In the busy emergency department where mental health nurse Kim Gallaher works, people at the lowest point in their life can wait up to 12 hours before being seen.
They've reached a point where they desperately need help, and need it now.
But after they're finally seen, sometimes all she can do is send them away. There often aren't enough beds available to keep people overnight, and waiting lists for external services are long.
"The abuse they've sustained, the neglect they've experienced, the racism they've experienced — we see all of their trauma, they talk to us about all of their worst experiences," she said.
"And we have to listen, because we care and we want to make something different.
"And then we have to say 'I'm sorry, I don't have the services to [help] you', and that's the bit that gets me — that's the bit that I get angry about."
It's no secret that Victoria's public health system is strained at the moment, but mental health is facing its own crisis.
Despite the 2019 Royal Commission into Victoria's Mental Health System and billions of dollars of investment over the past year, the sector is in dire straits.
Kim and other mental health workers have told the ABC patients are still falling through the cracks, often with terrible consequences.
What's causing the crisis?
Chief among the problems is a major shortage of workers, with hundreds of vacancies across the state and no-one to fill them. Those that are left are facing burnout.
"[The Victorian government] basically said they're going to implement all of the recommendations from the royal commission," Ms Gallaher said.
"That's a huge undertaking — and yes, we're on our way to doing that — but without staff, this doesn't work."
The government's ambitious program to implement the recommendations, some by the end of this year, has led many workers to leave frontline work and move into non-clinical roles.
One worker said this comes at a time when acute services are busier than ever with '"incredibly unwell" people.
Those that are left on the frontline tend to be junior staff, filling roles once reserved for those with more experience.
Health and Community Services Union secretary Paul Healey said new job vacancies were increasingly being advertised online as a result of the royal commission.
"Over 3,000 new positions are coming into mental health, which is really exciting, really needed," he said.
"But without the workforce there, it's not going to do."
The reasons for the shortage are numerous, but include the recent halt in immigration, a lack of healthcare workers wanting to pursue a career in mental health and people leaving due to burnout.
Workers also say pay is an issue.
Adding salt to the wounds for the remaining frontline workers, Ms Gallaher said, is that mental health workers in the public health system have not had a rise since April 2019.
Their four-year enterprise bargaining agreement (EBA) was meant to start in 2020, but was only approved by the Fair Work Commission on Friday after being signed off by the government last year.
This also means their pay rises of approximately 10 per cent, to come in over four years, have yet to kick in.
Meanwhile, general nurses had their pay increases implemented in 2020.
"We look after the patients, but who's advocating for us? Who's looking out for the [mental health] nurses so we don't leave, so we don't go: 'I can get a much easier job somewhere else and earn the same amount of money'?" Ms Gallaher asked.
"Why would I stay? And there's a lot of people [thinking that]."
Staffing problems could be leading to increased use of force
Victorian Mental Illness Awareness Council chief executive Craig Wallace said the staffing crunch was having a profound impact on service users and patients.
He said a lack of staff was leading to the increased use of force and restraint in Victorian hospitals.
A recent report by the organisation found 7,500 instances of staff restraining patients and locking them in a room alone in 2020-21.
That's an increase over the past four years, despite the government agreeing to end the practice by 2031.
"And of course, we're greatly concerned about how [the worker shortage] could lead to the use of restrictive interventions."
Another mental health sector insider, who did not want to be named, said Victoria was lagging far behind other states in recruiting and retaining frontline staff despite all the planned reforms to the sector.
They said the federal government should also put more money in the system to increase staff numbers.
In a statement, Mental Health Minister James Merlino said the government was committed to building the mental health workforce.
"Without the care of our dedicated mental health professionals, the new beds, inpatient facilities and community mental health services we're busy building won't get Victorians the support they need — that's why this year's budget delivered the largest investment in our mental health workforce in this state's history," Mr Merlino said.
Despite the strain she is under, Ms Gallaher is not planning to leave the frontline.
"I'm not at that point yet, and I'm glad I'm not at that point yet," she said.
"I love what I do and I want to make services better."
She said she just hoped the government's plan to get others to join her worked.
