Psychiatrists: ED figures expose a mental health system out of beds, housing, community care and time

New data on the pressures in Sydney's emergency departments (EDs) once again lays bare the heavy lifting Sydney's public hospitals are doing in the absence of a well-resourced and connected mental health system.

Royal Prince Alfred Hospital recorded 690 mental health episodes of care in the April to June 2026 quarter, the highest in Sydney, followed by Campbelltown (532), Concord (529), Liverpool (382) and Nepean (345). Bureau of Health Information data shows mental health episodes of care now carry the longest average hospital stay of any care type in NSW, longer than non-acute care such as rehabilitation and palliative care, and more than four times the average acute stay.

The Royal Australian and New Zealand College of Psychiatrists (RANZCP), NSW Branch, says while an ED is not a place for someone in mental health crisis, the current state of the system has caused people to turn to them as a last resort for help.

"EDs are loud, high stimulus places built for triaging physical trauma. They are not therapeutic places for people experiencing a mental health condition, but Sydney’s health care workers are doing commendable work providing acute mental health care in these settings to make up for a system that hasn't kept pace with demand, in particular chronic underfunding of community and outreach care," Chair of the RANZCP NSW Branch Dr Ian Korbel said.

He said the same data pointed to bed block driven partly by a lack of housing for many people living with mental illnesses. 

"Long hospital stays can also reflect difficulties finding appropriate housing, psychosocial supports and other services people need for a safe discharge. When people cannot leave hospital safely, beds remain unavailable for others who need acute care," Dr Korbel highlighted.

The report comes after the NSW Government released its much-anticipated gap analysis, which confirms widespread, unmet need throughout NSW’s mental healthcare system, spanning inpatient, ambulatory, community mental health and psychosocial services for those with severe and complex mental illness.  

“The RANZCP NSW Branch has long campaigned for this gap analysis to be made public, but we’re disappointed that the data released was vague on some important details,” Dr Korbel said.

"Every Local Health District has been de-identified. We're told no postcode is thriving, but not which ones are furthest behind.

“It’s clear that we’re in a difficult situation with each LHD reporting major issues, but also significant differences in the nature and extent of those issues between regions. 

"Unfortunately, these gaps make the analysis difficult to use and risk holding back real service improvement. Without clear place-based data, we cannot have meaningful conversations about where need is greatest, and where mental health services are making an impact, whether in outer suburbs, regional centres, small rural communities or the middle of the city.

“Good planning needs transparent data.”

Dr Korbel said pressure on EDs would ease significantly if community mental health teams were properly resourced to treat people before they reach crisis point.

"If we fund community mental health teams adequately, fewer people end up in crisis at the ED door in the first place. People are best treated early, and they're better treated in the community, not in an emergency department. Right now, community teams are stretched so thin that for many people, the only door left open is the emergency department."

RANZCP NSW Branch says the gap analysis also confirms a mental health workforce stretched well past capacity, particularly in community and outreach roles. 

"We don't have enough psychiatrists working in community and outreach settings to meet demand, and that shortage is one of the reasons people may be unable to access timely care in the community and ultimately present to an ED in crisis," Dr Korbel said.

"Vacancy rates for psychiatrists in the public system remain significant and show no sign of easing, especially outside metropolitan Sydney. Until we fix the workforce pipeline, we'll keep treating the symptoms of this crisis in emergency departments instead of preventing it."

RANZCP NSW Branch is calling on the NSW Government to:

• Match the gap analysis with a fully funded implementation plan within 12 months
• Adequate, ongoing funding for community mental health teams
• Investment in short- and medium-term housing to end bed block
• Measures to attract, train and retain more mental health workforce, including psychiatrists across the state
• Local Health District-level data and benchmarks in every future gap analysis.
  
  

ENQUIRIES: For more information, or to arrange an interview, call Dishi Gahlowt on +61 437 315 911 or email media@ranzcp.org.

The Royal Australian and New Zealand College of Psychiatrists is a membership organisation that prepares medical specialists in the field of psychiatry, supports and enhances clinical practice, advocates for people affected by mental illness and advises governments and other groups on mental health care. For information about our work, our members or our history, visit www.ranzcp.org.

In Australia: If you or someone you know needs help, contact Lifeline on 13 11 14 or www.lifeline.org.au or the Suicide Callback Service on 1300 659 467 or www.suicidecallbackservice.org.au.

In New Zealand: If you or someone you know needs help, contact Lifeline NZ on 0800 543 354 or www.lifeline.org.nz or the Suicide Crisis Helpline on 0508 828 865 or www.lifeline.org.nz/suicide-prevention.