When Chloe's* teenage son was experiencing serious suicidal thoughts she took him straight to a major hospital in Sydney for emergency care.
But after arriving at the emergency department of Sydney's Royal Prince Alfred Hospital (RPA), they waited 28 hours to be seen by a psychiatrist.
"If … you go into hospital with appendicitis — life threatening — you see a specialist straight away," she said.
"You go into hospital suicidal — life threatening — what's the difference?"
NSW spends the least per capita on mental health services compared to every other state and territory.
Mental health practitioners say stories of services failing those in critical need are becoming commonplace.
Eventually, Chloe's 16-year-old son was admitted to the paediatric unit in February 2020, and then into an adult mental health ward, because there were no available beds for people his age.
"It's just pretty scary, what goes on in an adult mental health facility," Chloe said.
For the next 21 days her son, who also experiences bipolar disorder, was treated by a revolving door of more than 20 different psychiatrists.
"They would change every day ... there was no consistency," Chloe said.
This incident occurred about three years ago, but another mother, Michelle*, had a similar experience in June this year.
Her 25-year-old daughter — deemed a harm to herself by her psychologist — was admitted and sent to the same emergency ward in an ambulance.
But there were no beds available.
She wasn't seen by a psychiatrist until about 40 hours later.
"I feel really sorry for the staff, they are really stretched," Michelle said.
"It's not their fault."
Both women can afford private healthcare, but said they still needed to advocate at every step to get their children treatment.
"You've got to imagine how many people can't do that. Or don't have parents that are capable or able to do that for so many reasons," Chloe said.
'An absolute lottery'
Mental Health Minister Rose Jackson, on behalf of RPA, said she was concerned these patients were unable to receive adequate support when they were vulnerable.
"We acknowledge that significant improvements to the system are needed and remain committed to doing everything we can to provide timely support for people experiencing a mental health crisis," she said.
"Our mental health services, including RPA, are experiencing increased presentations and barriers to discharge leading to increased wait times in emergency departments."
She said RPA was focusing on inpatient processes and discharge pathways, and had since increased staffing in its mental health department.
Australian Institute of Health and Welfare figures show in the 2020-21 financial year NSW spent $220.23 per capita on specialised mental health care services, compared to $235.60 in Victoria and $230.96 in Queensland.
But that divide has grown substantially in recent years, after Victoria in 2022 and Queensland the following year, introduced a mental health levy to businesses that pay more than $10 million annually in tax.
NSW has invested $2.7 billion in mental health services for 2023-2024 financial year.
Doctor Angelo Virgona, NSW chair of the Royal Australian and New Zealand College of Psychiatrists, hopes the state will follow in the footsteps of Victoria and Queensland, which invested billions into the sector after a royal commission, and an inquiry.
"In NSW it's an absolute lottery. Sometimes you can luck out ... but mostly people just miss out," Dr Virgona said.
'Never been this bad'
Sam Harvey, executive director and chief scientist from the Black Dog Institute, said workers in the sector are pushed to the brink in a system that is "gridlocked".
"We are hearing from frontline mental healthcare workers who say that they have never seen it as bad as it is now," Professor Harvey said.
"They've never had more trouble recruiting staff to work in the service.
"And they've never seen the services, so overwhelmed with people."
Dr Virgona said the system had already passed breaking point, with staff vacancies at levels "we've never had before".
The psychiatrist of more than 33 years said the case of one of his recent long-term patients highlighted the severity of this issue.
The man was suffering a serious depressive disorder, and the condition had deteriorated to the point his wife was worried about him at home.
"So I sent him up to the local emergency department with a letter detailing his history, who I was, that I had treated this man over a long period of time ... and that this was a really serious problem," Dr Virgona said.
The man was discharged an hour after presenting at the Sydney hospital, told to go home and continue taking his medication.
"I found out that the person who had assessed my patient was a really junior clinician, they weren't medical," he said.
"Ten years ago, we had a senior psychiatrist working in that department, because that was the pointy end of the business ... and a registrar, pretty much around the clock.
"Now they don't have the resources to be able to provide that level of care."
'Screaming' for more support
Mental illness is now the number one reason people go see their GP in NSW.
But junior doctors can earn more working towards another specialty, while observing how difficult it is to work in a sector so poorly resourced.
The NSW Labor government is currently undergoing a gap analysis of mental health services in consultation with peak bodies, to assess where the system is failing people.
An Upper House inquiry, led by Greens MP and former rural GP Amanda Cohn, is looking into equity, accessibility and the appropriate delivery of outpatient and community mental health care in NSW.
Priscilla Brice, chief executive of mental health body BEING, said the inquiry was hearing that "all corners of the mental health sector are stretched beyond their intended capacity".
"Without exception," she said.
"Every service is extremely stretched and screaming for more support for community-based mental health services."
She said it was disappointing the Minns government did not increase funding for mental health services in their recent budget, as the industry had been failed by insufficient investment for years.
Dr Virgona said communication between the different services was poor, making it difficult for patients to navigate.
Someone with a complex mental health diagnosis can deal with up to six different health professionals or networks, from GPs to federally funded support workers, each acting alone.
"The scope is enormous, we can't fiddle around the edges anymore," he said.
"If a government were to come in and actually fix this, what a legacy they could leave behind. You would be considered a saint."
Professor Harvey said, ironically, it's never been a better time for people needing help with mental health treatment.
"Because we've now got really good treatments that we know work."
* Names changed for privacy