A corridor in one of the country's busiest emergency departments has become a makeshift waiting room.

People wait on chairs and sleep on the floor.

In April, one man in desperate need of help waited 93 hours — almost four days — for a mental health bed.

The man forced to wait in Sydney's Westmead Hospital has schizoaffective disorder, a condition that combines psychosis with mood episodes like mania or depression. Two other men, one with paranoid ideation and another with schizophrenia, waited 88 hours and 86 hours alongside him.

These wait times are part of an extraordinary number of leaks Four Corners has received from within the NSW mental health system, uncovering a shocking deterioration of services the state government doesn't want Australians to see.

Doctors and other health workers say they can stay silent no longer, fearing they are witnessing the collapse of public mental health care in NSW.

They've seen people in serious mental health crisis turned away from care, patients discharged before it's safe, and interminable wait times boil over into life-threatening violence.

'My patients deserve better'

Teaghanne Sarina, a mental health nurse at Westmead Emergency Department and Cumberland Hospital, has seen wait times at the ED blow out.

"When the [ED] is full, you are either sat in the waiting room or, if you're scheduled, you're sat in a chair that sort of sits outside where nursing staff can keep an eye on you in a contained environment.

"You'll remain there … until we can find a bed space available to you."

Ms Sarina, a NSW Nurses and Midwives' Association delegate and assistant secretary of the Cumberland branch, heard about the man forced to wait more than 90 hours.

"I cannot fathom how that individual felt.

"They were [scheduled] under the Mental Health Act, which meant they didn't have any right to leave the hospital, they couldn't go home.

"They were stuck in an overstimulating environment, which we know is not a therapeutic environment for a patient presenting with a mental health crisis, and that seems to be happening more and more.

"I think largely that is due to the fact that we have had such an extensive increase in our general population in these areas without there being an increase to services and resources.

"If nothing changes, people will get hurt and there'll be a mass exodus of staff. My patients deserve better. My colleagues deserve better. I deserve better."

'I thought I was going to die'

Excessive wait times can lead to frustration, which can escalate into violence against staff. It's a trend witnessed by doctors around the country.

CCTV footage leaked to Four Corners shows a man trying to escape the hospital after waiting for hours in the ED in April.

When nurses and security tried to stop him, he bit one of them.

This has become the norm for frontline staff. One security guard described Westmead's emergency department as a "fight club".

Sometimes it has devastating consequences.

Omar Tlais worked as a security guard at Westmead for almost three years. After what happened to him, he'll never go back.

"I've been bit, I've been punched, I've been kicked, I've been spat on.

"In June last year, I was called to attend the emergency department for a code black … there was a patient who … was very irritated.

"From my knowledge, he had been there for over 12 hours.

"A nurse came over and explained to the patient that they were going to sedate him.

"He obviously wasn't too happy with that. He said, 'I just wanted to see a doctor.'

"It got to the point where he was again calm and compliant. He said to me, 'OK, look, I'll do it.'

"As soon as he saw the needle, he pretty much stood up from the bed, jumped pretty much on my back, pulled a knife out of his jacket and stabbed me in the neck.

"I thought I was going to die."

'Never embarrass the minister'

Workforce shortages have forced mental health services to close and left staff struggling to keep the system functioning.

Two mental health wards and a mental health assessment centre at Cumberland and Westmead hospitals were quietly closed in January.

Four Corners has found that overnight at Cumberland, Australia's largest mental health hospital, there's only one trainee psychiatrist to cover the entire facility.

To clear beds, doctors have told Four Corners they have been forced to discharge patients before they're ready.

Anu Kataria worked for 22 years as a psychiatrist at Cumberland. She said they would arrive at work to texts asking them to "please discharge" patients as "there's 15 people waiting [at Westmead ED], there's a dozen waiting at Blacktown".

"It was constant and pretty unrelenting.

"[The messages were coming from] high up … I suspect that they had people telling them what to do.

"When I was a very junior consultant, a senior consultant once asked me, 'Anu, what do you think your role in this hospital is?'

"He said, 'Your job is to keep the minister for health out of the newspaper. You will never do anything to embarrass the minister.'

"Jam-packed emergency departments are an embarrassment to the government. Nobody wants to see a jam-packed ED.

"Therefore, the pressure flows all the way down.

"It feels pretty terrible. It feels that I'm failing to do what I want to do.

"My patients are a lot unhappier. The pressure on me to not treat them fully is infinitely higher. The expectation from senior administration, from the executives, is that I just get people out as soon as I can.

"The people that we look after, especially in the public health system, are essentially voiceless.

"We know we can have much better outcomes.

"We are limited by the system in which we work, and that's hurtful, that's injurious, that's painful."

Many patients and their loved ones have told Four Corners being discharged early has made their mental illness worse, resulting in a cycle of quick deterioration and re-admission.

Warning: The following sections contain references to self-harm and suicide.

A loaded nail gun in public

The problems are also endemic at Sydney's largest hospital, the Royal Prince Alfred (RPA).

Over her decade at the hospital, Suzy Goodison saw overloaded staff struggling to keep up with the increasing volume and complexity of patients.

She recalled a patient from January, a young man with schizophrenia who had been missing for six months after being released from jail.

"He came into RPA, to the emergency department, and he had shot nails actually into his knees because the voices were telling him to do that. He was admitted to the orthopaedic ward.

"He was a significant risk of harm to himself and to others.

"I immediately flagged that this man needed … a bed in an acute mental health unit and that I was very concerned about him being in the general hospital …

"I then went off on a weekend … When I called on the Monday, he'd absconded from the hospital ward, and no-one knew where he was.

"He had no fixed address and I don't know what happened to him."

Four Corners: "Could he still be out there in the community in that current state?"

Dr Goodison: "Yes. He was walking around with a loaded nail gun in public.

"It is another Bondi Junction waiting to happen.

"These are the risks that we carry when we work in this field and it becomes a moral injury when I can't deliver that care to keep either individuals safe or the community safe.

"It's pretty awful and demoralising and I think it wears you down and it felt hopeless at times.

"There were times when I thought, 'What am I actually doing for this patient?'"

Mental health admissions to RPA Hospital in the last quarter of 2024 were 54 per cent higher than the same time the year before.

The increase has been partly blamed on a breakdown of community mental health services.

After dealing with the hospital system, patients are supposed to be assigned to a mental health team in the community staffed with psychologists, social workers, nurses and, ideally, psychiatrists.

Four Corners has been told a Sydney Local Health District community crisis team meant for the most severe patients is down eight staff.

There's now only one part-time psychiatrist for about 130 patients.

'The bit I struggle with most'

Another concerning problem in the NSW mental health system is how it struggles to care for vulnerable children.

Child and adolescent psychiatrist James Lawler said more young people than ever before were presenting to emergency departments.

"[I had] triple the normal workload. It was the job of three psychiatrists that I was doing in one.

"It's kind of scary actually."

With limited beds and pressure to keep ED wait times down, he was forced to make tough decisions.

"The hard one is being on call. You get a lot of kids presenting to the emergency department and being told by your colleagues, 'Here's the presentation: This person's tried to end their life or has hurt themselves really badly,' … and making a decision to discharge and just hoping for the best.

"I think that's the bit I struggle with most; doing that in the middle of the night and hoping that the family and child end up OK.

"I've realised over the course of last year that the work I was doing was just becoming so constrained and I was having to give that advice so quickly to parents that I was walking away from sessions realising that they didn't really trust what I'd said was genuine and they probably weren't going to listen.

"And I don't know that there's much point that I keep working in an environment like that because I'm not really helping people.

"So you're sort of left with the option of either just continuing to provide care that you don't think is at a good standard or trying to speak up and change the system."

Four Corners has uncovered critical shortages of beds in child and adolescent units across NSW — there aren't enough psychiatrists to staff them.

• In Campbelltown's adolescent unit, eight new beds built over a year ago have never been opened. The hospital told Four Corners it has enough beds to meet the community's needs.
• In Concord Hospital's Walker Unit, just over half of its 11 beds are available.
• In the regional city of Orange, the adolescent unit was forced to close for a period when its only psychiatrist went on leave.

NSW Health is scrambling to recruit child and adolescent psychiatrists on lucrative, short-term contracts in a bid to plug critical workforce gaps.

Resignations

For years, NSW Health has struggled to hire psychiatrists, prompting the profession's peak body to enter 15 months of negotiations with the state government in search of a solution.

The doctors' union, the Australian Salaried Medical Officers Federation, pushed for a 25 per cent pay increase for the state's psychiatrists, saying they were the lowest paid in the country and needed incentives for retention and recruitment.

"That's not something the government is able to agree to," NSW Mental Health Minister Rose Jackson said in January.

"We have to think about the broad, not just mental health system, but overall state budget.

"We have put our own proposition on the table and my view is that it's really reasonable … it's 10.5 per cent over the next three years."

With no movement, 206 psychiatrists — including Dr Kataria, Dr Goodison and Dr Lawler — announced they would resign, saying they could no longer work in a system that was failing to treat people.

Deadlocked with psychiatrists, the NSW government referred their pay request to the Industrial Relations Commission, the state's workplace disputes referee.

Sixty-two psychiatrists have gone through with their resignations. Others are waiting for the commission's decision, expected in early June.

It's only one part of a much larger crisis.

NSW Health said it was investing more than $2.9 billion into mental health services, including funding for community support.

"The NSW government recognises … the system is in need of improvement and reform — both in terms of supporting our specialist mental healthcare workforce and the broader delivery of mental health care to the community," a spokesman said.

"A patient will not be discharged if it is not clinically appropriate … we will never turn people away."

"We want to make it very clear — if anyone is in need of mental health treatment they should reach out for help, our system is designed to provide it, and has continued to, throughout this process."

EDITOR'S NOTE: June 2, 2025: A previous version of this article mentioned a job ad for a locum in the Nepean Blue Mountains health district. That job ad was later clarified by the locum agency as being for the South West Sydney health district.