Psychiatry: A Profession on the Brink

The Psychiatry Crisis

In late January 2025, New South Wales (NSW) reached an extraordinary juncture in mental healthcare when more than two-thirds of the state’s public staff specialist psychiatrists threatened to resign—and over 200 followed through. The stakes for mental health patients, trainee psychiatrists, and the broader public are enormous. With the NSW Government apparently unable to meet the financial and structural demands presented by the Australian Salaried Medical Officers’ Federation (ASMOF), this unprecedented crisis signals more than just a pay dispute. It highlights deeper, systemic problems around remuneration, burnout, and the fragile pipeline of specialists that our healthcare system relies upon to care for Australia’s most vulnerable.

The current crisis underscores a longstanding tension: psychiatrists trained in the public system shoulder enormous clinical burdens in challenging environments, yet earn significantly less than colleagues in other states—or those working privately. With 29% of staff psychiatry positions sitting vacant, according to the Royal Australian and New Zealand College of Psychiatrists (RANZCP), something must change. Otherwise, services designed to treat Australians experiencing severe mental illness could buckle under the weight of inadequate funding and policy inertia.

Longstanding Gaps

Staff specialist psychiatrists in NSW have been voicing concerns about their pay and working conditions for some time. The state government’s most recent offer of a 10.5% pay rise spread over three years (equating to about 3.5% annually) was deemed insufficient by ASMOF, which contends that salaries in other states can be up to 30% higher for the same role, and that the pay rise barely covers inflation. When 203 of NSW’s 295 staff psychiatrists submitted their resignations, it was not just an economic protest. It was also a protest against an untenable workload, against a system that increasingly relies on locums to plug gaping holes in permanent staffing, and against structural burnout that leaves trainees and early-career psychiatrists disillusioned.

There’s a strong sense that at the core, this mass exodus is rooted in respect. Psychiatrists in public hospitals are often the backbone of acute and complex mental health care: they manage severely ill inpatients, conduct forensic evaluations, and coordinate multidisciplinary teams dealing with some of the most harrowing human experiences. Meanwhile, community psychiatry services—already under strain—are left with few avenues for expansion if morale in the public system sinks even further.

The Impact of Chronic Understaffing

The RANZCP warns that 29% of all staff specialist psychiatry positions in NSW remain unfilled. This shortage amplifies stress on the existing workforce. When a single psychiatrist is forced to manage the workload of two or three peers, that person’s ability to provide thoughtful, compassionate, quality care deteriorates. Over time, burnout risk climbs sharply, and the environment becomes even less appealing to potential recruits.

To fill the void, the state depends on locum psychiatrists. While locums can be a short-term solution, their day rates can be three times higher than those of staff specialists. Some short-term locum contracts, as reported, can go up to AU$3,050 per day. Such an approach may temporarily staff wards but only deepens structural inefficiency. When you factor in the administrative overhead and potential discontinuity of patient care—as staff rotate in and out—the entire system suffers.

Critics argue that competitive pay and improved conditions for permanent staff would offer a better long-term solution. Indeed, paying inflated locum rates to fill positions is akin to treating a haemorrhage with a series of quick Band-Aids. Each patch might prevent immediate collapse, but does nothing to address the root tear causing the bleeding.

A Question of Fairness and Equity

One of the central arguments made by the psychiatrists involves comparing their base salaries to those interstate. The NSW Government’s official base salary scale ranges from around AU$186,241 annually for a newly qualified specialist to AU$251,618 for the most senior specialists. This is before factoring in additional allowances, which can increase total packages to around AU$354,479. To the public, these figures may look generous. However, the complexity of psychiatric care, alongside the grueling nature of public sector work, often tells a different story.

Many psychiatrists question how “well-paid” they really are once intense shift work, on-call demands, risk of violence in acute psychiatric settings, and the administrative burden of under-resourced mental health services are weighed. Moreover, the Government acknowledges that around half of all psychiatrists are already at the top of the pay scale, meaning the margin for future financial progression within the public system is limited. When private practice can offer salaries 30% to 50% higher, it becomes increasingly logical, though regrettable, for specialists to leave public positions.

What Does This Mean For Patient Care

Perhaps the most concerning aspect is what this crisis means for the people seeking or requiring psychiatric care. Mental illness often carries stigma, making timely and empathetic professional support crucial. If nearly 70% of the current psychiatrist workforce in public hospitals can—and do—walk away, thousands of patients might face longer wait times, abrupt discontinuities in their treatment, and the potential closure or scaling back of psychiatric wards.

RANZCP’s most recent update implores the NSW Government to intervene immediately, citing the risk of reduced safety for patients. Consider the already overloaded emergency departments: any spike in psychiatric presentations due to short-staffing would stretch resources further. Some individuals in mental health crises could even end up in the judicial system for behaviours stemming from untreated conditions. This is not mere speculation; it is a pattern observed when mental health services are not comprehensively available.

Finding a Way Forward

So, what should be done? First, there must be a recognition that these resignations are not a mere bargaining tactic; they illustrate an acute, potentially catastrophic, breakdown of trust between frontline psychiatrists and the NSW Government. Any resolution that attempts to minimise or dismiss the doctors’ concerns will fail to address the underlying malaise.

A realistic, competitive pay offer may need to come close to bridging the gap with other states. While a 25% rise is the union’s stated figure, some form of compromise that tangibly narrows the pay disparity might be a starting point. Psychiatrists in NSW should not feel financially penalised for choosing to serve the state’s public health system.

Money is only part of the solution. A genuine commitment to workforce wellbeing—enough psychiatrists, adequate administrative support, manageable rosters, and mental health services that do not collapse under seasonal surges—would help retain staff. The RANZCP’s call for improved training pathways is pivotal, ensuring that new psychiatrists can step in and build lasting careers in the public sector.

Without senior psychiatrists, the pipeline of future specialists is threatened. The Government, in conjunction with the RANZCP, should implement strong incentives for high-quality supervision, protected teaching time, and structured mentorship, allowing trainees to flourish.

Any resolution must keep patients at the heart. If we fail to sustain a credible public psychiatry workforce, individuals with serious mental illness will pay the highest price. Collaboration between health and social services could lighten the load on acute psychiatric wards by ensuring robust community support, housing assistance, and crisis outreach.

We must not underestimate the gravity of this crisis. The mass resignation of over 200 psychiatrists from the NSW public system is a clarion call. It reflects a system at breaking point, burdened by decades of underinvestment in mental health, staff burnout, and uncompetitive remuneration.

The NSW Government faces a stark choice: resolve the impasse swiftly and meaningfully, or risk dismantling the scaffolding that keeps our public mental health system afloat. Locum band-aids, while helpful in the short term, will not address the deeper festering wounds. A truly sustainable solution must balance economic feasibility, workplace conditions, and genuine respect for the psychiatrists who dedicate their careers to public service.

Royal Australian and New Zealand College of Psychiatrists. (2025, January 10). Update on New South Wales workforce issues. https://www.ranzcp.org/news-analysis/update-on-new-south-wales-workforce-issues