The NSW government must urgently rebuild the state's mental health system, one of the nation's leading psychiatrists says, as he warns the situation is "as bad as it's ever been".
Professor Pat McGorry, a former Australian of the Year, met with the state's premier on Thursday following a mass resignation of psychiatrists and the shutdown of beds at hospitals.
"It's like working in a third world sort of environment, to be honest — the moral injury of turning away seriously ill people every day and not being able to provide the care that people need and could benefit from," Professor McGorry said.
"It's not like [the NSW government] doesn't get the problem; what's needed is for them to commit to a plan to rebuild."
More than 200 psychiatrists in the state's public health system resigned in January in protest, saying the years-long decline in services meant they were unable to care for their patients.
Psychiatrists in NSW are the lowest paid in the country and are in a pay dispute with the state government, calling for a salary increase they say would improve their ability to recruit and retain, instead of losing practitioners to other states and the private sector.
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"I think with the current dispute, the psychiatrists have just come to the end of their tether, really. These are dedicated people that have remained in the public system under very adverse conditions for many years," Professor McGorry said.
"The system's got into this sort of terminal stage, and they can't stand it."
About 70 of the psychiatrists who resigned have rejoined as independent contractors, or visiting medical officers (VMOs) and locums who are temporary stand ins.
Premier Chris Minns sought to reassure the public at a budget estimates hearing on Wednesday.
"Just as emergency provisions were put in place across the health system during the COVID emergency, we've got senior officials in NSW Health that are working on ensuring that there are enough mental health beds in place," he said.
"When there have been closures, we have been able to get locum help in. I also want to make the point that locum help and bringing in VMOs, visiting medical officers, is not a long-term solution to the problem."
Professor McGorry and some of the country's most eminent psychiatrists have written to the NSW government saying these temporary measures are just aggravating the problem and that patients are suffering because of the system failures.
"It's just demoralising and frustrating. Families, frantic parents can't get particularly their adolescents and young adult children, into evidence-based care," Professor McGorry said.
"[There are] people who are in desperate circumstances, like some of my patients, homeless, at risk of being in prison or criminalised, but for no fault of their own, there's a whole spectrum of misery out there because of the failure of this system."
Mr Minns acknowledged there were fewer mental health beds in the state but ruled out a pay rise for psychiatrists that would bring them on par with others in the country.
"The result has been that there has been a decline in the mental health bed capacity in NSW," he told the budget estimates hearing on Wednesday.
"I think that there's also a growth in the number of people seeking psychiatric care or urgent mental health care in the emergency departments as well as the wards, so this is a real challenge for the NSW government.
"We don't believe we can solve the challenge by unilaterally agreeing to a 25 per cent pay increase in one year for psychiatrists across the public health system."
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Leading mental health professionals say the system is failing to care for those who need it most — people who require urgent attention for the most serious psychiatric illnesses.
But we don't often hear from those people and their loved ones who have dealt with this firsthand.
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"In some ways you might think, what's the point? Because we've had a whole series of these exposes and crises … there's another sort of dissent into crisis and then a half-baked attempt to fix it," Professor McGorry said.
"We can't give up because this is too important, the prevalence of mental illness in particularly teenagers and young adults, has increased dramatically, so it's even more urgent than it's ever been."
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