The resignation of psychiatrists from Sydney’s Royal Prince Alfred hospital has led to the closure of an HIV psychiatry clinic with 200 patients, as well as a loss of specialist psychiatrist services for patients in the pain clinic and the most unwell eating disorder patients.
Minutes from a Royal Prince Alfred (RPA) and Balmain hospital medical staff council on 10 February, seen by Guardian Australia, also contain slides from a presentation about psychiatrist resignations that state “there is no HIV psychiatry clinic”.
Dr Suzanna Goodison, a psychiatrist who resigned from the RPA, said there were about 200 patients discharged from the HIV clinic, and that some of those patients have since had contact with acute care mental health services as they have become unwell, while many others had to be discharged to their GPs.
Goodison said the specialty support that was available in the clinic was vital as HIV places greater challenges on the treatment of mental health conditions. “As a group they’re not only more at risk because of the psychosocial factors of being a marginalised community, but the virus itself creates cognitive changes.”
Positive Life NSW, the largest peer-led representative body of all people living with HIV in Australia and a partner of NSW Health, said: “Positive Life NSW is concerned about the impact of public health psychiatry resignations which will be detrimental to the health outcomes of all people including those who are living with HIV.”
A spokesperson from Sydney Local Health District later confirmed the district had temporarily introduced alternative measures to support the psychiatric care of individuals living with HIV.
“The health and safety of our most vulnerable consumers is paramount,” they said.
“Those who were previously seen by our dedicated HIV psychiatry clinic have now been referred to our RPA clinic where they will be treated with the same care and compassion.”
John Rule, the director of research at the National Association of People with HIV Australia, said “people living with HIV have higher rates of anxiety, depression and PTSD and therefore the loss of any services would be a very big loss for this population group. There was already a shortage of available support.”
The presentation slides also state there is no psychiatrist in the clinical liaison service for eating disorder inpatients or outpatients. Consultation liaison psychiatrists give advice on the psychiatric care of patients who are admitted in other wards of the hospital.
Goodison said the eating disorder patients who are not admitted in the psychiatric unit who require the consultant liaison psychiatrists are the patients who are so medically unwell they have to be admitted under the endocrinology specialists.
Without concurrent mental health support, Goodison said it places undue pressure on medical teams and means those eating disorder patients don’t receive continuity of care.
The slides state the district has lost three consultation liaison psychiatrists and are now left with only 3.3 full-time equivalent staff specialists, and that their ability to care for outpatient clinics in renal, renal transplant and rheumatology have been “significantly curtailed”.
The presentation also states there is no pain clinic psychiatrist. Goodison said depression is highly prevalent in people with chronic pain (up to 60% in some studies) and is a predictor of poorer functioning overall, worse described pain, reduced capacity to work and significantly increased health care costs over the longer term.
“If they are depressed, it can significantly impact on the capacity to engage in pain programs, for example, or rehabilitative approaches and confer the worst prognosis in terms of recovery and impacts on their quality of life,” she said.
The document also notes the potential flow-on effects in the emergency department, increased bed pressures and registrar training due to the resignations.
It also stated that psychiatrists’ resignations come in the context of the moral injury they feel – that “public psychiatry has become about risk management rather than providing care based on clinical assessment and need”.
The Sydney Local Health District spokesperson said “clinical care is delivered based on priority and escalation processes are in place to always ensure safe care. The district has employed locum psychiatrists to help manage patient needs and we are continuing to recruit to fill vacant positions. We have also employed more allied health staff to provide support,” the spokesperson said.
“It is important for anyone experiencing mental health distress or concerns to understand our services are still available at any time.”
Arbitration before the NSW Industrial Relations Commission between NSW Health and the Australian Salaried Medical Officers (Asmof) returns on Friday. Asmof is seeking a special levy to increase staff psychiatrists pay by 25% to stem the flow of specialist doctors leaving the public system.
• This article was amended on 4 April 2025 to replace the quote from Positive Life NSW, after an initial quote was provided in error.
