By Hamish Cardwell of RNZ
Wellington's centralised mental health triage system is 30 per cent understaffed, pushing out wait times and clinicians say it is making patients harder to treat.
For now, the shortfall is being covered by frontline staff from elsewhere, but that's taking them away from caring for the increasing number of people desperately needing help.
'I felt a real sense of hopelessness' - Max
In June, Max* was in a mental health crisis.
Increasingly desperate, he contacted Te Haika - Wellington's mental health triage centre.
His GP and counsellor also made referrals, and the service promised to contact him within days - it never did.
Finally establishing contact three weeks later, Max said Te Haika told him it had never got the original referrals - Max believes they lost his paperwork.
He ended up waiting six weeks to be treated - during which he self-harmed and thought of taking his own life.
"I felt a real sense of hopelessness that I had been trying to do the right thing.
"I was like right, if I can't keep myself safe and the support services in place also can't do that, then what hope do I have left."
The wait made his mental state worse - each day harder and harder.
Max said nearly all his interactions with Te Haika was with different staff members - meaning he'd have to repeat his situation and trauma.
Staff frequently mis-gendered him - leading Max to believe they had not read his file.
He said after every interaction with Te Haika staff he would cry.
"The last thing that I would want would be to finally talk to someone and have it leave me feeling worse, that's not what they should be there for.
"And ... having to explain all of the different compounding circumstances every time, like re-living things in a way, also had an impact."
Emma's teenage child's experience
For Wellington mother Emma*, it took four months from a GP referral for Te Haika to make contact about her teen daughter.
In that preliminary discussion, the Te Haika staffer indicated her child was a fit for the service, but a proper consultation about whether she could actually be taken on was not available for three months.
Waiting 'confusing' and 'frustrating' for patients - mental health nurse
The triage centre is about 30 per cent understaffed.
The region's Mental Health, Addiction and Intellectual Disability Service, which is responsible for Te Haika, said the average wait time for non-urgent referrals was 14 days - with acute referrals dealt with within 24 hours.
RNZ has spoken to a number of Wellington clinicians who say, in recent months, there has been up to 100 unprocessed referrals sitting with Te Haika - some months old.
A Wellington region community mental health nurse, Sarah*, said delays could lead to patients' mental health deteriorating, making them harder to treat.
"And it can also be really confusing for them as well, and frustrating, there's no clear information around their wait times, there's no clear information about what this process entails, so I can imagine it's really distressing for the individual and their whānau," she said.
"They might also have some preconceived unhelpful beliefs that people don't care or there's no support for them or their situation is futile or hopeless, and so this kind of delay could strengthen those unhelpful beliefs for them."
Sarah said the crunch at Te Haika meant it made administrative errors, making more work for their own stretched and understaffed teams.
"And so clients are getting double-booked for appointments, or not booked at all, or the communication with the receiving mental health team isn't taking place.
"And so that leads to further time for clinicians to sort that out and resolve those issues, that leads to clients being messed around because they have an appointment and it gets changed," Sarah said.
Covering at Te Haika taking clinicians away from treating patients
In a temporary measure, clinicians from other parts of the region's mental health service are being pulled in to help out at Te Haika.
Wellington region mental health clinician Molly* said, because of that, some appointments which would take two weeks are now taking up to two months.
"This is causing huge stress in the already struggling mental health teams and is affecting their capacity to do core clinical work.
"This is causing significant waits for clients and family from triage until initial appointment, and further bottlenecks before therapy starting."
She said staff workload was "not sustainable", and burnout and lack of capacity could lead to a tragedy.
Mental Health, Addiction and Intellectual Disability Service Executive Director Karla Bergquist said "we are very disappointed to hear of these experiences".
She said the team works incredibly hard to make sure everyone gets the help and support they needed.
She reiterated that urgent referrals are managed within 24 hours, and "any person who is seeking urgent support can be assured that they will receive it".
But she accepted non-urgent referrals were taking longer to triage.
Bergquist said it was recruiting to fill vacancies equivalent to 6.65 full-time roles for its team of nearly 22, and it was developing an ongoing recruitment campaign.
She said Te Haika has received 1700 referrals this year and has an increased focus on early intervention by working with primary care providers in a number of initiatives.
Eating disorder unit also understaffed
The eating disorder service CREDS, which covers the Wellington region, Manawatu-Whanganui and Hawke's Bay, is also nearly a quarter understaffed.
The Mental Health, Addiction and Intellectual Disability Service said earlier this month it was in the final stages of recruiting for 5.2 full-time equivalent roles for its team of just over 19.
It said wait times for this year have been impacted by an increased number of referrals and the Covid-19 alert level changes last year.
The average wait time for its programmes for the latest reporting period is 63 days, those with urgent needs are seen within days.
In April, RNZ reported there were 163 people on CREDS's waiting list.
RNZ has also reported in July that Wellington children and teenagers with severe mental health needs were facing more than six month wait times for treatment to start in some cases.
The DHB's child and adolescent mental health service - CAMHS - had been operating at about half capacity at times this year after many staff left - some due to stress and overwork.
* RNZ has agreed not to name people in this story
Where to get help
If you are worried about your mental health or someone else's, the best place to get help is your GP or local mental health provider. However, if you or someone else is in danger or endangering others, call police immediately on 111. Or if you need to talk to someone else:
Lifeline: 0800 543 354 (available 24/7)
Suicide Crisis Helpline: 0508 828 865 (0508 TAUTOKO) (available 24/7)
Youthline: 0800 376 633
Kidsline: 0800 543 754 (available 24/7)
Whatsup: 0800 942 8787 (Mon-Fri 1pm to 10pm. Sat-Sun 3pm-10pm)
Depression helpline: 0800 111 757 (available 24/7)
Rainbow Youth: (09) 376 4155
Samaritans: 0800 726 666.