TRANSCRIPT
A patient experiencing an acute exacerbation of chronic schizophrenia was made to wait almost 88 hours to see a nurse in a NSW hospital emergency department.
Another with suicidal plans made to wait 85.
A third, in psychosis, for 77 hours.
But the beds they're waiting for don't exist.
That's data from just days ago, leaked by a member of Westmead Hospital.
It tells of a state on the verge of a public health crisis.
This is Dr Pramudie Gunaratne, NSW Chair of the Royal Australian and New Zealand College of Psychiatrists.
"This government has allowed our mental health system to limp along, barely functioning for years, and we are now seeing that it is about to collapse. This is incredibly frightening for us and our patients and this is the news we are hearing from the frontlines, in terms of what's happening in our wards and our emergency departments. "
Last week, more than 200 New South Wales public sector psychiatrists – the lowest paid in the country – resigned.
They're demanding the state government address chronic staff shortages by boosting pay; something New South Wales Premier Chris Minns says it can't afford to do.
"They ask, the wage increase that psychiatrists are asking for, a 25 per cent wage increase is not something that we can afford. And we would be in a situation where we were saying no to nurses, no to police officers, no to teachers, but yes to psychiatrists specifically because they threatened to cripple the public health system if we didn't. I mean, I think that would be an open invitation to other groups who've got asks of the New South Wales Government to do the same thing."
Instead, New South Wales Health has offered a 10.5 per cent wage increase over three years.
A further 10 per cent onerous duties allowance has also been put on the table.
But the pay negotiation is only one element of the dispute playing out.
Decades of under-funding has meant psychiatric patients consistently face extreme lengths of stay in NSW emergency departments.
This is Professor Ian Hickie, co-director of Health and Policy at the Brain and Mind Center of the University of Sydney.
"The pay dispute, which is obviously attracted to considerable attention is at the heart of the resignation issue, is really the tip of the iceberg of a much more fundamental problem in the administration of public mental health in New South Wales. And that's indicative of a wider set of problems across Australia in the public sector that we've seen in other states and territories that have led to the Royal Commission in Victoria and commissions of inquiries in most other states."
Proposed reforms to the public mental health system would see 5,600 nurses manage care for mental health patients, including diagnosis and recovery.
Another 2,000 health professionals, including psychologists, occupational therapists and social workers, would then oversee case management and therapy.
New South Wales Mental Health Minister Rose Jackson says the result will be to lighten the load on psychiatrists.
"There is already system reform that is underway and in fact that's been welcomed and repeatedly called for to make sure that psychiatrists who are absolutely at the really pointy end are only dealing with the most complex cases. Many other people who can be supported in the community through social work, through counselling, through other forms of engagement are able to receive that in a timely and effective and quality way."
But many are critical of that approach.
General Secretary of the Nurses and Midwives' Association Shaye Candish says it's ludicrous.
"The health system and the local health districts within the health system are really not adequately consulting with us or our members. So from our perspective, we're very frustrated. Our members do not want to be picking up the burden of this work. It is not part of their responsibility and this dispute needs to be resolved between the psychiatrist and the government."
Emergency Psychiatry Staff Specialist at St Vincent’s Hospital, Dr Jacqueline Huber says the result of non-psychiatrists being asked to step in to do the work of psychiatrists is terrifying.
"Psychiatrists spend over a decade training to make life or death decisions in emergency departments and if non-psychiatrists are expected to take up this load, I really feel for them and I really feel for our patients."
That sentiment is echoed by Professor John Buchanan from the University of Sydney Business School.
"They're not substitutes, they have not had the same training. They do not have the same options in managing people in terms of making directions on sectioning and the like and issuing medications. So any thought that the nurses can somehow step in here is fanciful."
The need for total system reform is more urgent now than ever, with ward and bed closures plaguing the state.
Chief Executive of Mental Health Carers New South Wales, Jonathan Harms, has one clear message: care delayed is care denied.
"It's very hard for families to know how to support people who are experiencing these very complex conditions. This is where we want to rely on the systems of our psychiatrists, our psychologists our peer workers and people with experience and expertise in this area. So to deny them access to that care is not consistent with their human rights and not consistent with their wellbeing."
SBS reached out to the New South Wales Premier for comment – but received no response by deadline.
