Last week Auckland lost eight acute psychiatric beds. They were closed because staffing levels at the North Shore Unit, He Puna Waiora were so low that it was not possible to staff the unit safely. Funding shortfalls have meant it has been chronically understaffed, leading to staff burnout and increased assaults by patients on staff and other patients. It is now a place nurses simply can’t work safely anymore: so they choose not to.
Since then we’ve heard that the same situation exists within the Auckland District Health Board who currently have 18 vacancies within their acute unit. Counties Manakau DHB is also experiencing staff shortages with many staff working double shifts just to keep the unit open.
The Auckland DHB Community Acute Services, who manage acutely unwell people in their home to prevent them going into hospital, has now been closed altogether due to not having any staff available to run it.
The PSA believes that many other regions face the same issue, including Wellington and the West Coast. They have called these cuts just the “tip of the iceberg” when it comes to the reality of the problems we now face in the public mental health sector.
How did we get here, and what does this recent crisis tell us about the state of mental health services in New Zealand?
One of the big problems with the mental health sector in this country is that through a serious of historical accidents and deliberate funding decisions by successive governments we have a fractured and relatively disparate system, with many independent and interlocking parts coming together to be what we might consider in totality a “system.”
Acute services, for those suffering from psychosis or severe mood disorders, and/or being at risk of harming themselves (or others) have been catered for by the core public services, provided nationally by the DHBs. Over the years, varying levels of psychotherapy and ongoing support have been included as part of DHBs' services, dictated largely by funding levels.
The public services have always been supported in various ways, first in terms of crisis phone services like Lifeline, Youthline and other more specialised phone services (gambling, alcohol, etc.). Low-cost counselling services have been provided by NGOs – Relationship Services Aotearoa being the largest – with many small local agencies picking up the slack.
Of course, if you were fortunate enough to be able to afford full private services then you have always had plenty of choices.
But over recent years funding to all parts of the sector has, in real terms, shrunk.
The Council of Trade Unions estimates that the current funding shortfall in the Health sector overall, compared with 2009/ 10 funding levels, is around $1.2 billion dollars, and that District Health Boards are underfunded by $152 million. Furthermore, these funding shortfalls are cumulative, with each year from 2010 to the present experiencing a significant shortfall.
Essentially, funding increases have failed to keep up with population growth, ageing and inflation.
In 2015 funding for the largest NGO provider of counselling, Relationships Aotearoa, was cut. Since then many other services have faced shrinking budgets. Lifeline Aotearoa’s contract will not be renewed past the end of this year.
And given that we no longer have a funding “ring-fence” guaranteeing funding levels within DHBs for mental health, they are often the first to feel the pinch.
Talk therapy, expensive and time consuming as it is (from an accountant's point of view) is pretty much always first to go and many Community Mental Health Services now have no choice but to explicitly assess for ability to pay for private therapy as part of their clinical assessments.
Next to go is ongoing supportive care for the chronically unwell, whose primary clinical treatment is regular medication. If the client is ‘stable’ they get referred out to their GP, and lose the informal but important support of regular appointments with people who have time to listen and assess their ongoing state of mind.
If they become unwell, or suicidal, they can come back through the revolving door, but once they’re stable again, back to the GP.
All of this means New Zealand no longer has a functioning Mental Health Service. It has slowly and surely been whittled down to little more than an acute response service.
This is now also in crisis.
So it is little surprise that as also reported this week, Youthline is experiencing unprecedented call levels, to the point where they are simply unable to answer every call. Lifeline also reports similar demand for services.
So despite what the Mental Health Foundation CEO Shaun Robinson says, the fact Youthline is experiencing record demand for their help line is not due to the fact we are now more comfortable asking for help.
It’s due to the fact no one else is answering the phone.
The Ministry of Health’s response? To roll out the same cut-and-paste quotes about how much they’ve increased funding.
However the reality known by professionals in the system for some time is that we have now reached the point that unless urgent emergency action is taken, we face a system at risk of complete collapse.
The Ministry of Health needs to stop answering every question by citing the ways they’ve increased spending; I believe people are not interested in numbers when the system is clearly falling apart and people's lives are at stake.
The situation requires urgent action to ensure continuity of services in the acute wards and it also serves to further highlight the need for a National Review of Mental Health Services in New Zealand.
It is on this background that Mike King, myself and Action Station came together to carry out the People’s Review of the Mental Health System (there is also a Facebook page for the review).
Until the government takes positive action we will keep inviting anyone involved with mental health in New Zealand – from mental health professionals to those with either personal or family experience of the system – to tell their story, anonymously if necessary.
“[It] is possible to foresee that at some time or other the conscience of society will awake and remind it that the poor man should have as much right to assistance for his mind as he now has to the life-saving help offered by surgery; and that the neuroses threaten public health no less than tuberculosis and can be left as little to the latter to the impotent care of individual members of the community … institutions or outpatient clinics will be started to which analytically trained physicians will be appointed … Such treatments will be free”
(Sigmund Freud speaking at the Fifth International Psycho-Analytical Congress in Budapest in 1919).
Kyle MacDonald is a psychotherapist, NZ Herald columnist and co-host of the NewstalkZB Mental Health talkback show “The Nutters Club with Mike King.” For more see: psychotherapy.org.nz