The Growing Crisis: When Mental Health Facilities Turn into De Facto Prisons
Sydney’s mental health system is facing a critical juncture, increasingly burdened by the diversion of individuals from the criminal justice system. A senior psychiatrist’s recent warning highlights a disturbing trend: mental health facilities are being stretched beyond their capacity, effectively functioning as holding cells rather than centers for treatment and recovery. This shift is not merely a logistical challenge. it has profound implications for patient care, staff safety and public safety.
Section 19b Orders: A Rising Tide
The use of Section 19b orders – allowing magistrates to divert individuals with potential mental health or cognitive impairments to mental health facilities for assessment and detention – has surged in recent years. Data from the NSW Bureau of Crime Statistics and Research shows a significant increase, rising from 2215 cases between October 2019 and September 2020 to 3428 between October 2024 and September 2025. This escalating trend underscores the system’s reliance on mental health services to manage individuals who might otherwise enter the criminal justice system.
The Dual Patient Cohort: A Dangerous Mix
The core of the problem lies in the increasingly complex patient mix within these facilities. As outlined by UNSW Conjoint Professor of Psychiatry Matthew Large, hospitals are now tasked with treating two distinct groups simultaneously. The first comprises individuals diverted from the justice system, often with serious offenses and potential for unpredictable behavior. The second, and traditionally the majority, consists of individuals seeking treatment for mental illness who are generally non-violent and require a recovery-focused approach. Combining these cohorts creates an environment that compromises therapeutic care and elevates risk for both patients and staff.
This situation is exacerbated by the fact that hospital staff, primarily nurses, are not trained as correctional officers. They are skilled in providing care, not managing custody. As highlighted in recent cases involving Mooniai Leaaetoa and Luke Peter Francis, individuals under Section 19b orders have been able to abscond from facilities, sometimes leading to further alleged criminal activity.
The Strain on Resources and the Broader Crisis
The Australian Society of Psychiatrists acknowledges that the issue isn’t necessarily the patients themselves, but rather a systemic crisis. Dr. Pramudie Gunaratne, the organization’s chief executive, emphasizes the lack of adequate upstream community support for the 58,000 people in NSW living with severe and complex mental illness. This lack of support leads to individuals reaching crisis points and requiring more intensive, and often inappropriate, interventions.
The Bondi Junction attack inquest recently recommended increased community outreach and specialist teams, particularly for those disengaging from care. This underscores the need for preventative measures and early intervention to address mental health issues before they escalate to the point of requiring diversion to the justice system.
Absconding Rates: A Concerning Statistic
Data from NSW Health reveals that roughly 200 admitted mental health patients absconded in the 2025/2026 financial year, representing approximately one percent of patient admissions. Although the overall rate is relatively low, absconding rates at Cumberland Hospital, which treats the most severe and complex patients, are significantly higher – 0.75 per 1000 bed days compared to the state average of 0.23 per 1000 bed days.
Looking Ahead: Potential Future Trends
The current trajectory suggests several potential future trends:
- Increased Demand for Secure Mental Health Facilities: As Section 19b orders continue to rise, the demand for facilities capable of providing a secure environment will likely increase.
- Integration of Security Protocols: Hospitals may be forced to adopt more stringent security measures, potentially blurring the lines between healthcare and correctional facilities.
- Focus on Early Intervention: Greater investment in community-based mental health services and early intervention programs will be crucial to prevent individuals from reaching crisis points.
- Specialized Training for Staff: Mental health staff may require additional training in de-escalation techniques and managing potentially violent situations.
- Legislative Review: A comprehensive review of Section 19b and related legislation may be necessary to ensure We see being used appropriately and effectively.
Frequently Asked Questions
- What is a Section 19b order? A Section 19b order allows magistrates to divert individuals with potential mental health issues to a mental health facility for assessment and detention.
- Why are absconding rates a concern? Absconding poses a risk to both the individual who has left the facility and the wider community.
- What is being done to address the issue? NSW Health has initiated reviews of security protocols, and there is growing recognition of the need for increased investment in community mental health services.
Pro Tip: If you or someone you know is experiencing a mental health crisis, reach out for help. Lifeline Australia is available 24/7 on 13 11 14.
What are your thoughts on the challenges facing the mental health system? Share your comments below and let’s continue the conversation.
