In an unprecedented act of defiance, more than 200 of around 295 staff specialist psychiatrists in New South Wales (NSW) public hospitals have tendered their resignations, effective January 21, to protest the state Labor government’s woeful pay offer and its refusal to address seriously under-resourced mental health services.
The psychiatrists are a strategic and irreplaceable part of mental health care in the public health system. Responsible for supervision of trainee psychiatrists and mental health nurses, their dire warnings—that the state’s public mental health system is at the point of collapse—have been ignored by the Minns Labor government.
They are covered by the Australian Salaried Medical Officers Federation (ASMOF), which is calling for an immediate 25 percent increase, less than the 30 percent the union says would be necessary to bring salaries into line with the rest of the country and stop hundreds of senior psychiatrists leaving NSW.
The NSW government has opposed these demands, offering the highly skilled specialists, who spend years obtaining their qualifications and work extended unpaid hours, just 9.5 percent over three years, with an additional 1 percent superannuation. The psychiatrists have consistently opposed this offer over the past 16 months of negotiations, with 98 percent voting it down last year.
Labor has sought to impose the same de facto salary cap on all other public sector workers, with the notable exception of the police.
In December, the Labor government provocatively demanded that the psychiatrists participate in a six-month “productivity and efficiency pilot project,” without committing to any increase in the pay offer. Additional salary rises, NSW Health declared, would only be granted if the efficiency measures resulted in “verified savings” for the government.
Following this, an ASMOF mass meeting on December 16 saw 150 psychiatrists, mostly from Sydney, announce they would quit. This number has now passed 200—more than two-thirds of the current workforce—and includes senior psychiatrists from regional hospitals.
Some 96 percent of psychiatrists attending the meeting said they would not participate in the “efficiency pilot,” describing it as an insult that would only result in further burnout of overworked staff, more bed closures and reduced services.
NSW’s public sector mental health services are already at breaking point, with about 140 senior psychiatrist positions (one in three) unfilled, under conditions of escalating demand for mental health services nationally.
The latest data from the Australian Institute of Health and Welfare (AIHW) reports that 22 percent of Australians aged 16–85 experienced a mental disorder in the past 12 months.
Matthew Large, a conjoint professor in psychiatry and mental health at the University of NSW, told the Australian, “we’re treating fewer than half of the severely mentally ill people with schizophrenia and dual diagnosis problems [mental illness coupled with substance abuse] we should be treating.”
The Royal Australia and New Zealand College of Psychiatry says that 30 percent of NSW’s psychiatrists are considering leaving the profession in the next five years and 43 percent of the workforce intend to retire in the next decade. The College says that Australia’s current psychiatry workforce only meets 56 percent of the national demand.
The Labor government has done nothing to resolve this roiling crisis or increase public hospital mental health funding, but has attempted to fill the gaps with temporary staff—or locums—who are hired through private profit-making employment agencies at a cost that can exceed $3,000 per day.
Senior psychiatrists report that wide areas of NSW public hospitals’ understaffed and under-resourced mental health services are operating on a “worse case” system—i.e., beds are made available by early discharge of patients, not because their treatment has been completed, but to make way for more severely ill patients.
Understaffing at Campbelltown Hospital is currently so bad that it can only use two of the six beds in its Mental Health Intensive Care Unit and only 12 of the 20 in its High Dependency Unit.
Shellharbour Adolescent Mental Health Inpatient Unit was recently forced to stop admissions for a week after one staff member took unplanned leave during the New Year period. The $10.8 million five-bed high-security Freshwater Mental Health Unit, completed in August 2023, is still not open because of staffing and funding shortages.
On Monday, the Sydney Morning Herald reported that five inner-city Sydney hospitals were at a grave risk of losing the ability to provide electroconvulsive therapy (ECT), which is used to treat patients with complex mental health disorders.
Last month, the Labor government attempted to stop the resignations and brought the dispute before NSW’s Industrial Relations Commission. The court directed the ASMOF to “stop taking any steps to coordinate, organise or facilitate staff specialists… to resign.”
The union has fully complied with this anti-democratic order, stating on December 19, “this is a grassroots movement of psychiatrists who have chosen to resign.”
The NSW government, which is closely collaborating with federal Labor Health Minister Mark Butler, has made clear it will not grant the psychiatrists’ demands and is attempting to blame them for the catastrophic state of public hospital mental health services.
NSW Minister for Health Ryan Park has claimed that Labor’s 9.5-percent-over-three-year pay rise offer would be the largest rise for psychiatry staff specialists in more than a decade. This is a deliberate fraud, omitting the fact that it is barely higher than the current official annual inflation rate of 2.8 percent and falls far short of making up for real losses in recent years.
The psychiatrists’ union, however, continues calling on the government to negotiate a deal. ASMOF acting executive director Ian Lissner told media this week he hoped the government would “see the evil of its ways.”
These and similar appeals will fall on deaf ears. The NSW Labor government’s actions are not an accident but part of an escalating attack on public sector health workers across all skill sets and healthcare in general by all state and federal governments, Labor and Liberal-National alike.
The NSW Labor government will further eviscerate public hospital mental health services, to the point of collapse, rather than allow psychiatrists to win a decent pay rise and spark similar demands by other public health sector specialists.
As Health Minister Park admitted to the media yesterday, “Whilst there are several hundred psychiatrists, there are around about 4,200 staff specialists (across all medical specialties).
“I think people can understand that if we were to move into this area of providing this level of increase, the likelihood of many other staff specialist groups asking for an increase akin to this is very, very likely, and that is not something that [the NSW government] can deliver, it’s not possible for any government to deliver.”
Park’s claim that the government has no money is a lie, exposed by the millions of dollars in concessions and incentives it provides to giant engineering and construction companies, property developers and big-business investors.
Park then declared that, starting next Monday, the government would establish a mental health emergency operations centre in collaboration with local health districts to “identify and fill potential gaps” and provide increased support for its Health Direct call centres.
This is hot air. None of these services is capable of providing adequate and safe care to the mentally ill and their families.
Translated into plain English, the Labor government is pushing public hospital senior staff psychiatrists off a cliff and throwing the poorest and most vulnerable mentally ill patients onto the already overstretched community welfare services and ultimately onto the streets.
While public hospital psychiatrists continue submitting their resignations, ASMOF has not called for any industrial action. Nor has it appealed to other doctors and medical practitioners in the federation or nurses, midwives and other health workers to denounce the government attacks and mobilise in support of the psychiatrists.
The NSW Nurses and Midwives Association and the Health Services Union, which have negotiated sell-out deals and other concessions with the Labor government, have said nothing about the Labor government’s attack on psychiatrists and public mental health services.
This deathly silence demonstrates that NSW public hospital psychiatrists cannot defend their salaries and fight for fully staffed and properly funded mental health services while trapped in the existing union framework.
The first step for specialist staff psychiatrists is to recognise that they are in a political struggle against the state Labor government and its big-business program, and that their allies are health workers across the state and nationally.
Psychiatrists must establish democratically controlled rank-and-file committees, independent of the union bureaucracies, in every hospital and involving other health workers.
Such committees will open the way for broad-ranging discussions on how to develop a unified struggle of all health workers against the assault on public health for decent wages, adequate staffing and the most modern equipment through the allocation of billions of dollars in state funding. In other words, a program of action based on a socialist perspective, where public health is funded according to public need, not capitalist profits or what governments claim they can afford.
This is the program for which the Health Workers Rank-and-File Committee, established four years ago under the initiative of the Socialist Equality Party, fights.
We urge NSW public hospital psychiatrists to contact the Health Workers Rank-and-File Committee to discuss your experiences, conditions confronting medical practitioners and patients in your hospital, and how to establish a rank-and-file committee to take forward this struggle.
Contact the Health Workers’ Rank-and-File Committee (HWRFC):
Email: sephw.aus@gmail.com
Twitter: @HealthRandF_Aus
Facebook: facebook.com/groups/hwrfcaus