Public-sector doctors treating the community's most serious mental health needs are resigning en masse over claims of untenable working conditions.
One-half of NSW public psychiatrists have submitted resignations via their union after a year of stalled negotiations to overhaul the sector's funding.
It comes amid a national shortage of psychiatrists and as a coronial inquest into the April mass stabbing at a Sydney shopping centre examines fault lines in mental health care before a man killed six people.
The doctors' union said NSW had been bleeding psychiatrists to other jurisdictions as pay fell 30 per cent behind that in other states.
Those remaining were overworked and completely demoralised from working in "a broken system".
"They don't want to leave, but after a year of advocacy going nowhere they've been left with no other option," Australian Salaried Medical Officers' Federation NSW president Nicholas Spooner said.
"With one-third of psychiatry positions across NSW already vacant, we really can't afford to lose any more staff."
The psychiatrists' college, which trains and represents the workforce, said the dire situation was having a lasting effect on the next crop of doctors treating life-threatening illnesses.
Four in five trainee psychiatrists based in NSW say they do not want to stay in the state's public-health system.
"It's staggering," Royal Australian and New Zealand College of Psychiatrists NSW branch president Pramudie Gunaratne told AAP on Tuesday.
"Trainee psychiatrists are observing (their supervising) psychiatrists working in this really overstretched, over-burdened system.
"It doesn't really encourage them to stay in the system ... so it becomes this long-term problem."
Warnings of untenable working conditions and the impact on patients had been raised with the state government for a year but appeared to have fallen on deaf ears, Dr Gunaratne said.
"Public psychiatrists see things like psychosis, people who are actively suicidal, people who are so depressed they stop eating and drinking and they need to come into hospital," she said.
"These are psychiatric emergencies and they are life-threatening illnesses."
In March, a number of leading NSW mental health organisations warned the sector's long-term underfunding had put it on the brink of collapse and called for larger government investment.
Premier Chris Minns agreed public mental health workers were vital, particularly as frontline services like police and paramedics relied on them for specialist care in emergencies.
"(But) at the moment, the union ... is asking for a 30 per cent increase - that's more than we can pay," he said.
"That's not us shutting the door on the psychiatrists or their union - we want to sit down and negotiate."
The pay and conditions of doctors in Australia's busiest health system are a growing issue for the state Labor government amid workforce frustrations.
Doctors making up half of the NSW hospital medical workforce are hoping a crossbench bill can provide their first real review of pay and conditions in 17 years by giving them access to the state's industrial court.
Emergency specialist and Wagga Wagga MP Joe McGirr's bill for visiting medical officers has won Australian Medical Association backing.
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