Mental health services are being stretched to capacity in Northland due to a sharp increase in the number of people using them.
Along with that increase, staff safety has been identified as an issue at the Tumanako Inpatient Unit at Whangarei Hospital. Over the last five years assaults on mental health staff accounted for 101 of 153 total staff assaults, equating to two out of three.
As a result, the board started a formal review of the service's management structure in February, which is due to be completed in September.
The review had a focus on improving service performance, patient safety and service quality, financial performance and sustainability.
General manager for the service Kim Tito said the board was continually reviewing and adapting to cope with the changing needs.
"We have an ageing population, people living longer and with more chronic health conditions, including mental illness," Mr Tito said.
"The nature of mental illness means that on occasion there may be risks to the patient's own health, for example self-harm or suicide, or to others."
"We are seeing more people and seeing them more often in order to try and provide the best possible care."
While in 2011 around one in 30 people in Northland were using the service, that number jumped to one in 20 people in 2014. Not only was there an increase in demand, there was an increase in the severity of conditions.
The Tumanako Inpatient Unit, which has 25 beds for acute care, was close to 100 per cent occupancy for the last two years.
In February, that number was 102 per cent but when including patients on leave it rose to 118 per cent.
While two beds were set aside at the unit for children and youth, they were used for adults when not occupied due to the higher demand.
"There are emerging needs, we are having to plan and develop new responses for, ie people with high and complex needs that current services are unable to meet," Mr Tito said. It was an issue not just facing Northland, he said.
"Northland DHB endeavours to maintain healthy and safe staffing levels at all times, and there is currently a drive to fill some nursing vacancy gaps so that we are able to maintain the required staffing levels."
Northland District Health Board's mental health services also ran $490,000 over budget in the year to April. It was mainly because of the demand for the inpatient unit leading to a "very high" rate of overtime, chief executive Nick Chamberlain said in a report to the board.
The total budget for the 2014/15 year was $8.58 million.