Why so many psychiatrists are quitting

Australia Broadcast Center

2 days ago

Sam Hawley: Hi, just a warning before we begin this episode, we will be discussing suicide. ... There are so many stories of patients being left in emergency rooms for too long, of being admitted but then discharged too early or even being sent home without any care at all. As a result, in New South Wales, psychiatrists are quitting in droves, leaving a system they say is broken. And they're now speaking out amid fears it could lead to another Bondi Junction-style attack where innocent people are killed or injured. Today, Avani Dias on her investigation into a mental health system in desperate need of repair. I'm Sam Hawley on Gadigal land in Sydney. This is ABC News Daily. Avani, you've been investigating a crisis in mental health care in Australia's most populous state, of course, New South Wales, but this is really important for everyone across the country, right? Because if this sort of care is not available at a time of crisis, there can be really serious consequences.
Avani Dias: Absolutely, Sam, and I think the first thing that pops into everyone's head is the Bondi Junction attack, which was just so devastating. And we've been hearing the inquest over the last couple of weeks and, you know, that just shows when there are gaps in the mental health system, there can just be such, such serious consequences. It's obviously worth noting that the Bondi Junction attacker, Joel Cauchi, had been treated in the Queensland public system until 2012, then by a private psychiatrist also in Queensland, and that was years before he moved to Sydney. But when I spoke to all these psychiatrists across New South Wales, they told me they saw the news breaking and they just got this pit in their stomach. They thought, oh, my goodness, is that my patient? And a lot of them actually told me they weren't surprised by this attack because of the just devastating conditions they're watching in the public mental health system.
Sam Hawley: All right, well, as we said, of course, there's a real problem at the moment in New South Wales because this year alone, more than 60 psychiatrists have quit in protest over the state of the system. At least another 100 have actually threatened to resign their permanent roles. Now, tell me about Dr Suzy Goodison. She used to work at Sydney's largest hospital, RPA.
Avani Dias: Yeah, so Dr Goodison resigned with all the other psychiatrists in January, and hearing her talk about the state of the system and what she had seen at her decade at RPA, it was really clear that she just felt what she called a moral injury. She felt she couldn't treat her patients properly.
Dr Suzy Goodison, psychiatrist: I realised that I was burning out. Sorry. I just couldn't keep walking on by and pretending that this was normal and that we were delivering care that was adequate.
Avani Dias: People were coming in for care and she spoke of these cases where she worked in the emergency department and she would actually say to people who were critically unwell that they should just go home because she thought the wait times that they would have to experience in the emergency department would actually make their conditions worse.
Dr Suzy Goodison, psychiatrist: There were people who I remember being discharged and they'd be back in the emergency department the next day. It's pretty awful and demoralising and I think it wears you down and it felt hopeless at times. There were times when I thought, what am I actually doing for this patient?
Avani Dias: And then she spoke about one of the last cases that she saw in January. It was this man who was living with schizophrenia and he had come into the hospital, he was looking for care.
Dr Suzy Goodison, psychiatrist: And he came in to RPA, to the emergency department, with a nail gun and he had shot nails actually into his knees because the voices were telling him to do that. And so I immediately flagged that this man needed a significant amount of care. He needed a bed in an acute sort of mental health unit and that I was very concerned about him being in the general hospital. I then went off on a weekend and when I called on the Monday, he'd absconded from the ward, the hospital ward, and no-one knew where he was. He had no fixed address and I don't know what happened to him.
Avani Dias: So could he still be out there in the community in that current state?
Dr Suzy Goodison, psychiatrist: Yeah.
Avani Dias: She was just really worried about the fact that some of these people who were so unwell, who needed treatment, weren't getting it in time and then they could be just out in the community.
Dr Suzy Goodison, psychiatrist: These are the risks that we carry when we work in this field and when I can't deliver that care to keep either individuals safe or the community safe. And... Sorry. It's another Bondi Junction waiting to happen.
Sam Hawley: How concerning. And you've also spoken to another psychiatrist, Avani, who quit the New South Wales health system this year. She had one word to describe what's going on and it is broken.
Avani Dias: Yeah, it's a pretty big word, isn't it? And, I mean, it is really what we are witnessing, according to these doctors, medical staff, patients, is the collapse of mental health care in New South Wales in the public system. And, yeah, we spoke to this one psychiatrist, Dr Anu Kataria, and she has worked at Australia's largest mental health hospital, Cumberland Hospital, for 22 years and she also resigned with the other psychiatrist. But she echoed this really disturbing pattern that doctors have told us about, that she was told by bosses to discharge patients before it was safe to do so.
Dr Anu Kataria, psychiatrist: We often would reach work and at half past eight in the morning get a text message saying, ED is backed up, Westmead ED is backed up, there's 15 people waiting, there's a dozen waiting at Blacktown and we're the overflow hospital for Blacktown Hospital as well. Please discharge. The expectation from senior administration, from the executives, is that I just get people out as soon as I can.
Avani Dias: And we heard from a lot of people as well that that was their experience. They'd be dealing with these serious mental illnesses and then asked to leave and they felt they weren't ready.
Sam Hawley: All right, well, we're going to unpack what is going so wrong in New South Wales, but before we do, Avani, what about mental health services across the country? Are they any better?
Avani Dias: Well, the thing is that in New South Wales, the government is spending the lowest per capita in the country on mental health services. So it is really the bottom of the barrel when it comes to spending and that's why we decided to focus on New South Wales. But, yeah, a lot of the other states aren't far behind and we actually received the results of a landmark national survey by Beyond Blue and it revealed that rates of severe mental illness in Australia are rising. So now four and a half million Australians are experiencing a serious mental health challenge, but more than half of them aren't getting the help they need when they need it. And so that just shows you that this is a national problem, but New South Wales really is struggling the most when it comes to these services.
Sam Hawley: Well, Avani, as you went about your investigation, you not only spoke to psychiatrists, of course, but you wanted to hear from people who'd had experiences trying to get help in the New South Wales system and you had a really big response, didn't you?
Avani Dias: That's right. We asked our audience at Four Corners to tell us their stories about getting help for a serious mental illness in New South Wales and the response was overwhelming. There was one case that really stood out to me and that was the case of Carly Richardson. She's 20, she's had depression, she has PTSD, she's been in and out of the mental health system since she was 13, so super little and she's still dealing with these severe mental illnesses. And she actually self-harmed around New Year's and she actually went to hospital to try and get help but was discharged early.
Carly Richardson, former patient: I had a suicide attempt in the ward and I was saying, like, look, I'm not OK, you know, like nothing had changed for me. And they said to me, they're like, we can't do anything because the beds everywhere were full. So they just had to send me home, essentially. Once I got out, I didn't even make it home before I was sectioned again by six police officers and brought back to the emergency department after trying to harm myself again. And once again, I was, like, sent home just 10 hours later.
Avani Dias: She was just really worried about the lack of help out there for someone who was in such a severe state like she was.
Sam Hawley: And you've heard a lot about safety in emergency departments.
Avani Dias: That's right. And, you know, this starts from a kind of earlier position because we were leaked a whole series of wait times at one of Australia's busiest emergency departments, Sydney's Westmead Hospital. And this came from inside sources who told us people were waiting four days in one case in emergency to get treatment for a serious mental illness. So that was a man with schizoaffective disorder and he waited 93 hours. We had another case in that month where two men had been waiting more than 80 hours to be seen. There are so many different examples like this. That leads to agitation, frustration and anger. And so doctors are telling us that it then exacerbates this mental illness and what they're seeing then is people lashing out, acting violently, and then frontline staff are the ones that are actually dealing with that. We spoke to one security guard at Sydney's Westmead Hospital. He actually got stabbed by a mental health patient who had been waiting for hours.
Sam Hawley: So, Avani, what do the psychiatrists say is needed to fix the system? At the heart of their dispute is pay, isn't it? What do they want?
Avani Dias: There's been months and months of negotiations with New South Wales psychiatrists who are saying they want a 25% pay increase. And they're saying it's not because we want more money necessarily, it's because they need a solution to actually retain staff in the system. They're finding that staff are either moving interstate or they're going to the private system where they can make a lot more money. The government, on the other hand, has said, look, doctors already make a lot of money, they don't need this pay rise. And so now they're deadlocked and they've gone to the workplace disputes referee to kind of nut this out and that's still ongoing, the Industrial Relations Commission.
Sam Hawley: What has the state government had to say then? Can it actually meet this pay demand?
Avani Dias: Well, the New South Wales Mental Health Minister, Rose Jackson, she declined our requests for an interview, but she has in the past said that the government needs to think about the overall state budget, that it can't necessarily afford this sort of pay rise and that the government's gone back with this counter offer of 10.5% over three years.
Rose Jackson, NSW Mental Health Minister: Their solution to this challenge is a 25% wage increase in a single year. That's not something the government is able to agree to. We have to think about the broad, not just mental health system, but overall state budget.
Avani Dias: And what was really surprising was that, despite the minister not talking to me, we did hear from the state's chief psychiatrist. His name's Dr Murray Wright and he's the most senior advisor on mental health to the government, so he's a bureaucrat in the department as well and he said he actually supports this 25% pay rise. So that's contrary to the government.
Chief Psychiatrist Dr Murray Wright: I am sympathetic to the issues that they raise and I think in particular the disparity in wages between New South Wales and other states.
Avani Dias: So are you supportive of that pay rise?
Chief Psychiatrist Dr Murray Wright: Yes.
Avani Dias: But what the psychiatrist is saying is it's not just about this pay rise, it's a much bigger issue. There's a lot more that needs to be fixed and that comes down to under-resourcing and so there's a push for the government to do more there as well.
Sam Hawley: So, Avani, what is the way out of this then? Why would psychiatrists want to work in a sector if it is indeed broken and the sector needs more psychiatrists, clearly?
Avani Dias: Oh, the sector is desperate for more psychiatrists. We're seeing job ads coming out saying if we don't hire someone soon, this ward will have to close. Oh, my gosh. Wards are just shutting down continuously just because there aren't enough psychiatrists and that means as a patient, if you're trying to get help, you're just not going to get it. The New South Wales government has admitted to us that the system needs improvement, that it needs reform. It said it is investing $2.9 billion in mental health services and it's saying that if you do need help, you should seek it because there are services there. I guess the question is what can people do in the meantime as they wait for this system to be repaired?
Sam Hawley: Avani Dias is a reporter with Four Corners. You can watch her full report tonight on ABC TV at 8.30 or on iView. If this episode has raised any issues for you or anyone you know, Lifeline is one service that can help. Contact them on 13 11 14. This episode was produced by Sydney Pead. Audio production by Adair Sheppherd. Our supervising producer is David Coady. I'm Sam Hawley. Thanks for listening.