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Psychiatry Workforce

Published on: February 2025

Record: HANSARD-1323879322-149295

Psychiatry Workforce

Ms ROBYN PRESTON (Hawkesbury) (17:01:38):

I move:

That this House:

(1)Condemns the Premier and the Minister for Mental Health for presiding over mass resignations of public sector psychiatrists, threatening the health and wellbeing of mental health patients.

(2)Notes modelling showing that the Government's use of locums is far more expensive than the pay rise sought by psychiatrists.

(3)Calls on the Minister to sit down with psychiatrists and reach an agreement to end the crisis in our public health system.

I speak about the public psychiatrist crisis and a system that is failing under the Minns Labor Government. Mental health is real. Mental health care is not something that should be considered lightly or taken for granted. Nor should those employed in the public health system, who support the community of New South Wales, be disrespected. Mental healthcare funding in New South Wales has been devastated by a funding cut of $57.6 million since March 2023, which has left a broken mental healthcare system that lacks significant funding. It is our duty as New South Wales parliamentary representatives to support the mental healthcare system so that future generations are equipped with the skills needed to effectively manage their physical and mental health, as well as self-regulate their access to resources.

Funding is barely keeping up with inflation as it is. What happens when our youth are not provided with tools and assistance to manage their mental health issues? What happens when patients found guilty of heinous crimes are released back into society without proper attention to their mental health care and recovery? On 21 January this year hundreds of New South Wales psychiatrists resigned following a pay dispute with the Minns Labor Government that had festered for over a year. Our psychiatrists are currently paid 30 per cent less than their interstate counterparts in Victoria and Queensland. Psychiatrists in New South Wales are seeking a 25 per cent pay rise. As a result, some of those psychiatrists who have resigned from the public health system have now signed on as casual contractors or locums, potentially benefiting from a pay increase worth tens of thousands of dollars at the taxpayers' expense.

Apparently, the Minns Labor Government prefers to increase reliance on expensive locum doctors than to save New South Wales taxpayers $35 million a year by giving psychiatrists a 25 per cent pay rise even though modelling shows a potential cost-neutral outcome. In question time yesterday the Premier said, "We cannot afford it". Then, when referring to the independent review by the Industrial Relations Commission [IRC], he said, "If in the end the judge rules in favour of the increase, we will of course accept the decision." I am confused. In the same breath the Premier says that there is no money in the budget to cover the pay increase that psychiatrists seek but that he is prepared to honour the ruling of the IRC, which could include a pay increase in line with what the psychiatrists are seeking.

More costly than the proposed 25 per cent pay rise are the salaries of doctors who are being transitioned in to fill the missing specialist psychiatrist positions until an outcome is reached through a five-day arbitration hearing. On top of the strain being placed on the overall healthcare system, it is deeply concerning that doctors are stepping outside their scope of experience. Psychiatrists undertake 12 years of training to develop specialised skills and, until an agreement is reached, mental healthcare patients will not receive the urgent care they require and more strain will be felt across the health professions. The inadequate treatment of behaviourally disturbed patients poses an unacceptable risk to our healthcare workers and other patients. How can the community expect to receive the best medical care available if this situation continues?

The Sydney Morning HeraldThe Daily Telegraph

Since Labor was elected in March 2023, New South Wales has seen countless strikes and protests in relation to pay disputes, including by paramedics, nurses, firefighters, the Rail, Tram and Bus Union and now psychiatrists. How many more will we see before 2027? Quite frankly, the Minns Labor Government is making a farce of the mental healthcare system in New South Wales. It is time the Government stepped up and ended yet another self-inflicted industrial crisis. The Queensland Government is already leveraging the disaster by publicly advertising directly to New South Wales psychiatrists in newspapers such as  and , with ads that state:

NSW psychiatrists.

Queensland is calling.

Seeking better pay? We already pay more.

Queensland Health. Make a healthy career move.

As for our State's psychiatrists, Premier Minns must ask what really matters. Mental health is not to be toyed with. Those suffering from mental health issues are among some of the most vulnerable in our community. Early diagnosis and intervention are critical not only to a patient's wellbeing, but also to the wellbeing of their family, friends, colleagues, loved ones and the community in which they live. If the issue is not resolved soon, there will be further impacts that will undoubtedly cause massive problems for the people of New South Wales and our society. Already I am aware that patients presenting at the Nepean Hospital triage and assessment centre have had to wait four days before receiving treatment. How is that acceptable? The Minns Labor Government needs to sit down with psychiatrists and reach an agreement to end the crisis in our public health system before it is too late. Labor has fobbed off its responsibility to an independent review after 16 months of failed negotiations. Shame on Labor! Its disrespect for our staff specialists is nothing short of disgraceful.

Mr GREG WARREN (Campbelltown) (17:08:14):

I am delighted to lead for the Government in debate on the important issue of the New South Wales psychiatry workforce. I thank the member for Hawkesbury for bringing it to the House. I agree with the member for Hawkesbury on one point she made—we have found common ground. She is really confused. There is no doubt about that.

Ms Kellie Sloane:

Have some respect.

The DEPUTY SPEAKER (Ms Sonia Hornery):

The Clerk will stop the clock. Opposition members will cease interjecting. The member for Campbelltown has the call.

Mr GREG WARREN:

Thank you, Madam Deputy Speaker. I appreciate your intervention. The pay dispute is currently in arbitration. It is before the Industrial Relations Commission, which is examining the matter on a fast-tracked timeline. It will determine what is a fair and reasonable pay increase. The member for Hawkesbury referenced the Premier's comments during question time yesterday. I will forever be delighted to speak on behalf of a Premier who is honest. He will not apologise for saying we cannot afford the pay rise. There is an element of irony because members opposite were in government for 12 years.

The DEPUTY SPEAKER (Ms Sonia Hornery):

The Clerk will stop the clock. The member for Terrigal and the member for Oatley will be called to order if they continue to interject. Members will listen in silence to the member for Campbelltown.

Mr GREG WARREN:

The member for Hawkesbury said that no-one in the Government will sit down and talk. That is grossly untrue. The Minister for Health, Minister for Mental Health the Hon. Rose Jackson, her team and the Premier have paid astute attention to this very serious issue, which was ignored every year that the Liberal-Nationals Coalition was in power. The former Government capped psychiatrists' wages. Coalition members do not like including facts in the story, but I will talk about the facts. Yesterday in question time, the Premier did what good Premiers—which he is—do. He told the truth. Why is there an enormous cost issue that we are trying to challenge our way through? Why do we unfortunately find ourselves before the commission?

I have met with a couple of local psychiatrists, and they are wonderful, amazing people. The conversation I had with them was about their care for their patients and them being able to provide clinical support for people in desperate need, many of whom cannot afford to go to the private sector. The Government is very committed to the cause. It is committed to achieving a resolution. Yesterday, the Premier said he will accept any rulings. But he was real when he said we do not have the money to pay for it. The reason we do not have the money to pay for the claim is that wages were capped under the former Coalition Government. From 2018-19, the average wage increase for psychiatry staff specialists was 2.5 per cent. From 2019-20, the average wage increase was 0.3 per cent. From 2020-21, there was a rise of 2.04 per cent. From 2021-22, there was a rise of 2.53 per cent.

Following the election of the Minns Labor Government in March 2023, there was a 4.5 per cent increase—almost double any increase provided by the former Government. For 2024-27, there is a 10.5 per cent increase on the table. That is currently in dispute. The reality is that this Government once again has to be honest with the people of New South Wales. Everyone is coming to us because of the previous conservative reign. People fled to the prosperous States of Queensland and Victoria, where Labor Governments were in power and workers were looked after. In 2025 the Minns Government is dealing with those 12 years of conservative reign. The former Government had no respect for our workers and no respect for our psychiatrists. Its budget blew out to more than $180 billion in deficit while it capped the wages of everyone in the community who was caring for us. The reality is the Minns Labor Government, the Premier and all of my colleagues are committed to doing everything we can. We cannot do it overnight, but we will continue to fight for workers.

The DEPUTY SPEAKER (Ms Sonia Hornery):

Before I call the member for Vaucluse, I remind the member for Hawkesbury that she is on two calls to order. The member for Terrigal is on two calls. The member for Oatley is on two calls. If the member for Ryde continues to interject, he will be on a call. Members will listen in silence.

Ms KELLIE SLOANE (Vaucluse) (17:13:52):

The contribution of the member for Campbelltown was an appalling and embarrassing tirade. He did not once mention patients. We must always start with the patients. They are the vulnerable party in this dispute. They are the ones being impacted by the mass resignations that are happening on Labor's watch. They did not happen on our watch. The Government cannot make excuses. It should stop looking over its shoulder and blaming the Coalition. It is happening under this Government's watch. The mass resignation of staff specialist psychiatrists is tipping an already deteriorating system into a crisis of the Government's own making. The people paying for the Government's inaction are the vulnerable patients who are waiting days for mental health beds. Across New South Wales, mental health beds are closing. Emergency departments are under increasing pressure and stretched nurses and doctors are being asked to do more with less by the Labor Government. New South Wales deserves better.

Mental health services are essential services. The Minns Government has ignored the issue for 16 months and allowed it to evolve into the crisis we are facing today. The mass resignation of psychiatrists, which began in New South Wales on 21 January this year, did not come out of the blue. The Minister for Health and the Minister for Mental Health have known about this impending situation since October 2023, when the Australian Medical Association, the Royal Australian and New Zealand College of Psychiatrists and the doctors union wrote to both Ministers.

The DEPUTY SPEAKER (Ms Sonia Hornery):

Order! Government members will come to order. They will be silent and allow the member for Vaucluse to continue her contribution.

Ms KELLIE SLOANE:

They requested an urgent meeting and set out what they believed were the perilous circumstances surrounding the psychiatry workforce in New South Wales. Those alarm bells were sounded directly at this Government. The Minister for Mental Health received that letter in 2023. She has utterly failed to address the issue. While psychiatrists were resigning and mental health patients were left waiting in emergency departments, the Minister was sipping chardonnay and being ferried around the Hunter Valley at the taxpayers' expense.

Ms Trish Doyle:

That's a low blow.

Ms KELLIE SLOANE:

It is the truth, and it is disgraceful.

Mr Nathan Hagarty:

It was sauvignon blanc.

Ms KELLIE SLOANE:

I find those interjections offensive. This is a serious issue. It should be keeping Government members up at night. They should be listening. They are certainly not listening to the psychiatrists.

The DEPUTY SPEAKER (Ms Sonia Hornery):

The Clerk will stop the clock. Members on both sides of the Chamber will cease interjecting.

Ms KELLIE SLOANE:

The Government says it does not have the money to pay staff specialist psychiatrists. It does not even make economic sense. At the moment, we have a surreal situation where a staff specialist psychiatrist who resigns today will tomorrow be employed as a visiting medical officer on a much higher salary. Psychiatrists engaged as locums by recruitment agencies are earning as much as $3,050 a day. About a third of the psychiatrists who have resigned have rejoined as contractors. The Government is not telling us how much that will cost.

The Guardian

Today reported that modelling shows the Government could save $35 million a year and improve patient care by giving psychiatrists the pay rise. The public deserves transparency about just how much the Government has spent to date on a crisis of its making. It will be harder to measure the costs to patients and their families. Dollars matter, but the damage and pain to vulnerable patients who are bearing the brunt of the resignations is something the Government should be truly ashamed of. According to HealthStats NSW, in the 2023-24 financial year there were 130,040 emergency department presentations for mental health in New South Wales.

We know that rates of presentation for self-harm or suicidal thoughts were consistently higher among young females. Every hour waiting for the care that they need to receive only worsens their situation. We have young and homeless people who do not have the option to go to a private psychiatrist. They are the faces of the current crisis. It is not the fault of our psychiatrists, doctors or nurses. They are compassionate, caring and working very hard under the circumstances. It is certainly not the fault of patients. The test of any government is how it treats its most vulnerable. On that test, this Government has failed. Chris Minns must resolve this crisis and come clean on how much the failure of this Government has cost the taxpayers of New South Wales.

The DEPUTY SPEAKER (Ms Sonia Hornery):

Members will be on their best behaviour and cease interjecting.

Ms TRISH DOYLE (Blue Mountains) (17:20:22):

I move that the motion be amended as by omitting all words after "House" and inserting instead:

(1)Notes the former Liberal-Nationals Government's wages cap saw a real wages decline for psychiatrists in the public health system.

(2)Opposes the reintroduction of the wages cap on psychiatrists in the public health system.

(3)Notes most psychiatrists have converted to visiting medical officer arrangements, not locum arrangements, and these arrangements costs less than a 25 per cent pay increase.

(4)Notes the concerns about the resignations of psychiatrists and its potential impacts on the health system and mental health patients.

(5)Supports the expedited arbitration process the New South Wales Government and psychiatrist worker representatives are undertaking in the Industrial Relations Commission.

The DEPUTY SPEAKER (Ms Sonia Hornery):

The Clerk will stop the clock. The member for Oatley is almost on his last call. He will cease interjecting.

Ms TRISH DOYLE:

As we have heard today, the wage negotiation with New South Wales psychiatrists is a very complex issue. I start by reiterating members' comments that psychiatrists are a deeply valued and essential part of our healthcare system. We recognize the vital work they do for the community. We are all aware that psychiatrists are asking for a 25 per cent pay rise in a single year. Public sector wages were capped under the previous Coalition Government for over a decade, creating the wage disparity at the heart of the dispute. Since winning government, the Minns Labor team has sought to resolve the issue by meeting with representatives of the staff specialist psychiatrists on many occasions and offering a number of things, including a 4.5 per cent wage increase in 2023, which is a lot more than the 2.5 per cent wages cap.

We also proposed a 10.5 per cent pay increase over the next three years, which included super, and a pilot of productivity measures to further improve wages and conditions for psychiatrists. As has been noted before, we are of course committed to reaching a resolution. But we cannot fix the decade-long wages cap overnight. That is not feasible. The New South Wales Government is offering an extra 10.5 per cent over three years, on top of the existing 4.5 per cent increase. That represents 15 per cent, including super increases, in the first four years of a Labor government. That is a fair and reasonable offer, and it is the largest pay rise offered to the group in over a decade. I say again that it is the largest pay rise offered to that hardworking team in over a decade.

The New South Wales Government has tried for many months to negotiate a sustainable outcome with psychiatrists, but the threat of mass resignations as a negotiation tactic does not enable negotiations to continue. Despite that, the Ministry of Health has put extensive contingency plans in place to manage the potential impacts of psychiatry resignations. Those plans have, so far, limited the impact to less than 1 per cent of physical mental health bed capacity. That is important to keep in mind given the emotion around the issue. While there has been limited use of locums to deal with resignations, their use in this crisis is a short-term measure as we work towards the long-term solution that everyone wants. The 25 per cent award increase is permanent and unfeasible.

I finish by noting that the New South Wales Government acknowledges the hard work of psychiatrists in our healthcare system. I am sure that all members representing their communities have heard some of the most harrowing stories from healthcare practitioners in our electorates. We would stand and defend them and their work any day. We are committed to finding a resolution and to see arbitration through the Industrial Relations Commission as a fair and viable mechanism. I again thank psychiatrists for their work and will see them at the table.

Ms FELICITY WILSON (North Shore) (17:25:45):

I speak in support of the motion of the member for Hawkesbury because mental health is personal for me. Last year when my father died and I visited him in the Coroners Court, it was the first time I had seen him in decades because undiagnosed schizophrenia had fractured our family as children, leading to an unsafe environment for me and my sisters. Years later when he was diagnosed, the health system let him down when he went to a public hospital for psychiatric care and was sent home and told everything would be okay. He then went on to attempt to murder his mother and two neighbours, so, for me, hospital psychiatric care is personal.

Last year, shortly after he died, we saw the horrific stabbings in Bondi Junction. We all know that the assailant at that time had been diagnosed with schizophrenia. When we looked at the horror across our community and the fear that it could impact any of us at any moment—that people with schizophrenia or acute mental health disorders, when untreated and uncared for, can have that sort of impact on our society—we were concerned about the state of our mental health system. For the six people who died that day, for their families and the ones who care for them, for all those injured, and for people across the community, that was personal. The issue today is that the Government is not showing the care that the people of this State need for their mental health needs. Already, before the current psychiatric staff shortages, there were 30 to 40 per cent vacancies across hospitals for staff psychiatrist positions. For the children with suicidal ideation, for those experiencing eating disorders and for those dealing with new diagnoses, that is incredibly personal.

When people already cannot access the psychiatric care that they need in a hospital, when they cannot afford it in the private system, or they cannot access it because of waiting lists in the private system, we are letting down the people in our society who need care the most. When the Government says that it is dealing with it and when the Minister says it is being taken care of or dealt with, that is not addressing the challenge that real people are facing across our State. At the moment, we have an epidemic of mental health crises across New South Wales and across Australia. Every member in this Chamber knows it. But what we do not realise is that when we do not deal with it early on—when we do not diagnose, treat and care for people—not only do we not give people the right and opportunity to live fulfilling lives, we harm every person close to them and we risk harm to people they do not even know.

We have an obligation and responsibility to act. We know the facts. We know that there are huge vacancies. We know that our psychiatrists are quitting in droves because they feel they lack not only the pay that they need, but also a system and the working conditions that support them—things like overnight rosters that do not reflect their own needs or capabilities, being on call excessively, and receiving phone calls to administer the types of treatment that do not reflect the challenges of meeting their patients' needs.

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