'More than 500 patients each.' A mental health emergency is unfolding.

New South Wales psychiatrists have been left to care for more than 500 patients each, prompting a mass exodus that will leave existing doctors stretched even thinner, according to a psychiatric registrar. 

The registrar, who spoke to Mamamia on the condition of anonymity, says countless patients will be put at risk, including those with severe mental illness. 

"This is affecting the frontline and the very big parts of our mental health system that deal with very serious and severe mental illness — people who have things like psychosis, schizophrenia, mania, severe suicidality, depression, and criminal behaviour that may be associated with their mental illness," he says. 

Watch the trailer for Mamamia's twice-daily news podcast, The Quicky. Post continues after video.

"As you can imagine, having these very seriously ill patients and not having enough psychiatrists to look after them, it can cause severe issues on the frontline."

The registrar says patients are spending days waiting for beds to become available, leaving them extremely vulnerable, and destroying collective morale amongst psychiatrists who find themselves providing suboptimal care. 

"Psychiatrists can have up to five hundred patients each… and as you can imagine, mental health issues require people who know their patients very well, and over time can get a really good rapport with them. Having so many patients really stretches out the remaining psychiatrists and causes them to work in very suboptimal conditions."

According to the registrar, the initial shortage stems from the NSW government's decision to pay the state's psychiatrists around 30 per cent less than their counterparts from other states, prompting many professionals to obtain work outside of NSW. 

"About thirty per cent of jobs for psychiatrists have been vacant all over New South Wales, so the rest… have had to stretch themselves and do the work of those missing thirty per cent."

Practitioners "resigning in despair".

Now, he says, existing psychiatrists are resigning in despair, in an attempt to get the government's attention. 

"For months and months, they've been trying to get the government to have these discussions. However, the government has refused."

More than two hundred psychiatrists have submitted their resignations from the public health system, with 43 of them already having left the job. The mass exodus represents more than two-thirds of the state's public psychiatrist workforce, leaving just 92 specialists to manage the entire system. 

The situation reached a critical point when around two hundred psychiatrists submitted their resignation letters to take effect from January 1. Mental Health Minister Rose Jackson confirmed that while 43 psychiatrists have already left, this number is expected to rise. 

While the immediate trigger appears to be a pay dispute, with psychiatrists seeking a 25 per cent pay increase against the government's offer of ten point five per cent over three years, the underlying issues run much deeper. 

When it comes to pay, the registrar says the government is spending too much money on locum psychiatrists – casual practitioners who fill in for regulars – who get paid at much higher rates than psychiatrists are offered in public hospitals. 

"These jobs can be advertised for up to $3,500 a day, and this money is coming out of the budget. 

"From first-hand experience, I can say it is much more effective to have a full-time staff specialist psychiatrist compared to a locum psychiatrist because they're the ones who are going to be staying with the team long term and are able to contribute to the education of the trainee psychiatrists, as well as being involved with patients long-term. That makes such an invaluable contribution to the local community."

Making the situation even more dire, is that it's not just mental health patients being impacted by the shortage, almost all patients within the public hospital setting are affected.  

Listen to the full episode of The Quicky here. Post continues after audio.

Psychiatrists involved in "every aspect" of patient care.

"People may be surprised by this, but psychiatrists are involved in patient care in every aspect of public hospitals," the registrar says. 

"For example, transplants – psychiatrists are always involved, doing psychiatric assessments on the recipients and donors, and if there are no psychiatrists available, these life-saving operations can be delayed or even cancelled," he says. 

"We look after everybody, including people who have cancer and might be on steroids for their cancer treatment. 

"A lot of these medications have mental health side effects and if we don't have a psychiatrist available… that can impact their mental health."

Access to psychiatrists is particularly important for involuntary patients, who have been hospitalised against their will to receive mental health support for their own benefit, and for the benefit of the community. 

"If we don't have any psychiatrists who are able to review these patients regularly and make the very difficult decision to discharge them to community care, these patients will languish in involuntary detainment for longer than required," the registrar says. 

On the flip side, when patients are discharged, they're often unable to afford private health insurance, and without public psychiatrists working in the community, these patients are left without ongoing care, and may end up back in the hospital system.  

While the pay disparity is at the heart of the issue on the surface, the systemic disrespect of a group of professionals – who have generally studied for 14 years to then dedicate their lives to helping others – has played a role in the mass resignations. 

A pay rise is just part of the answer, says the registrar, emphasising that people like him need psychiatrists to want to work in NSW to train up-and-coming practitioners. 

"If we do retain more people through incentives like competitive pay compared to other states, then that would make the working conditions better for everyone," he says. 

"I'm really hoping for this to be resolved and have all of our psychiatrists come back to work. This is what they love and this is what they have dedicated their lives to 

"For me personally, I've been really buoyed by the public support that the psychiatrists have been getting. 

"However, I've been disappointed in the government not seeming to understand what psychiatrists do or value our work within the mental health system. 

"In the future, I think we need to keep active, keep political, increase public health knowledge in what we do, and hopefully translate that to outcomes for everyone."

Lifeline: 13 11 14, lifeline.org.au

Headspace: 1800 650 890, headspace.org.au

Beyond Blue: 1300 224 635, beyondblue.org.au

SANE Support line and Forums: 1800 187 263, saneforums.org

Feature image: Getty.