On the worst day of Jessica’s life, the only doctor who could help her was on a screen

Jessica Comish has seen the state’s public health system from both sides.

As a nurse, she watched her colleagues in the emergency department face wave after wave of sick and injured patients. Then, when her own mental health rapidly declined, and she ended up involuntarily admitted through the Shellharbour hospital emergency department in 2022, she saw how staff shortages were affecting another profession – psychiatry.

“There was one junior psychiatrist available via telehealth – they wheeled in the computer and the doctor spoke to me through the screen,” she said. “How can we have doctors who actually understand who we are as people and what we’re dealing with when they’re not even physically in the same hospital as us?”

The NSW public mental health system was already on its knees on what Comish described as the worst day of her life. Now, two-thirds of its staff specialist psychiatrists have resigned, and NSW Health has proposed plugging some of the holes by delivering psychiatry consultations through a “virtual hub”.

Health authorities have urged anyone needing emergency care not to avoid seeking help, but warn services will be affected by the resignations.

Doctors have warned the crisis will affect all patients due to the increased strain on remaining doctors and nurses, and hospital beds taken up by mental health patients waiting for treatment.

“I’m anxious for myself, but also for others,” Comish said. “We can’t afford to lose them [psychiatrists].”

Who is resigning, and why?

From Monday, about 205 of the 295 staff specialist psychiatrists employed by the state government will resign. The psychiatrists submitted their mass resignations in December after almost 18 months of failed wage negotiations with the state government.

The doctors say the dispute isn’t about pay, but saving a system that has been haemorrhaging staff interstate, where they can be paid up to 30 per cent more, and private practice, where they can earn twice what they would make in the public sector.

The government claims the 25 per cent pay rise would cost $90,000 per doctor, a figure the psychiatrists flatly reject.

When psychiatrists first threatened their resignations in October, they agreed they would be willing to withdraw if all psychiatrists employed by NSW Health were paid a level 4 salary with maximum drawings.

Based on the 2023 award, that would mean all publicly employed psychiatrists were paid at least $273,000 a year.

Why it matters

Psychiatrists are doctors who have specialised in the diagnosis and treatment of mental illness. Those working in the public hospital system deal with some of the most unwell patients in the state, including those who may be suffering psychosis, episodes of schizophrenia, or catatonia.

In NSW, there are about 90,000 mental health-related visits to emergency departments every year. An emergency department is the last place someone with a mental health issue wants to be, but sometimes it is the only choice.

“I do not want to go to hospital under any circumstances, unless I’m actually a physical risk to my life or someone else’s life,” says Comish, who was also involuntarily admitted to hospital in October last year.

It is also much better for the health system – and ultimately taxpayers – if a person’s mental health is managed so that they never reach hospital in the first place.

The average non-critical patient spends about 17 days in hospital, but the average length of stay for mental health-related admissions is more than 21 days.

What hospitals will be worst affected?

Most of the staff specialists who have indicated that they intend to resign next week are in metropolitan Sydney, the Hunter New England region and the Illawarra.

Mental Health Minister Rose Jackson said there would be less of an impact on regional areas because they already relied on a contract workforce of locums and visiting medical officer (VMO) doctors.

NSW Health has established a Mental Health Emergency Operations Centre to oversee the recruitment of locum doctors to where they are needed the most. There will be no restrictions on resigning psychiatrists taking up locum positions, which pay more than $3000 a day.

Jackson said it was difficult to predict the impact on each hospital, including whether beds would need to be closed, until the resignations actually go through.

“Until we really see whether those resignations go ahead and whether those individuals would potentially be willing to accept VMO or local roles, we can’t be clear about exactly what the impacts will be just yet,” she said.