Covid-19, our biggest health crisis in a century, has thrust healthcare into the spotlight. Over the course of this week, the Northern Advocate is exploring the role the health system plays in communities across Northland. Today, Adam Pearse examines the mental health and addiction part of our health system. It is a system that is under strain and not without its own issues but it also has a backbone of people working hard to meet patients' needs.
A mother of a patient at Whangārei's inpatient mental health unit, Tumanako, hopes other people will learn from her experience dealing with the facility.
The mother, Bethany*, became involved with Tumanako when her daughter, Lucy*, overdosed on pills and was placed into the 29-bed facility based at Whangārei Hospital on August 1.
According to Bethany, it then took 10 days until she was able to speak to the doctor caring for her daughter, which caused her a great deal of stress.
"We were in the dark pretty much," she said.
"We didn't know what was going on, we couldn't get into see the psychiatrist, we were on and off the phone, it was pretty crazy."
The family, who lived almost 10 hours away but drove to Whangārei and stayed for four weeks, had their first meeting with the doctor on August 10 followed by a second meeting on August 14, in which Bethany says she was informed they were planning on releasing Lucy from the unit - partly to free up beds in case a Covid-19 positive patient needed to be housed at the facility.
"We were blown away because she'd just had a [self-harm] incident a couple of days earlier, we still considered her high risk and even our daughter said in the meeting, 'I'm scared, I don't think I can keep myself safe', and we got the family advisor involved and pushed back and kept her in there," she said.
"It's just such a scary thought to think that they have to push people through that aren't ready just for the mere fact that they don't have enough resources and the beds available for the people to be looked after."
Over Lucy's eight-week stay in the unit, which was set to end this week, Bethany said her daughter had over a dozen incidents of self-harm or worse.
However, Bethany maintains she was only informed by Tumanako staff of one incident, despite establishing she would be informed of all such incidents by staff. All other incidents Bethany learned of through conversations with her daughter.
Then on September 11, upon ringing the unit to speak with Lucy's doctor, Bethany was informed that the doctor had resigned and a new doctor would be caring for Lucy.
"That really upset me because someone in [Lucy's] fragile state where change makes her anxiety a lot worse and we did have a self-harm thing that night," she said.
"Don't get me wrong, [Lucy] is still making that choice to [self-harm], but I just felt like why are we putting this extra pressure on these guys when they could have told her a week ago that the doctor was leaving?"
Lucy's first doctor will stay anonymous as attempts to contact the doctor for comment were unsuccessful.
Northland District Health Board mental health and addictions services general manager Ian McKenzie said while he wasn't intimately aware of Bethany's claims, he encouraged her to make a formal complaint so an investigation could take place.
McKenzie did say it would be "unusual" for a patient's family to wait 10 days to speak with their child's doctor and for a patient to be informed of a change of doctor on the day of the change.
McKenzie confirmed the unit was not keeping beds available for any potential Covid-19 positive patients, however, he did say plans were in place to do so if positive cases were found in Northland.
He said a Tumanako patient would only ever be discharged if the unit's medical professionals felt it was safe to do so.
McKenzie believed the care offered in Tumanako was good considering it was at about 95 per cent capacity on average and such units operated best at 85 per cent capacity or lower.
Lucy was set to be discharged this week and would go into her family's care for the time being. Bethany said she planned to lodge a formal complaint.
While Bethany was full of praise for the unit's nurses and Lucy's new doctor, who she said went above and beyond to help her daughter, her experience with the unit made her fearful other families might not have the confidence to challenge health officials as she did.
"Our fear is that families who aren't as vocal or haven't got the resources or the ability to search online and find out about the other people who can help them, will just sit there and take the doctor's word for whatever they want to do and not know any different."
Bethany hoped by telling her story, other families would speak up if they felt unsure while dealing with health services.
"Be the squeaky wheel. That was the only thing that got us results.
"I know it's hard not to trust the doctors because that's what we are conditioned to do, trust doctors and know that they're going to make the right decision, but I think questioning stuff and making sure that you're getting explained things in terms you understand were the biggest things for me."
It comes after the first suspected suicide in at least five years occurred at Tumanako in late August.
McKenzie confirmed the incident took place, but that it was the first of its kind in his five-year tenure as general manager. The death had been referred to the coroner and McKenzie said there would be an external review of the clinical practice leading up to and during the incident.
Detailed in the chief coroner's annual provisional suicide statistics, 39 Northlanders committed suicide from July 2019 to June 2020, an increase of 18 per cent on the previous year period (33) but a decrease from the period of July 2017 to June 2018 (41).
It was the third highest percentage rise behind Canterbury and Hawke's Bay. Overall, Northland was one of eight regions to see an increase in suicides in New Zealand from the previous year period.
In a recent report by Chief Ombudsman Peter Boshier, it detailed how the Whangārei unit had issues with a lack of privacy, out-of-date staff training and medication errors.
Read more: Ombudsman details Tumanakos' strengths/flaws
However, the report found there was no evidence tāngata whai ora (patients) had been subject to cruel, inhuman or degrading treatment or punishment - which had been found in two facilities in Wellington and Auckland.
The report, along with Bethany's story, contribute to an impression that Northland's acute mental health services were under-resourced and struggled to meet the need in the region.
Victoria Brown, a member of Māori health provider Whakawhiti Ora Pai's health promotion team, said Far North whānau did not have timely access to the region's crisis team – a service for people who were considered a danger to themselves or others.
"The process for me is too slow," she said.
"If I've rung a crisis team, they are [deliberating] whether they want to come up or not because of the distance ... and then they say, 'why don't you come into the hospital and get assessed', so they are always leaving the barrier up for whānau."
Brown was concerned that if the process seemed slow for someone who worked in the health system, it would seem very difficult for people without the inside knowledge to seek and receive the appropriate healthcare.
Ki A Ora Ngātiwai GP Dr Kyle Eggleton echoed Brown's comments, saying stories of the crisis team referring people in crisis to their GP or police were not uncommon.
"We have a crisis team which is, I'd have to say, perpetually difficult to get input from for some of our clients in crisis," he said.
"We've had people in some of our rural places who have been in real crisis with strong suicidal thoughts and when we've contacted the crisis team, we've been told to call the police so the police really become the default mental health service for many people."
Eggleton said such stories pointed to a struggling system which saw people with mental health needs fall through the gaps without good access to timely and culturally appropriate mental health services.
McKenzie said the crisis team worked hard to service Northland's population considering the region's difficult geography.
"[The crisis team], like any other service, peak and trough and some [incidents] span thousands of kilometres. If there is a crisis on one coast and a crisis on the other, we aren't equipped to deal with everyone at the same time.
"We do our damnedest to meet people's needs and I think out crisis staff are top clinicians who work very, very hard."
The hard work of service providers is a constant theme across the mental health and addiction services, no more so than at Northland's only inpatient detoxification unit.
Timatanga Hou is an eight-bed unit based at Dargaville Hospital which acts as a secure facility where people could address their addictions and develop strategies to live without them in the community.
Twenty-three-year-old Ravvivein Birchall is one of many success stories to come from the unit. Starting on methamphetamine at 18, Birchall became pregnant at 19 and gave birth to her first daughter in 2016 before coming to the unit a year later, trying to get clean.
However, Birchall's efforts to give up meth were not successful and she eventually gave custody of her daughter to her mother. It wasn't until she became pregnant with her second daughter in 2018 that Birchall considered going back to the unit.
Choosing between returning to the unit or giving up custody of her second child, Birchall made the decision to seek help again.
"It was heart-wrenching, but it was what I needed to get clean," she said.
Birchall has now been clean for 14 months and is working on improving her relationship with her mother and daughters, all of which she was very proud of.
"I feel amazing, you get a rush just realising how long you've been clean."
Asked to describe how easy it was source meth in Northland, Birchall speculated the number of crack houses in the region equalled the number of Northland corner dairies - multiplied by 500.
Birchall, who was interested in returning to work at Timatanga Hou, said the motivation to get clean had to come from within and advised anyone dealing with addiction to reach out to the unit for help.
"Take that first step and make the call to get help. As hard as it is, going on the waiting lists, just make that first step.
"Honestly, I don't know where I'd be without this place, I owe everything to the detox [unit]."
Stephanie Gough, 47, has struggled with addiction since the age of 14, attending a range of rehabilitation facilities across the North Island.
Gough has been through the Dargaville unit three times to deal with her alcohol and drug dependency and said the unit had offered some of the best support she had experienced.
"Unfortunately for me, I do keep falling over but it's places like [the unit] that have helped me get back on my feet," she said.
"I don't know what I would have done without it, to be honest."
Gough hoped people who were struggling to recover from their addiction could find the strength to continue on their journey of recovery despite of the reception they might get from others.
"People think that you don't try hard enough and you're a drain on the system and it's a daily struggle to try to beat that negativity and stay positive.
"It's not how many times you fall down, it's when you pick yourself up which matters, you can overcome any obstacle as long as you just keeping sticking with it."
Unit clinical nurse manager Rachel Beech has worked in mental health and addiction services for more than two decades and was in Dargaville when Timatanga Hou was opened as a three-bed unit in 2010.
Two more beds were added in 2012 before it was increased to its current eight beds. The average length of stay was about two weeks with at least 100 people going through the unit annually.
Currently, the waiting period for a room was five to seven weeks, down from the 10-12 weeks when the unit had only five beds.
Asked whether eight beds was enough, Beech said there would never be enough which indicated the importance of community-based rehabilitation programmes run by Odyssey House and Ngāti Hine Health Trust for people with long histories of addiction.
Regarding the unit, Beech said it was successful because of the welcoming nature of staff and their passion to aid others.
"It's one of the most common things that we hear that [the unit] is such a non-judgemental place to be so they feel accepted, and that the feel of the unit is warm and welcoming and people connect with that straight away.
"The staff and I want to be here, we want to support people to make change, we are passionate about it."
According to wastewater testing, Northland was the fourth worst region in amount of meth per capita as at July this year. Traditionally, Northland has been the worst by this measurement.
Northland DHB Alcohol and Other Drugs educator Noeleen Chaney is one member of the Te Ara Oranga meth harm reduction team, designed to combine police and health resources to reduce the drug's harm in Northland communities.
In her role, Chaney was a resource for communities to learn more about the impact of meth and what others could do to reduce harm in a region where the drug's prevalence was high.
"You probably wouldn't walk down too many streets before you had the opportunity to find meth if you were looking for it," Chaney said.
However, Chaney was encouraged by a growing interest from many communities to tackle their meth problems, which saw her travelling the region, advising groups on how to make sure their initiatives were long-lasting.
While she emphasised such work must be community-led, Chaney advised any interested community to contact the Te Ara Oranga team.
Discussions to address meth have been regular, especially in the Far North. Two weeks ago, a hui was held in Te Kao where almost 40 community members gathered to debate what was needed to curb the area's meth problem.
Some residents at Hope House, a rehabilitation facility in Kaitaia, attended the hui to educate the community on the drug. The hui ended with discussion of potentially forming a neighbourhood watch-type group.
Faye Murray, who founded Hope House with husband Tim, said it was good to see the community interested in the drug and how it operates.
Having struggled with alcohol and drug addiction themselves, Faye and Tim were committed to helping whānau in the Far North recover from their addiction.
In July, Hope House received just over $1.3 million in Government funding, which Faye and Tim planned to use to increase their cabin number from seven to 20, and to build an ablution block.
Faye hoped the funding would only further the positive impact they intended to have in the Far North.
"What we give people is our own journey of recovery, our experience and basically the 12-step programme we engaged in when we got sober.
"I know we are making a difference and like all things it takes time, but it's starting to happen."
*aliases have been used to ensure anonymity
Where to get help:
• Lifeline: 0800 543 354 (available 24/7)
• Suicide Crisis Helpline: 0508 828 865 (0508 TAUTOKO) (available 24/7)
• Youth services: (06) 3555 906
• Youthline: 0800 376 633
• Kidsline: 0800 543 754 (available 24/7)
• Whatsup: 0800 942 8787 (1pm to 11pm)
• Depression helpline: 0800 111 757 (available 24/7)
• Rainbow Youth: (09) 376 4155
• Helpline: 1737
If it is an emergency and you feel like you or someone else is at risk, call 111.