By Phil Pennington of RNZ
Health New Zealand Te Whatu Ora is scrambling to bring in new ways to cope with people in mental health distress from Monday, as police pull back from non-emergency mental health call-outs.
It issued new procedures to health staff aimed primarily at patient and worker safety a few days ago. This was followed on Friday by an update it said to “share urgently”, just 72 hours ahead of implementing the untested changes.
Health workers have expressed worries that they – and patients – will be exposed to more violence with less police back-up.
Police say they have no choice but to pull back as mental health callouts are cutting into their crime-fighting duties.
The Government said Monday’s first phase had been carefully planned to “stand up a workforce” to fill the gap left by police, who began gradually pulling back in recent weeks at the same time as trialling a new way of prioritising non-emergency calls.
Health NZ issued staff with three new mechanisms, called standard operating procedures, that will apply from Monday.
These cover what health staff do in response to police doing less transporting of people in distress – say from a family’s home to a clinic, or from a small hospital to a major one with better treatment facilities – spending less time on handovers to staff in emergency departments, and narrowing down when officers will respond to calls from a mental health or addiction facility.
The first phase of changes covered interactions with voluntary patients, which were “largely considered low risk”, Health NZ told RNZ.
For compulsorily detained people who can be more agitated or violent, other changes are planned to kick in from March, having been pushed back two months.
“Police have advised that they will always be involved where there is an immediate risk to life or safety, or an offence has occurred,” the procedures stated.
Health NZ was blocked from getting all the information it wanted to draw on for its plans, when a project to analyse mental health 111 and other calls to police ran into privacy and ethical problems.
Public Service Association health sector leader Ashok Shankar said they were not confident the procedures would manage the extra risks, and frontline workers had had little input.
“They have been rushed through,” he said, adding the association got a copy on October 15, asked Health NZ for a postponement but was told the procedures were only interim.
“They have only been put out to our members in the last week or so. And we have not had any engagement ... from what we are hearing from our members, none of them have been involved.”
The procedures failed to account for different risks between large urban hospitals and small rural ones, and for different roles such as security guards versus nurses, he said.
In an email on Friday, Health NZ’s head of safety attached “an important update on some streamlined processes which police have put in place to support the first phase of change. Information about this went out late yesterday”.
The Government has talked about police wasting valuable time on handovers or transportation.
The new directive on transportation said health workers were only to call for police help where there “is an urgent need for transportation and there is an immediate risk to the safety of the patient, staff, or others”; and after all other options had been explored first, and the situation become a “high-risk or emergency”.
The police say other agencies must step into the gap. However, the ambulance association has said its people would be put at more risk and needed stab-proof vests.
The procedures stressed that if there was “person-to-person physical aggression” or the “risk and likelihood of person-to-person aggression is imminent”, then health staff must call 111.
Top-priority 111 calls have not been part of the police pilot reprioritising less urgent calls.
RNZ has copies of the three standard operating procedures, covered below.
Police are instituting a higher threshold for transporting people in mental health cases from Monday.
“Please ensure all other options are exhausted before considering police assistance in non-urgent situations,” the procedure said.
Options included calling an ambulance or “support from security if appropriate”. Police will only be permitted to carry out mental health transportation if they are accompanied by a mental health practitioner.
The standard said it aims to ensure safe, timely, co-ordinated transfers, while ensuring staff safety “including in the event when police are unable to provide or decline assistance”. It aimed to ensure a national and common understanding of when to call police if there is a big enough risk.
“There are some non-urgent situations where police will attend, but not immediately.”
Police intend to spend less time on handovers to health workers. The procedure says they will depart as soon as a triage nurse has checked for any security alerts about the person.
“Police will undertake a safety assessment and liaise with emergency department staff or security before they leave to consider whether the patient is a risk to themselves or others.”
If there are safety concerns, officers will refer it up to a district command centre for further checks.
Police will call mental health workers to discuss a situation prior to bringing someone into emergency for assessment, including looking at alternative options “if appropriate”.
“If there are any concerns from police regarding aggression or safety and/or the patient not wanting to remain in [the emergency department], this will not be deemed a voluntary patient handover.”
Health NZ has told hospital staff to check their system for “alerts” about people police bring in, before the police leave.
Hospital security can also get involved.
Police intend to not go out so often to call-outs from a mental health inpatient facility.
“Before calls for police assistance are made and the person of concern is an inpatient or has been brought to a mental health inpatient unit for admission, all other health processes and procedures will have been considered and followed where indicated,” the procedure says.
The other processes might include behavioural efforts, medical or drug intervention, or getting facility security or the person’s whānau involved.
It gives the directive to make an emergency police call if there is violence or staff cannot contain the situation.
“Please ensure all other options above are exhausted before considering police assistance in non-urgent situations.”
Health NZ has set up a national operational working group of workers from mental health, emergency department, and security teams to adapt the new practices and procedures, the agency said.
“Our focus is on ensuring people receive the right care at the right time, while maintaining staff safety and the integrity of our services,” interim national clinical chief for mental health and addiction Murray Patton told RNZ in a statement.
“Each district is working with their impacted teams to ensure they can implement these changes to meet local needs, as well as engaging with local police.
“We will be closely monitoring how the first phase of change proceeds to ensure our planning for the subsequent phases are appropriate.”
– RNZ
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