The Bay of Plenty District Health Board has two mental health inpatient units - one in Tauranga and one in Whakatāne. Photo / George Novak
There have been 176 assaults on mental health staff at the Bay of Plenty District Health Board's inpatient units in the past five years, with the most serious involving staff being punched and treated for asphyxiation.
A nurses' union is "very concerned" about assaults and their psychological effect on nurses, and says some assaults go unreported.
The district health board's chief executive, Pete Chandler, said reports are taken "very seriously" and staff members are encouraged to report all incidents.
"We're acutely aware of the impact incidents of this nature can have."
Data obtained under the Official Information Act from the Bay of Plenty District Health Board showed there were 176 recorded assaults on health staff at its two mental health inpatient facilities in Tauranga and Whakatāne between January 1, 2017 and December 31, 2021.
More than a third of recorded assaults - 74 - resulted in harm being reported. Seven required a police callout.
The most serious of assaults requiring police to attend happened in April 2020 when a staff member entered a patient's room to give prescribed medication and attempted to move to another room.
The patient "suddenly punched [the] staff member in the eye twice".
Police were called immediately and the staff member was treated in the emergency department for a soft-tissue injury.
A second incident happened in July 2021 when a patient became "agitated" and was "verbally threatening" staff. The patient was given medication and returned to their bed space.
The patient emerged from their room and punched a staff member in the throat. The staff member was treated in the emergency department for asphyxiation.
There were also 124 recorded incidents of verbal abuse or threats on health staff at the DHB's mental health inpatient units. However, such incidents were "very heavily under-reported due to the nature of being able to report and also the level experienced".
The New Zealand Nurses Organisation mental health nurses section chairwoman, Helen Garrick, said the committee had been "very concerned" for a long time about assaults and the impact on nurses.
From what had been reported to the committee, Garrick said it could leave nurses feeling "undervalued" if they thought the fact they had been assaulted was not important.
Garrick said the organisation had done Official Information Act requests for all DHBs about assaults on staff and got data back from most of them. Their situations were "very similar".
Data obtained under the Official Information Act from Lakes District Health Board showed there were 130 recorded assaults on health staff at its Whare Whakaue Acute Inpatient unit between January 1, 2017 and December 31, 2021.
Speaking generally, she said many assaults go unreported.
"There seems to be a sense that reporting will get you nowhere.
"I do understand people just get sick of it ... and just get on with things.
"And then maybe later regret not reporting it because they realise that sometimes injuries or traumas may sneak up on you later on."
Garrick said there were several reasons behind assaults occurring, including that people in the mental health inpatient units were "very unwell".
"When people are distressed they become fearful and reactive to anything that happens around them because they're frightened ... and sometimes that comes in the form of an assault."
Staffing was another issue, in that there was a lack of "experienced knowledgeable skilful staff".
"We have a mental health worker shortage."
The presence of alcohol and methamphetamine also contributed to the number of assaults, she said.
Bay of Plenty District Health Board chief executive Pete Chandler said work was under way to make reporting assaults easier for staff given how busy they were.
"We're concerned about any under-reporting because we review all data each month at our board meetings and form a view on whether changes and interventions are working, or need to be revisited.
"Making sure we have the most accurate picture of assaults on staff and monitoring this trend with a view of what other investments we need to make has been a key topic of exploration between the board and management over the last year."
Bay of Plenty District Health Board mental health and addictions business leader Jen Boryer said there were several measures in place to keep staff safe, including rostered security guards and a "risk assessment" of admitted patients.
Staff were also trained in Safe Practice Effective Communication, which focused "heavily" on de-escalation. The training was an "accepted national training package" for people working in acute mental health settings, particularly inpatient units.
Further measures included duress alarm systems, the potential to "flex the facility environment" to respond to "increasingly disturbed behaviour", and the transition of acutely disturbed patients to intensive psychiatric care, which was a purpose-built, lower-stimulus area with a higher staff-to-patient ratio.
Boryer said de-escalation tactics included personal interaction, engagement and negotiation, "cultural matching" of service users and staff, and moving the person to a quieter area alongside removing any triggers for agitation or fear.
"Fast-acting medication" was also available to manage acutely disturbed patients.
If a situation got out of hand, staff would activate the personal duress alarm system and additional staff, who may include security, would attend the incident.
In August 2017, the Bay of Plenty Times reported staff in Tauranga Hospital's mental health unit had raised safety fears after attacks by patients high on P or synthetic cannabis.
Instead of hiring more security guards to help deal with violent patients, a letter and leaked emails showed staff claimed DHB management had asked them to calm aggressive patients by "talking them down".
In response at the time, the board said most mental health patients were not violent. It conceded security guards were not routinely used for interventions but if a duress alarm was activated there was an immediate response from appropriately trained staff.
Bay of Plenty police district prevention manager inspector Stephen Bullock said police worked closely with DHB staff when responding to incidents at DHB premises.
Officers approached all incidents of physical assault on a case-by-case basis using best practice as per police training. They used an operational threat assessment tool, TENR (Threat, Exposure, Necessity, Response), to assess and decide on appropriate action, Bullock said.