Mental health wards have begun to close in New South Wales as negotiations to avert the mass resignations of psychiatrists continue.
At Cumberland psychiatric hospital, the largest mental health facility in NSW and the oldest in Australia, the acute and rehabilitation wards have closed, and the NSW branch of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) predicts more will follow.
At a directions hearing of the NSW Industrial Relations Commission (IRC) on Tuesday morning, the doctors’ union agreed with the state government to seek expedited arbitration with a full bench of the commission to hear the dispute over five days from 17-21 March. A decision will be handed down soon after.
More than 200 psychiatrists working in the public system indicated they would resign after the government refused to agree to a 25% pay increase in a single year, which they say is needed to attract new doctors and retain those now working in the public system.
On Tuesday, the NSW minister for mental health, Rose Jackson, said of the 205 psychiatrists who had indicated they intended to resign, 25 had subsequently rescinded and 81 had deferred their resignations so that they were “not imminent this week”.
Jackson said that “100 [psychiatrists] have said that over the course of this week and next week, they do intend to resign, but as of today, none of those resignations have been processed”.
There are 443 psychiatrist positions in NSW, of which up to 40% were already vacant before the mass resignations.
Dr Pramudie Gunaratne, the chair of the NSW branch of RANZCP, said the majority of resignations had still taken effect on Tuesday even if the department’s administration had not processed the paperwork. She said a number of doctors had pushed out their resignations for duty of care to patients and to complete duties overseeing trainees.
“We have always maintained this is not an industrial dispute, this is not about wage increases for psychiatrists but it is about how can we fully resource a mental health system that is rapidly collapsing before our eyes,” Gunaratne said.
She said it was “an absolute disaster that we are here in the IRC rather than the government actually doing what they are supposed to do – which is to protect our public mental health system so that our patients and communities can be safe”.
Dr Anu Kataria, a psychiatrist who resigned from Cumberland hospital, where she had worked for more than 20 years, was devastated by the closure of beds. “I can’t tell you how sad I am,” she said.
“I have put a lot of time, hard work, effort into making the place better for my patients but it hasn’t happened because we’ve watched the whole service go downwards. What we have to offer our patients has become less and less.”
Kataria said she would consider returning to the public system if the government agreed to the raise of 25% and promised to do better by patients: “That’s what will keep me in the job.”
She said that seven psychiatrists had resigned from Cumberland hospital, part of western Sydney local heath district, and an additional seven psychiatrists who work in the other parts of the local health district, bringing the total in the area to 14.
Part of ward closures at Cumberland were also a result of vacancies that had not been filled for a very long time, she said.
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Gunaratne was concerned for very vulnerable people needing care.
“Patients won’t stop presenting to emergency departments, ambulance and police won’t stop bringing patients with mental illnesses to emergency departments but [with psychiatric wards closing] there will be nowhere for them to go.”
Asked about the closures at Cumberland, the NSW Health deputy secretary, Matthew Daly, said: “There’s been no formal services approved by the secretary for closure – as required under legislation – but there have been capping of referrals to one or two small services.
“There’s been amalgamation of services into new locations for purposes of the ease of delivery of service or access to mental health consumers.”
Asked about where patients already on psychiatric wards might go if there were not enough staff, Daly said there was “no blanket description, but NSW Health does not operate unsafe services”.
“If a service is unsafe, it will close, or it will amend its size. It’ll amend its model of care. It’ll relocate, as is the case with Westmead and Cumberland that they are relocating services to maintain safety of care, safety of supervision.”
Gunaratne said losing a significant number of forensic psychiatrists would have “big flow-on effects” for the justice system.
Dr Christina Matthews, a psychiatrist who resigned from working in the justice system, said she was concerned about an increase in people coming into prison who are mentally ill.
“These people are particularly vulnerable … if they come into contact with the justice system and cannot post bail they are at high risk of going prison.”
Want to share your experience with mental health care in NSW? Contact natasha.may@theguardian.com
