Dr Pramudie Gunaratne:NSW is the state with the lowest per capita spending on mental health.Credit:Louise Kennerley
Nurses had transferred her to the “seclusion room”,and from the small window cut out of the door I could see her whispering to herself as she lay curled on the single blue mattress on the floor. I wish we had another way to keep her safe overnight.
There are patients still queued in the emergency department waiting to see me:a university student slumped in a chair with a blanket over her shoulders after an ambulance had brought her in from the edge of a nearby cliff top,a young man with bloodshot eyes pacing barefoot flanked by two security guards after police found him wandering through traffic,a 12-year-old girl with bandaged wrists and her parents in tears. This is not an extraordinary shift. Any psychiatrist or trainee could tell you that this is the story of every night in hospitals across our state.
It is an incredible privilege to be given the responsibility of caring for people when they are at their most vulnerable. Yet,as doctors,we need to work within a system that allows us to provide that care.
In NSW,our public mental health system has been running (or more accurately,limping) with 30 per cent of psychiatrist positions unfilled. Even in the most prestigious hospitals in central Sydney,vacancies for psychiatrists have become abundant.
The caseloads for individual doctors are extreme. The injustice of sending patients away from our overloaded services when they are desperate for help weighs heavily. Even when people are accepted into care,the system is so under-resourced that clinicians cannot provide the standard of care that they are trained to give. This is why I needed to leave a broken system,before it broke me.
A seclusion room is used for the sole confinement of a distressed or agitated person.Credit:Eamon Gallagher
The current situation is unsurprising given NSW is the state with thelowest per capita spending on mental health. We are also bleeding psychiatrists across the borders given the significant pay gap for public psychiatrists compared with our neighbouring states. Disappointingly,15 months of discussions with the state government regarding this chronic understaffing and under-resourcing has resulted in little action. Now,203 of the state’s remaining 295 public psychiatrists have submitted their resignations and are preparing to walk.