Mental health improvement programme officially proposed eight months ago

A mental health improvement programme announced by Health Minister Dr Jonathan Coleman in early May was proposed last July. Photo / Mark Mitchell.

Exactly who would pay for a programme to improve secondary mental health services took six months to decipher and it was another two months before it was announced.

In that time Otorohanga man Ross Bremner seriously injured his father, and killed his mother, an elderly couple and himself, and Wellington man Simon Frank allegedly stabbed his wife to death.

In both cases, it is understood that leading up to the attacks, the dead women raised concerns with mental health authorities about the behaviour of the men who each had a history of mental illness.

Earlier this month Health Minister Dr Jonathan Coleman admitted "more needs to be done" when he announced extra money would be allocated in today's Budgetfor secondary mental health and addiction services.

But a leaked document, seen by the Herald, shows the Health Quality and Safety Commission was asked to investigate costings last year for the programme, which would target the country's high use of seclusion, improve physical health, improve how patients are transferred, standardise medications prescribed, and ensure lessons are learned from serious events and complaints.

The draft proposal, dated July 20, 2016 was an outline for investment by the Ministry of Health or DHBs to improve the quality and safety of mental health services.

"Over recent months concerns have been expressed by leaders within the mental health and addiction [MHA] sector," the proposal said.

"These concerns include significant events where normal processes for review and improvement have been impeded and significant criticism of services and health professionals in the public domain."

DHB chief executives had agreed with a proposal by Waikato DHB chief executive Dr Nigel Murray to support a mental health quality improvement programme similar to a Scottish patient safety model.

The proposal was written by Waikato mental health clinical director Dr Rees Tapsell with help from clinical directors at Counties Manukau and Auckland DHBs.

The chief executives wanted leadership from the commission, and the ministry asked for costings.

An initial five-year national quality improvement programme was proposed to improve five nationally agreed priorities with the cost of the programme anticipated at $1.4 million a year or $7m over five years.

The proposal included costings for the 2016/17 financial year but it was not announced by Coleman until earlier this month, with funding to be drawn from DHBs.

Labour's spokesman for mental health David Clark said the proposal should have been acted on faster.

"The situation is dire around the country and we've got specific incidences that illustrate just how stretched the service has become."

Clark said resources were stretched so thinly that mental health workers sometimes made mistakes or could not cope with the demand.

"So staff turnover is high, staff sickness is high, experienced people are leaving the sector, and police are being called in more frequently in acute cases."

Dave Macpherson, the father of Nicky Stevens - who died after leaving a Hamilton mental health facility unescorted - said mental health injuries and deaths in the past eight months including that of 21-year-old mother Chelsea Brunton might have been prevented if the programme was launched earlier.

Like Stevens' death in 2015, Brunton went missing from Palmerston North Hospital's mental health unit after going outside for a cigarette on May 6. She was found dead four days later.

David Codyre, one of the psychiatrists who called for the programme, said the proposal had not been ignored but that a person had been working fulltime for about six months on costings for the proposal.

Health Quality and Safety Commission chief executive Dr Janice Wilson said the programme would begin on July 1.

She said senior leaders in mental health approached DHBs in July last year about the need for an improvement programme.

"The Ministry of Health and DHBs requested a proposal from the commission for such a programme, and a draft proposal was presented to DHB chief executives in November 2016."

After a meeting of DHB chiefs and board chairs in March the proposal was approved and announced as part of a social investment package on May 4.