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“It should never cost the clinician to actually give a shit” inquiry hears

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Amanda Cohn
NSW Greens MP
15 February 2024

The final hearing for the mental health inquiry has heard that the current mental health care system is failing domestic and family violence survivors and how emergency departments are used as a catch all when there is nowhere else for people to go.

Dr Karen Williams, Consultant Psychiatrist at Ramsay Clinic Thirroul spoke about the fragmented and under-resourced system of mental health support available to domestic and family violence survivors.

“Every week a GP will see at least five women who are currently being abused. All of these health services that these women are being seen in… the patients are not receiving any trauma therapy, trauma education or any diversional therapies we already know are needed for PTSD treatment to be effective,” Dr Williams said.

“Within our public health service, with all the money being spent on mental health, there is currently only one publicly funded psychiatric bed dedicated to treating these survivors.”

“If any one of these women are to feel acutely suicidal, there is no public service I can send them to safely. The only unit completely dedicated to treating abuse survivors providing evidence-based holistic model of care is a small private hospital that I opened over a year ago.

“The service providers themselves are impatient and overworked, and that makes these patients feel even more worthless than they already feel… it's certainly retraumatising to have a system that is blind to what the patients actually need,” Dr Williams said.

Dr Williams spoke about how current Medicare rebates are disincentivising quality of care for people who have experienced trauma.

"It should never cost the clinician to actually give a shit," Dr Williams said.

Dr Clare Skinner, Immediate Past President & NSW Faculty Board Member, Australasian College for Emergency Medicine discussed emergency departments being a last resort stop for people experiencing mental health distress.

“The points that have already been made about navigation and integration and fragmentation across the system bear out in emergency departments which often serve as a safety net for the health and social services systems when other elements fail,” Dr Skinner said.

“A lot of the mental health services have wrong doors… they've been designed to support people and be a form of early intervention but if there's nowhere to go from those systems, then they come to the emergency department. We become a catch-all… which becomes really frustrating and damaging for patients who are anxious and in crisis and we can't navigate it either,” Dr Skinner said.

Dr Skinner also spoke about the barriers for people receiving emergency mental health care in regional areas.

"They (regional hospitals) are less likely to have a trained mental health clinician on the ground."

"For example, someone experiencing psychosis, police might be called. They might have to be transported hundreds of kilometres to get to a (gazetted) mental health facility if they're under the mental health act. It's a combination of police or ambulance (who transport the patient) depending on which service is initiated first and that's another big cause of inequity. Depending on their knowledge of mental health issues…, the person who calls the emergency services, some will define the acute severe behaviour or disturbance as a medical issue and call an ambulance and others will define it as a criminal issue and call the police and that can label you for the rest of your journey in the system,” Dr Skinner said.

Dr Amanda Cohn, the Inquiry’s Chair and NSW Greens spokesperson for Health including Mental Health, reflected on the importance of today’s evidence for the inquiry when it considers how mental health care can be improved across NSW.

“Trauma-sensitive care is crucial for people who have experienced chronic and complex trauma but our current system isn’t resourced to meet that need.”

“Emergency departments should be a place people can go when they need immediate care, but right now they’re being used as a last resort because there is nowhere else for people to go when they’re mentally unwell,” Dr Cohn said.


Media contact: Josh Appleton - [email protected] - 02 9230 2566

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Amanda Cohn
NSW Greens MP
15 February 2024
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“It should never cost the clinician to actually give a shit” inquiry hears

The final hearing for the mental health inquiry has heard that the current mental health care system is failing domestic and family violence survivors and how emergency departments are used as a catch all when there is nowhere else for people to go.