In a troubling development, psychiatric patients at a major Sydney hospital are being subjected to shockingly long wait times in the emergency department, with some individuals in the midst of psychotic episodes waiting over five days for care. The alarming situation, arising amid an ongoing pay dispute between New South Wales and its psychiatrists, is leaving vulnerable patients suffering needlessly as resignations further deplete already understaffed mental health teams.
Patients in Crisis Endure Agonizing Waits
At one inner-city hospital, the six patients with the longest ED stays as of Monday morning were all psychiatric patients. One individual actively experiencing hallucinations had spent over 130 hours—more than five full days—waiting for a mental health bed to become available. Several others in the throes of psychosis or at risk of suicide also languished for days on end:
- 87+ hours for a patient having a psychotic episode
- 64+ hours for another patient in the midst of psychosis
- 25+ hours for a suicidal patient
- 16+ hours for a patient with a manic disorder
Waiting for an inpatient bed in the chaotic, over-stimulating environment of the emergency department for days on end can be hugely detrimental to these patients’ wellbeing, potentially exacerbating symptoms and leading to further deterioration. As psychiatrist Dr. Kamran Ahmed explains:
“When people present with a mental health emergency, they can be distressed and agitated. The emergency department can be very busy and noisy, which can exacerbate their symptoms further. They’re potentially suffering for longer than they should be because they’re not getting the right treatment in the right environment, or the right kind of support.”
Dr. Kamran Ahmed
Root Cause: Psychiatrist Shortages and Pay Disputes
The excessive wait times psychiatric patients are facing stem from two main factors – a severe shortage of psychiatrists across New South Wales, further exacerbated by resignations due to an ongoing pay dispute between staff psychiatrists and the state government.
Staff specialist psychiatrists, who fill permanent public hospital roles, argue they are significantly underpaid compared to their counterparts in other Australian states. The pay discrepancy, they say, has led to challenges recruiting and retaining psychiatrists, leaving many positions vacant and placing additional strain on those who remain. With working conditions becoming untenable, more psychiatrists are opting to resign, as has recently occurred at the hospital reporting these extreme psychiatric patient wait times.
As psychiatrist numbers dwindle, there are not enough on hand to assess and admit patients in the ED in a timely manner. And with mental health wards running over-capacity, psychiatric patients are getting stuck in a holding pattern in emergency.
A System-Wide Emergency
Sadly, this is not an isolated issue but rather a symptom of a public mental health system in crisis. Another major Sydney hospital reported a schizophrenic patient waiting 87+ hours and a suicidal patient waiting 85+ hours in late January. Twelve psychiatric patients there had exceeded 24 hours in the ED, most tagged as “mental health no bed available”.
Dr. Ahmed asserts that across New South Wales, psychiatrist shortages and a dearth of inpatient mental health beds are “almost certainly” contributing to ballooning ED wait times for this vulnerable population. In the specialized psychiatric ward environment, patients would be closely monitored by mental health nurses and have regular psychiatrist assessments to provide tailored treatment and medication management. The ED, while providing triage and immediate crisis care, is not equipped to provide that ongoing, specialized level of psychiatric support.
As the psychiatrist shortage reaches a boiling point, patients are bearing the brunt of a system stretched too thin. How many will deteriorate or suffer needlessly in busy emergency rooms as help remains out of reach? The dispute between New South Wales and its psychiatrists requires urgent resolution before lasting damage is done. For the sake of patients in desperate need, this mental health emergency demands immediate action.
