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Ethan Annetts was 11 when he started self-harming. By the time he saw a psychiatrist, he was an adult and suicidal.
Ethan spent years on the waitlist for an assessment, and was trapped in an unending cycle of hospital presentations and discharges without any ongoing care, his mother, Jo Cockle said.
With no other options, an extremely distressed Cockle enrolled in suicide prevention classes herself. If she hadn’t: “I don’t think he’d be here,” she said.
NSW has the worst child and adolescent psychiatrist shortage in the country, a shortfall projected to almost double in the next two decades, a new analysis of federal government data revealed.
The federal government’s Thriving Kids policy, which will shift demand from the NDIS to state-based services, risks exacerbating the problem, leaving more families without timely access to treatment, the peak body for psychiatrists has warned.
An extra 64.3 full-time child and adolescent (CAD) psychiatrists are needed just to meet the current demand of families across NSW, found a report released by the Royal Australian and New Zealand College of Psychiatrists.
By 2048, that shortfall will have grown to 119, the report found.
The state’s psychiatrists shortage is almost triple that of Victoria’s, which needs an additional 21.5 full-time clinicians, it read. Nationwide, there is just one specialist for every 571 children with moderate to severe mental illness.
Professor Valsamma Eapen, a psychiatrist who led the report, said resourcing constraints mean children can only access help after their condition has become severe, and Thriving Kids could “add more pressures onto the already stressed system”.
Cockle put Ethan on a wait list to see a paediatrician when he was 13.
“When he finally got called up, he was 17 and a half, and they actually said: We can no longer see you because you’re too old now,” Cockle said.
Ethan’s sister, 12-year-old Grace, was granted funding to see a specialised counsellor two years ago, but still hasn’t been given an appointment.
“There aren’t any available, or if they are available, they’re full,” Cockle said.
“It’s my job to provide for my children, and not being able to provide for their basic human rights, I can’t even put it into words. It’s heartbreaking,” she said.
Dr Joel Killey, who ran a CAD psychiatric unit at a public hospital in Sydney’s north, said it was “frustrating, exhausting and quite sad” to see the mental health of young people deteriorate as they repeatedly returned to hospital with progressively severe presentations.
“They should have been referred earlier, and they should have been given an effective intervention earlier, but the resourcing isn’t there,” Killey said.
NSW community mental health teams receive the lowest state government funding per capita of any Australian state.
Killey left the public system and moved into a private telehealth role for better pay and conditions, as many other psychiatrists have done, and in increasing numbers since 2024 when more than half of the state’s staff specialist psychiatrists resigned.
RANZCP NSW Branch Chair Dr Ian Korbel said there was already a shortage before this exodus, and while some psychiatrists returned after the Industrial Relations Commission ordered the Minns government to give them a 20 per cent pay rise, “we didn’t see everyone come back”.
He hoped new NSW rules that allow trained GPs to prescribe ADHD medication will ease the burden on psychiatrists, and said investing in child and adolescent mental health provides “the biggest bang for our buck”.
“If we get people when they’re in the early stages of their illness, that’s where we can have the biggest impact,” he said. “We can get them essentially back to normal levels of functioning, rather than having the morbidity that has occurred from long periods of untreated mental health problems.”
In a statement, a federal government spokesperson said more than $2.8 billion is currently invested in youth mental health, including $490.3 million for 20 new psychiatrist-led youth specialist care centres across Australia, and training programs for specialist psychiatrists.
NSW Mental Health Minister Rose Jackson said in a statement that she recognised the growing demand, and acknowledged there was “always more work” needed to meet it. Jackson said her government had invested in recruitment, training and new models of care to strengthen the mental health workforce and improve access to support for children and young people.
The report found that each additional full-time CAD psychiatrist generated an estimated $5.85 million in lifetime social and economic benefits, including reduced mental health system use, increased parental workforce participation due to a lower care burden, and improved education and lifetime productivity.
Thriving Kids will move children with mild-to-moderate developmental delays or autism off the NDIS and into state-based mental health systems. Autistic children are more likely to have a co-occuring mental health condition like anxiety, depression or ADHD, and the introduction of an early identification screening is also expected to lead to increased demand. The RANZCP said details about the transition have not been finalised, despite its rollout date of October 2026.
“Where and how this will fit in, and how state interpreters are going to fund and deliver these services, is really not yet known,” Eapen said.
A federal government spokesperson said, “significant implementation work has been completed” on Thriving Kids, while the NSW government said they were working closely with the Commonwealth and monitoring potential impacts on demand, access and wait times.
Now that Ethan has been able to see a psychiatrist and get the right medication, “everything [is] a bit easier for me to handle in terms of getting a job, going to work, education, going to TAFE; I was able to do that stuff again,” he said.
