Mental health cases at one hospital's emergency department have jumped almost 400 per cent in the past five years, with no extra staffing to cope with the demand.
The presentations to Waikato Hospital's already overrun ED come at the same time as mental health "crisis contacts" have grown by more than 300 per cent in the region.
Staffing has been stretched to pressure point to cope with the increases and mental health workers are "visibly distressed" by their workload, according to a report to Waikato District Health Board's hospitals advisory committee today.
The report has raised eyebrows over why the situation was left to deteriorate to this point.
"The sustained pressure in the inpatient setting is a mirror image of what is occurring in our community teams - and the wider community," DHB mental health and addictions executive director Vicki Aitken said.
"Over time, existing adult community resource has been drawn from in order to effectively provide resourcing for crisis and home treatment services," she said.
"This has a knock-on effect of creating strain across all areas of community mental health."
The impact on teams was clear, Aitken said.
"There are less staff to provide the necessary treatment interventions."
Total resourcing for the region's crisis service was up to four staff mornings and afternoons with an on-call system overnight.
It often meant response times and demand resulted in unnecessary delays for much-needed assessment, Aitken said.
"This is particularly the case if staff are deployed to a crisis in Hauraki and another occurs in South Waikato at the same time, which is not uncommon."
The crisis team respond to urgent mental health incidents in the community.
Aitken said referrals to the crisis team peaked in December 2017 at 520 for the month, compared to 164 in early 2013, an increase of 317 per cent.
Statistics also showed presentations to Waikato Hospital's emergency department of people needing mental health assessment jumped from 42 in February 2013 to 167 in January this year, an increase of 397 per cent.
"While all areas of our service are under significant stress, some areas are now having staff whom are visibly distressed by the workload and the limited ability to respond to referrals."
Aitken said this was most true for the infant, child and adolescent mental health team, where youth crisis presentations were often complex and could take considerable time to resolve.
"Meanwhile, adult community services are struggling to meet demand across our community settings."
She said presentations in this area were largely complex and high needs and there appeared to be a direct link between that demand and the need for inpatient care, "often for longer periods where individuals take a considerable amount of time to get well".
Increasing prisoner numbers were also adding to the system backlog with a number of mentally unwell prisoners awaiting transfer.
The Ministry of Health was notified of the waiting list weekly, Aitken said.
The Regional Forensic Psychiatric Service, located at the Henry Bennett Centre at Waikato Hospital, alerted Waikato, Bay of Plenty, Lakes and Taranaki DHBs to the pressure on the 49-bed service and the need to "expedite" patients back to their own DHB when secure level care is over.
Aitken also talked about initiatives aimed at reducing the pressure including:
• nurses now deployed at Waikeria and Springhill prisons;
• a plan to base a mental health nurse practitioner in Waikato Hospital's ED;
• creating a specific triage role within the mental health service for older people;
• using police to spread details on where to get help when they attend mental health and drug incidents;
• continuing the Let's Talk Wellbeing to combat suicide;
• piloting a multi-agency programme to deliver effective safety responses to families to prevent minimise and family harm;
• And eliminating seclusion by 2020 as part of a national collaborative.
Last year the Herald revealed Waikato DHB had the highest seclusion hours of eight DHBs questioned, including locking-up a psychotic patient who had used cannabis and methamphetamine and violently assaulted staff and patients, for 23 consecutive days.
Waikato District Health Board member Dave Macpherson, whose son Nicky Stevens died in 2015 after leaving the Henry Bennett Centre unescorted, questioned why nothing had been done sooner to address the problems.
"These figures show how dramatically the mental health treatment deficit has grown and I have to wonder why the board and the Government did nothing to acknowledge the extent of the problem," Macpherson said.
"It's going to take very significant resource increase from the Government to deal with this, plus the workforce planning improvements that should have started years ago."