About 200 public-sector psychiatrists in NSW - representing about two-thirds of the workforce - are due to quit from Tuesday, pending a last-minute resolution of their increasingly bitter standoff over pay.
The state Labor government will seek an urgent hearing before the Industrial Relations Commission after leaders refused to give in to their demands for an immediate 25 per cent pay rise.
There are 140 long-term vacancies in a state system doctors say is under-resourced and severely stretched.
Suzy Goodison, one of the psychiatrists threatening to quit, said she had seen a catastrophic decline in services during her decade in the "decimated" system, which was also experiencing a lack of allied health staff, nurses and psychologists.
"To tell someone who is acutely suicidal that I cannot offer them a bed ... and to discharge them to what I know are completely depleted community services ... it's caused me to experience a moral injury," Dr Goodison told reporters.
Royal Australian and New Zealand College of Psychiatrists NSW chair Pramudie Gunaratne said doctors were sick of propping up the broken system.
"Psychiatrists are standing up to a government that has shown no interest in providing any meaningful changes in mental health," she said.
But Premier Chris Minns said the dispute with psychiatrists was not systemic reform but rather "their personal salaries", reiterating providing a 25 per cent pay lift was not possible.
"To resign unless you get it ... puts the system under enormous pressure," he said.
Staff specialist psychiatrists earn a starting salary of $186,241 in NSW, rising to $251,618 for a senior doctor. With superannuation and other entitlements the government claims that figure can rise to $438,000 per year.
Doctors say they can earn higher salaries interstate and the government's offer of a 10.5 per cent lift fails to make up the shortfall.
About 200 public-sector psychiatrists in NSW are due to quit on Tuesday over a pay row. (HANDOUT/THRIVE PR)
Mental Health Minister Rose Jackson said psychiatrists would immediately have access to a 10 per cent "onerous duties allowance" in addition to the broader pay offer.
The government was seeking an "urgent intervention" from the industrial umpire and that hearing could happen as soon as Monday afternoon.
NSW is preparing contingencies including fly-in doctors and sending patients to the private health system.
Public patients in mental health distress will be assessed virtually by telehealth psychiatrists.
Dr Gunaratne said it was a ridiculous plan for a government that claimed it could not fund wage increases.
"To continue to prop up our mental health system with short-term contract staff who cost two to three times that of a permanent psychiatrist is damaging for patient care and it is an absolute waste of taxpayer dollars," she said.
Major changes to public mental-health services might have to follow, Mr Minns said.
It could mean having the psychiatrists' workload shouldered by lower-paid workers such as psychologists, nurses and counsellors, but the premier denied that would lead to lower levels of care.
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