Doctors baulking at $3k a day to plug mental health gap

Interstate psychiatrists are baulking at $3050 a day to stand in solidarity with quitting NSW colleagues as the state resorts to telehealth to deal with an unfolding mental health crisis.

As NSW Health scrambles to lessen the impact of two in three public psychiatrists resigning on Monday and Tuesday, AAP can reveal public patients in mental health distress will be assessed virtually by psychiatrists.

That's provided health officials can cobble together enough of the specialist doctors on temporary contracts amid concern it will involve "dangerous work" and undermine a campaign to address long-term retention issues.

A semi-retired psychiatrist with experience across public, private and remote settings told AAP said recent locum work in NSW public hospitals had already been difficult amid worsening staff shortages.

Speaking on the condition of anonymity to have frank discussions, he said he was not "the slight bit interested" in re-entering the NSW public system, particularly in crisis conditions.

Crisis rates of $3050 per eight-hour shift, usually reserved for work in high-pressure acute units, are being offered to qualified psychiatrists to form a telepsychiatry hub.

"It's almost dangerous work (next week) ... the safety issue is a big issue," the veteran psychiatrist told AAP.

"I'm not going anywhere near it.

"There might be some people who do but I doubt they will get the numbers they're looking for."

Expressing fears for patients and trainee psychiatrists staffing the hospitals, he said telehealth would only work in some situations where establishing a rapport with the patient was not a critical issue and the patient could remain still.

"If they're frightened and anxious, how are they going to be reassured with a TV screen, albeit with a human on it?" the veteran psychiatrist said.

"If they're psychotic or suicidal, the confidence of the people assessing them is quite important."

A single locum and agency commission fees will cost NSW more than $850,000 for a year - over three times a senior public psychiatrist's salary.

Doctor and state MP Amanda Cohn said patients' mental health would suffer and taxpayers would be charged a fortune come Wednesday.

"I know that there are interstate doctors who have explicitly said they will not take these locum jobs in support of their NSW colleagues," the Greens health spokeswoman told AAP.

"Even if they can manage to fill those shifts, extremely vulnerable patients will lose the relationship they have with a trusted professional and risk being re-traumatised."

The departure of about 200 NSW salaried public hospital psychiatrists on Monday and Tuesday comes on top of 140 long-term vacancies.

It's expected to leave the state with little more than 90 staff specialists, who form the core of psychiatric care in city hospitals.

Regional hospitals will be less affected due to their already heavy reliance on contract and temporary doctors.

Psychiatrists say a 25-per-cent pay increase is needed to halt long-term retention issues and allow NSW to compete with salaries interstate.

But it would cost $241 million over four years, the government says as it stands by an offer of 10.5 per cent over three years.

Crisis talks between the mental health minister, the doctor's union and the peak body for psychiatrists are expected to resume on Monday after failing to resolve the impasse this week.

NSW Health referred questions about the take-up of locum offers to earlier comments by secretary Susan Pearce.

"Introducing locums into this workforce is not what we want," she said on Wednesday.

"We are doing this as a short-term measure to address what we're facing."

It also confirmed telepsychiatry was part of next week's contingency plans, which also include increased referrals to private hospitals.

Acute psychosis and other high-risk cases requiring involuntary care must, however, remain in public hospitals by law.

The federal health department is also talking with federally funded independent primary health networks about potential impacts on community mental health sector.

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