"This is a crisis," he said. Dr Haikerwal, a Victorian GP and chairman of the World Medical Association Council, said after talking to psychiatric trainees in Victoria over the weekend, he was concerned about a low pass rate in their training program and the workload they faced in the stressed public hospital system. He said it was possible that changes introduced under the Mental Health Act last year in Victoria had increased the demands on psychiatrists and trainees, who were already having to quickly move very sick patients through the system because of high demand. "They often have to work overtime to do paper work which has increased several fold since new legislation came in and they have to go to court more often…so the burden has increased astronomically with the additional requirements," he said. "I think the government should go directly to the registrars and doctors working in the hospital system full time and ascertain the impact it is having on them."

This concern was backed up by another Victorian psychiatrist who did not want to be named. Dr Helen Schultz, a Melbourne psychiatrist who mentors training doctors, said the medical community was shocked by the deaths and hoped those affected would seek help if they needed it. "My heart goes out to all registrars and I really want to encourage them to go to their GP as a first port of call if they are not coping," she said. "Psychiatry training can be very tough at times." President of the Royal Australian and New Zealand College of Psychiatrists Murray Patton described the deaths as "very sad and tragic", but said they could not be explained by single factors, such as the rigours of their training program. "I don't know that we can say that there is a link between them in any way. This is obviously something that the coroner will be investigating," he said.

Dr Patton said the college was keen to ensure the stresses of the training program were mitigated as much as possible and that a group had recently been set up to work on the welfare of psychiatrists and psychiatric trainees. He said the college had removed one "high stakes clinical exam" that many trainees had found stressful and replaced it with assessments that take place inside their workplace. But one psychiatrist told Fairfax Media that this may be causing stress for trainees because it means they will be assessed by their supervisors, rather than an independent psychiatrist who does not know them. "No other college lets supervisors determine the registrar's progress towards fellowship, for obvious reasons. ie, if you get on the wrong side of a consultant, your career is ruined," said the psychiatrist who did not want to be named. But Dr Patton said there would be multiple examiners involved in the process.