source : the age
A clinical director at St Vincent’s Hospital has asked a Sydney court to stop sending people accused of crimes to their overwhelmed emergency department as magistrates divert rising numbers of mentally unwell people from the justice system to public hospitals.
The senior figure made the request to Downing Centre Local Court on Monday concerning people who magistrates deemed to be mentally ill or disordered as St Vincent’s contended with 17 mental health patients in its emergency department.
They included 15 patients waiting to be admitted to already full mental health units and two patients who had been in the emergency department for 10 days.
“That is a huge number of patients,” said Dr Pramudie Gunaratne, chief executive of the Australian Society of Psychiatrists.
“It’s really symptomatic that the rest of the mental health system, particularly community-based [services], is not working very well if there are that many people in the ED.”
Under Section 19b of the Mental Health and Cognitive Impairment Forensic Provisions Act, magistrates can send people who may be mentally ill or impaired to public hospitals where they are detained and undergo psychiatric assessment.
Section 19b orders became a focal point for security and resourcing concerns in NSW’s mental health system in February after two men under the orders at Cumberland Hospital allegedly killed three people in separate incidents weeks apart.
Professor Matthew Large, a senior Sydney psychiatrist, said these were predictable outcomes when mental health facilities are expected to function as prisons and nurses as prison guards.
Forensic psychiatrists said Section 19b orders were also used for non-violent, vulnerable people whose psychiatric conditions deteriorated because community mental healthcare services were overwhelmed and under-resourced.
A St Vincent’s spokesman said the hospital has advised the local court that the staff member’s informal request was no longer required. The spokesman said that, like all emergency department mental health services, St Vincent’s experiences surges of demand.
Data from the Bureau of Crime Statistics and Research show the number of people dismissed by NSW lower courts due to being mentally ill or disordered rose from 435 in 2021 to 561 in 2025.
Most of these people were under Section 19b orders and were diverted to emergency departments.
“For some people, the first meaningful contact they could have with the mental health system comes after they have deteriorated so badly that something happens, and the police get involved, and they end up in front of a magistrate,” Gunaratne said.
“We know that diversion into mental healthcare reduces reoffending. It’s not about being soft on offenders, it’s about recognising that if we treat mental illness as part of why someone is in court, then treating mental illness is one of the best ways to stop them reoffending.”
Large suggested, where possible, diverting most people to their local health district, particularly if they have previously received treatment, rather than the hospital closest to the bail courts.
“That would make a huge difference,” he said.
“Say a person gets released from Waverley court, and they come from Wagga Wagga, and they’re in a Sydney unit, it’s impossible to [get them home] and impossible to co-ordinate care.”
Mental Health Minister Rose Jackson said the state government acknowledged pressures on emergency departments and the mental health system, which is why it had increased the mental health budget by more than 20 per cent.
“Much of this funding has gone to improving community-based mental health care, which has been identified as the area of greatest need,” Jackson said.
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