'Big problem': Psychiatrist speaks out on crisis as Premier Minns digs in

They are among about 200 of the state's 295 public hospital psychiatrists who plan to leave their jobs by today.

Psychiatrists are seeking a one-off pay increase of 25 per cent, having rejected the government's offer of 10.5 per cent over three years.

The Australian Salaried Medical Officers' Federation and the NSW government will return to the Industrial Relations Commission today in a bid to resolve the dispute.

Premier Chris Minns said yesterday "we've worked incredibly hard on contingency plans". Mr Minns said this included "fly-in teams using the private hospital system".

"If this continues, we're going to have to look at longer-term reform," he said.

This included using "counsellors, psychologists and mental health nurses" to assess and treat public patients.

The federation said there were 416 staff specialist psychiatrist positions in NSW.

"Currently 125 positions are unfilled, leaving 295 people working [before the resignations]," it said.

Dr Fajumi, the Hunter New England Mental Health medical staff council chair, said "the government wants to paint this as being about money".

"It's a lot more than that," said Dr Fajumi, who works part-time at a mental health unit at the James Fletcher campus in Newcastle.

She said the Hunter Region had about 40 psychiatrists working in public hospitals and community mental health teams.

They work at sites such as the Mater, Maitland and Morisset mental health hospitals and with children at Nexus at John Hunter.

"The trainee psychiatrists are not staying. They're going to private practice or interstate. Senior psychiatrists are leaving too," Dr Fajumi said.

"That is a big problem. We can't rely on overseas doctors to fill these gaps. There's a shortage of psychiatrists everywhere."

When trainees complete their training, they can go interstate and "earn 30 per cent more in Queensland and Victoria and 40 per cent more in Western Australia in the public system". "The ones who stay in the area can go to the private sector," she said.

Dr Fajumi's role includes working on call at night. "When you're on call, you cover the whole district," she said.

In a typical shift, she receives calls from trainee psychiatrists and mental health clinicians about psychotic, suicidal and distressed patients, including children.

This involved patients presenting to emergency departments, including the Mater, Maitland, Tamworth and Taree. There can be long waits for assessments. The doctors have to decide whether to admit patients to hospital or send them home.

Patients have previously told ACM Newcastle Herald that pressure on hospital beds and staff shortages meant they were sent home while severely unwell.

Dr Fajumi said locum psychiatrists were used in the Hunter and "the number is increasing". This was the case "in many health districts".

"The LHD [local health district] is doing its best to fill gaps with locums when they can. They can't always get locums."

The federation said short-term locum psychiatrists were paid "about two to three times that of a permanent psychiatrist".

Dr Fajumi said psychiatrists "carry a lot of responsibility".