Hospital or jail? The gaps in Australia's mental health system
A recent Sydney Morning Herald investigation has highlighted the growing pressure on NSW's mental health system after a senior clinician at St Vincent's Hospital asked a Sydney court to stop sending patients to its overwhelmed emergency department.
At the time, 17 mental health patients were in the emergency department, including 15 waiting for admission to already-full psychiatric units and two who had been there for 10 days.
Australian Society of Psychiatrists (ASoP) CEO Dr Pramudie Gunaratne spoke with SMH.
“That is a huge number of patients. It's really symptomatic that the rest of the mental health system, particularly community-based [services], is not working very well if there are that many people in the ED.”
The investigation also revealed that the number of people dismissed by NSW lower courts due to mental illness or disorder increased from 435 in 2021 to 561 in 2025, with most diverted to emergency departments for psychiatric assessment.
Dr Gunaratne highlighted how gaps in mental healthcare can leave vulnerable people entering the justice system before receiving the treatment they need.
“For some people, the first meaningful contact they could have with the mental health system comes after they have deteriorated so badly that something happens, and the police get involved, and they end up in front of a magistrate.”
She also emphasised the importance of treatment in preventing further involvement with the justice system.
“We know that diversion into mental healthcare reduces reoffending. It's not about being soft on offenders, it's about recognising that if we treat mental illness as part of why someone is in court, then treating mental illness is one of the best ways to stop them reoffending.”
In an accompanying editorial, the SMH argued that "jail or hospital should not be the only choice for treating mental health", highlighting longstanding gaps in community mental healthcare and calling for greater investment in long-term clinical and rehabilitation services.
The crisis at St Vincent's reflects a broader systemic problem. Without accessible community treatment, sufficient inpatient capacity and appropriate rehabilitation services, people with severe and complex mental illness are too often left without care until they reach crisis point.
Australia needs a mental health system that intervenes earlier, provides continuity of care and ensures that emergency departments and courts are not the default entry points to treatment.
