Mental health care across NSW was thrust into the spotlight when Cumberland Hospital patient Setefano Mooniai Leaaetoa, 25, absconded care and allegedly mounted a murderous stabbing spree on Tuesday.
Another patient at the western Sydney hospital, Luke Peter Francis, 31, reportedly fled after threatening a nurse and taking her access card, before he was allegedly involved in a police pursuit that left two women dead on February 14.
But statewide data showed absconding from mental health care is not unique to Cumberland Hospital.
About 200 in-patient admissions in NSW since July 1 have absconded, at an average of around six per week.
A NSW Health spokesperson noted that was about one per cent of the total 20,000 mental health in-patient admissions in that time frame.
Patients abscond from Cumberland Hospital's acute mental health care unit at an average of 0.75 incidents per 1000 bed days - more than three times the state-wide average of 0.23.
Premier Chris Minns conceded security was not good enough across NSW and it was putting the public at risk.
"We need to make sure security is in place to protect staff and to protect the wider community, I'm not satisfied that's the case at the moment at Cumberland," he said.
"We've seen a number of people who have been responsible for security breaches that have gone on to commit alleged terrible crimes in our community ... we are committed to ensuring safety and security is upgraded so the public is safe."
A formal review into the two recent incidents and security protocols at Cumberland Hospital has been announced.
The NSW Nurses and Midwives' Association has continuously campaigned for higher staffing levels at Cumberland.
Unwell people leaving care at Cumberland was common and staff called police to report incidents about once a fortnight, according to one mental health clinician working there.
Clinicians would flag high-risk cases with their superiors and ask for multiple staff to be assigned to patients but would get told they don't have the resources available, registered nurse Nick Howson told the Sydney Morning Herald.
NSW opposition mental health spokeswoman Sarah Mitchell called for urgent attention to given to Cumberland Hospital before more innocent lives were lost.
"The mental health system is at breaking point ... with chronic bed shortages and exhausted staff walking out the door," she said.
Advocates for mental health patients say the community supports needed when people are discharged from facilities like Cumberland Hospital are inadequate.
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