Frontline services for young people are affected due to staffing issues. Photo/Getty Images
It had been another difficult change at Porirua’s adolescent psychiatric unit, where chronic understaffing had made the task of caring for seriously mentally ill teenagers an exhausting struggle.
“We are in the red,” wrote an employee in the local health authority’s safety monitoring system, in what had become an almost daily routine at the 12-bed facility.
Shift after shift between November and April, rangatahi regional adolescent unit did not have enough experienced staff to properly care for seriously ill adolescents admitted to the facility, according to security records obtained by the Herald.
During this six-month period, employees recorded dozens of “safe staffing” incidents, which together show how employees routinely worked overtime to fill roster gaps, rationed care they were lavishing and worried about the safety of their colleagues and the very vulnerable patients under their watch.
The conditions in the unit – which sparked a showdown late last year between staff, unions and management – are a stark illustration of a workforce crisis plaguing the services mental health across the country.
In recent months, a significant Herald An investigation has detailed how an inconsistent and underfunded public mental health system has been pushed to the brink because it does not have enough trained staff to deal with a growing wave of distress.
Here are some of the key points from our report:
Staffing shortages have a direct and significant impact on the availability and quality of care for people who desperately need it.
The HeraldThe investigation documented numerous instances of frontline services interrupted, restricted or withdrawn due to staffing issues. An example is the rangatahi unit. Another is the Central Region Eating Disorder Service, which provides intensive treatment for people with anorexia and bulimia in the lower North Island. It closed for 12 days in December because it did not have enough staff, according to a briefing from health officials to Health Minister Andrew Little.
Across the country, mental health care providers have raised the thresholds for accessing specialized treatment. People who are accepted into services face increasingly long waits for assessments and therapy; in too many cases, the care provided is insufficient or inappropriate. Often people in crisis are referred to hospital emergency departments where they wait for hours in distress to be sent home with little follow-up. It is almost impossible in some places to find vacant beds for people who need hospital treatment.
As a result, many people with life-altering mental disorders do not receive prompt and effective care, with potentially enormous consequences for their safety, well-being, careers, finances, education and relationships. Thousands of Kiwi families are enduring unnecessary anguish because they cannot get help for their loved ones. The mental health crisis is also putting enormous pressure on communities, charities, GPs, schools, police and other public services which have their own resource challenges.
Frontline staff are doing heroic work, but they are exhausted.
Caring for people with serious mental illness requires a great deal of skill, experience and tolerance. It’s not an easy task at the best of times.
Because the services are so expansive, clinicians often have workloads much larger than recommended levels. They regularly work overtime and double shifts. They spend more time with patients in crisis, which is time consuming, stressful and catastrophic when something goes wrong. In some places, inexperienced personnel are put in situations for which they are not equipped, without adequate supervision.
Many clinicians have chosen to leave mental health services for better paying and less stressful jobs in other public agencies or in private practice. Some went to Australia instead. Those who remain feel increasingly “desperate”, according to a clinical psychologist, because it seems increasingly difficult to provide the treatment their patients need – and because they do not feel that the government or their bosses in the regional health authorities really listen to their concerns. .
“There just doesn’t seem to be a way out of our current situation,” says the psychologist.
This is a crisis that has been brewing for years.
Covid-19 has added to the strain on mental health services, pushing more people into distress and worsening workforce issues, but that has not caused this crisis. Alarms have been flashing red for a long time.
In the mid-1990s, the landmark Mason Inquiry identified workforce constraints as “probably the single most important concern in the mental health sector” and called for an urgent national strategy to secure sufficient numbers psychiatrists, psychologists, nurses, social workers, occupational therapists. and other industry professionals.
Over the following decades, however, successive governments – also led by National – failed to develop an adequate pool of local talent, while not doing enough to reduce demand for services. The number of people seeking mental health treatment has steadily increased, but services have remained fragmented, disconnected, inconsistent, underfunded and understaffed. District health boards relied on the goodwill of staff to do more with less and recruited heavily from overseas, but international recruitment became much more difficult after the pandemic.
Labor gets it, to some extent, and has initiatives underway to increase the workforce.
Jacinda Ardern’s administration made mental health the top priority of its high-profile 2019 ‘Wellness’ budget and committed about $2 billion to mental health-related initiatives, including hand development. -work. On Friday, Little announced a new initiative that he promised will put more “boots on the ground,” a regulatory change that will allow counselors to work in clinical roles in public services for the first time.
Health officials say they have created about 990 frontline mental health jobs in primary care settings in recent years and added about 710 new graduate nurses to specialty services. In internal briefings obtained by the Heraldthey told Little they were working on a series of other “innovative” measures to expand the workforce that will relieve pressure across the system.
But the government must do much more.
The Herald interviewed dozens of clinicians, support workers, managers and others in the sector who hailed this government’s increased attention to mental health, but said its grand ambitions had not further improved the conditions on the ground. On the contrary, they say, the pressures at the hard end of the system have worsened.
Labor opted to prioritize getting early intervention in place for people with milder conditions in primary settings, a gap that needed to be filled, but specialist service clinicians say it has done at the cost of improving other parts of the system.
While ministry officials are working on creative measures to attract new recruits to the sector, experienced staff keep leaving because they are so fed up. Over the past two years, 1,778 nurses have left the industry, an “exit rate” of nearly one in five, according to Nursing Council figures. The exodus drains vital skills and expertise from the system that cannot easily be replaced.
“We’re going as fast as we can,” Little told the Herald, but senior industry officials are growing impatient. They want urgent action to prevent existing staff from leaving, including paying them better. More generally, they want clear and ambitious plans to improve services, including an overhaul of training regimes to develop a better pipeline of local psychiatrists, psychologists and other specialists.
It is a project that will take many years, perhaps decades, and will require sustained attention and investment by future governments beyond this one.
Help us investigate
This story is part of a series looking at the state of mental health services and how to improve them. We need your help to continue our report. If you have experience of mental health services, as a patient, carer, staff or manager, and have information that would help us understand the pressures on them, please contact Surveys Editor Alex Spence at [email protected] We will not publish your name or identify you as a source unless you wish.
Where to get help
If it is an emergency and you or someone else is in danger, call 111.
For advice and support
safety rope: Call 0800 543 354 or text 4357 (HELP)
Suicide Crisis Helpline: Call 0508 828 865 (0508 TAUTOKO)
Need to talk? Call or text 1737
Depression Helpline: Call 0800 111 757 or text 4202
For children and young people
Youth Line: Call 0800 376 633 or text 234
What’s new: Call 0800 942 8787 (11 a.m. to 11 p.m.) or webchat (11 a.m. to 10:30 p.m.)
For help with specific issues
Alcohol and Drug Helpline: Call 0800 787 797
Anxiety Helpline: Call 0800 269 4389 (0800 ANXIETY)
To present: Call 0800 688 5463 (0800 OUTLINE) (6pm-9pm)
Safe to speak (sexual abuse): Call 0800 044 334 or text 4334
All services are free and available 24/7, unless otherwise specified.
For more information and support, talk to your local doctor, hauora, community mental health team or counseling service. The Mental Health Foundation has more helplines and service contacts on its website.