National telehealth service Whakarongorau struggling to recruit staff to triage mental health crisis calls

Whakarongorau Aotearoa operates triage lines for Health NZ mental heatlh services across the country. Photo / 123RF

Mental Health Minister Matt Doocey wants a consistent national phone triage service for people experiencing urgent mental health problems. But Alex Spence reports that the national telehealth service that currently handles many crisis calls is struggling to find enough qualified staff.

The national telehealth service is struggling to recruit enough qualified clinical staff to operate 24/7 phone lines for triaging people with mental health problems, according to employees and union representatives.

They say the understaffing at Whakarongorau Aotearoa’s specialist mental health team, which provides triage lines for many of Health NZ’s public mental health services, as well as supporting police and ambulance services by handling some 111 calls, is causing distressed callers to wait longer and putting enormous strain on its workforce.

“We’re sat here trying to plug all of the gaps all over the country and we’re in crisis,” said a mental health nurse in the early mental health response (EMHR) team.

According to an internal document, Whakarongorau’s EMHR unit has a budget for 29 full-time clinicians but has “significant gaps” in its rosters because of staff turnover, sick leave, and recruitment challenges. In a recent four-week period, more than half the shifts were understaffed.

“We are expecting it to become even more difficult in the coming weeks and months until we can recruit more clinicians,” the document said. Hiring more qualified staff was challenging because of national workforce shortages and because Whakarongorau pays less than Health NZ.

Bruce Tomlinson, a delegate at NZNO, the nurse’s union, said: “We are operating at times at a half to a third of the numbers that we need to for some of our shifts because of not being able to attract and retain staff.”

The pressures at Whakarongorau are an obstacle to the Government’s ambitions to establish an improved national system for responding to people experiencing a mental health crisis.

Matt Doocey, the Mental Health Minister, has previously said he views triage lines as an important component of a reformed crisis-response system. Doocey has said he wants to have a national point of contact for mental health that is as easy to access as it is to summon police, fire, or ambulance services by calling 111.

Asked if he was aware of the staffing problems at Whakarongorau and if the Government will provide more funding for mental health triage lines, Doocey told the Herald: “I am aware of the many and varied workforce pressures across both the public and private mental health and addiction sector.”

Doocey said he has received a proposal from the police, Health NZ, and the Ministry of Health for a five-year transition to a “multi-agency” crisis-response system. Police are eager to offload more of the calls they respond to involving people in mental distress to health and social agencies, claiming that it has diverted resources from its core criminal justice responsibilities.

Responding to challenges - Mental Health Minister Matt Doocey. Photo / Andrew Warner

Doocey said the recommendations are under “active consideration” but would not comment on the details until the proposal is presented to Cabinet later this or next month.

At Whakarongorau, frontline nurses said they feel increasingly overwhelmed by the volume and complexity of calls they get from people in acute situations.

Tomlinson, the NZNO delegate, said that some calls are easily dealt with by using “comforting words” and providing guidance on local resources that the person could access. But the team also frequently receives calls involving immediate threats to safety.

“I honestly don’t keep count anymore,” Tomlinson said. “Once upon a time when we were adequately staffed, and our callers weren’t having to wait, it would be like, catch a call, have a quick breath, and then you might have a delay, depending on the time of day. Sometimes you’d be waiting 10 minutes for a call. Typically now it’s back-to-back calls and people are in the queue waiting. Some of them are having to wait for quite a while.”

Whakarongorau insists it does not set targets for call-handling times, but staff say they feel pressured to turn over calls quickly because others are waiting to get through.

The team’s caseload has recently increased after taking over the 24/7 triage line for the Wellington region.

Health NZ scrapped the region’s phone triage service, Te Haika, and outsourced the function to Whakarongorau in a controversial restructuring that the Herald first reported in August. Te Haika had been widely criticised and was so understaffed that, at one point last year, patients were told not to call the 24/7 line at night.

One Capital & Coast mental health patient said that, although Te Haika was flawed, she had found it helpful at times when she was feeling suicidal. Its staff had access to her medical records, knew her personalised safety plan, and were joined up with her regular clinicians.

In contrast, the Whakarongorau nurses are not as closely integrated with her team at Capital & Coast, she said, so “every time you call up, you’re just going to be a new person in their system”.

The patient said that, so far, her experiences with the replacement service at Whakarongorau have been frustrating, which has made her less inclined to call for help.

She has also had disappointing experiences with Whakarongorau’s counselling line, 1737, which is dedicated to non-urgent mental health problems and is operated by a separate part of the organisation to the EMHR triage services.

One night recently, she texted 1737 for help and received a reply saying: “We are experiencing high demand on the service. This means we are unable to provide timely support right now. If this is not urgent, please text us back another time.”

Adding to the pressures at Whakarongorau, staff say, is that police have recently declined to send officers to conduct “welfare checks” on people whose safety the Whakarongorau nurses are concerned about. Health NZ’s mental health services are usually too busy or understaffed to respond, which the Whakarongorau employees claim leaves them “stuck in the middle”. They say staff and service users are increasingly being placed in unsafe situations.

Tomlinson, at NZNO, said the Government needs to bolster mental health telehealth services with more staff and funding. “What’s the cheaper thing to do?” he said. “Put a decent fence with signs at the top of the cliff? Or keep your ambulance and emergency services at the bottom?”

Whakarongorau, previously known as Homecare Medical, is owned by the primary care organsations ProCare and Pegasus Health and funded by various Government departments. Its telehealth services also include Healthline, the National Poisons Centre hotline, and gambling and addiction counselling helplines.

Brian O’Connell, chief operating officer at Whakarongorau, said: “The EMHR team are a specialist, highly respected team who, every day, make a difference to people’s lives. They are a taonga for our organisation.

“Pressure on the mental health system, sector, and staff across the motu is well documented and reported on. As is the increasing complexity of the calls that come through to telehealth services, and the challenge of finding appropriately experienced mental health nurses, given the specialist nature and shortage across the sector. This all impacts the EMHR team. In addition, our staffing has reduced as a result of turnover and we are actively recruiting.”

Alex Spence is an investigative reporter and feature writer focusing on social issues. He joined the Herald in 2020 after 17 years in London where he worked for The Times, Politico, and BuzzFeed News. He can be reached at alex.spence@nzme.co.nz or by text or secure Signal messaging on 0272358834.