An external review of Northland's mental health services has found Whangarei Hospital's Tumanako Inpatient Unit is crisis-driven, practises a medication-driven model of care and staff feel overworked, undervalued and unsafe.
The review into quality, safety and clinical risk issues across regionwide services, carried out over December and January, has made 39 recommendations on how to heal Northland District Health Board's Mental Health and Addiction Services.
Recommendations included simplifying its management structure; developing a philosophy of care which reflects recovery orientation; increasing bed numbers from 25 to 29; enhancing communication; developing a five-year mental health and addiction strategic plan; employing additional staff where workloads are excessive; developing a framework to monitor growth in demand; and adding a second crisis team. When it came to Maori mental health the DHB should consider having a Maori development leader and for the mental health and addiction team to undertake Maori/cultural responsiveness training.
The Tumanako Inpatient Unit scored worse than other sites for staff morale and confidence. According to the post-review report the DHB received in February, some work teams had "a siege mentality" culture, and many staff felt there was a lack of management communication and leadership.
The review, commissioned by CEO Nick Chamberlain in response to "ongoing concerns about the quality and safety of the service and clinical risk", found there was no strategic direction in place for the overall service, inadequate budgets and other planning to cope with a year-on-year increase in demand, and a cumbersome management structure. Among concerns raised by more than 130 staff during the review were that they had limited or no therapeutic input into patient treatment, and there was a lack of consistent documentation and discharge planning.
Dr Chamberlain has welcomed the findings and the raft of recommendations, saying he commissioned the review in response to ongoing concerns raised in-house.
"We think the review should be viewed in a positive light and we were not surprised by the number of recommendations or the findings, many of which were already well known and many of the solutions and recommendations were already planned, and some came directly from previous planning sessions," he said.
The service's management structure had already changed, a process that was under way anyway following the resignation earlier this year of Kim Tito, the services' general manager and also manager of Maori Health. Dr Chamberlain said neither that resignation nor other recent senior staff departures were related to the review. The review was critical of the DHB not increasing its mental health services budget in the face of a year-on-year increase in demand.
"We have been very transparent with the review recommendations because they provide us with a number of longer-term sustainable solutions to the ongoing challenges of trying to meet rapidly increasing demand with finite resources, that must be carefully prioritised against other service demands and health need," he said.
"Recruitment for psychiatrists is ongoing and the review has provided impetus for changes to be made, particularly in reviewing the model of care."
The review panel met with more than 130 staff, received 12 written submissions and analysed documentation, including previous reviews.
There are 328 people employed in the DHB's mental health services, and 10 staff vacancies. In the last two years the turnover was 78, about one-quarter of staff.