but it is most acute in New South Wales.
“The ongoing issues from workforce shortages mean that we’re losing psychiatrists and our trainees to other states, which creates an additional issue for the staff issue in New South Wales,” she said.
Penny Sharpe, the acting premier of New South Wales, has said the state cannot afford to give staff specialists psychiatrists such a large salary increase. The risk is that it would encourage other public health professionals asking for the same increase, she added.
In December 2024, the state health department instead proposed a six-month “productivity and efficiency pilot”, suggesting it could enable additional salary or allowances for staff specialists if the pilot delivered savings. The pilot aimed to reduce clinical duplication in duties like clinical ward rounds, clinical handovers, and multidisciplinary team meetings, as well as increase administrative support and reorganise after-hours and on-call processes.
But Gunaratne said the proposed pilot was not well received by those in public mental health, who felt the government had not listened to them.
“The psychiatrists have been in conversations with the government for 15 months, saying that we are overstretched, that we need more staff, [and] that the system is not functioning the way it should to provide good care,” she said.
Medscape article – Australian state psychiatrists resign en masse (Open access)
See more from MedicalBrief archives:
Australian Ministers urged to probe unsafe hospitals, inept bosses and bullying claims
Dangerously decrepit facilities put UK mental health patients at risk
Psychiatric patients overload Eastern Cape health services
DA: Eastern Cape has only 13 psychiatric nurses for 1,421 mental health beds