Frontline services for young people are being affected because of staffing issues. Photo / Getty Images
It had been another tough shift at the adolescent inpatient psychiatric unit in Porirua, where chronic understaffing had made the task of caring for acutely mentally ill teenagers an exhausting struggle.
"We are in the red," an employee wrote in the local health authority's safety monitoring system, in what had become an almost daily routine at the 12-bed facility.
On shift after shift between November and April, the regional rangatahi adolescent unit did not have enough experienced staff to properly care for the severely unwell teenagers admitted to the facility, according to safety logs obtained by the Herald.
In that six-month period, employees recorded dozens of "safe staffing" incidents, which together show how employees regularly worked overtime to cover roster gaps, rationed the care they provided, and worried about the safety of their colleagues and the highly vulnerable patients under their watch.
The conditions at the unit – which provoked a confrontation late last year between staff, unions, and management – are a stark illustration of a workforce crisis gripping mental health services across the country.
In the past several months, a major Herald investigation has detailed how a disjointed, underfunded public mental health system has been pushed to the brink because it doesn't have enough skilled staff to cope with a rising tide of distress.
Here are some of the key points from our reporting:
Staffing shortages are having a direct, significant impact on the availability and quality of care for people who desperately need it.
The Herald's investigation has documented numerous instances of frontline services being disrupted, restricted or withdrawn because of staffing issues. The rangatahi unit is one example. Another is the Central Region Eating Disorder Service, which provides intensive treatment to people with anorexia and bulimia across the lower part of the North Island. It closed for 12 days in December because it didn't have enough staff, according to a briefing by health officials to Health Minister Andrew Little.
Across the country, mental health providers have raised thresholds for access to specialist treatment. People who are accepted into services face increasingly long waits for assessments and therapy; in too many cases the care provided is inadequate or inappropriate. Often those in crisis are directed to hospital emergency departments where they wait for hours in distress only to be sent home with little follow-up. It's nearly impossible in some places to find vacant beds for people who need inpatient treatment.
As a result, many people with life-altering mental conditions are not getting timely and effective care, with potentially enormous consequences for their safety, wellbeing, careers, finances, schooling, and relationships. Thousands of Kiwi families are enduring unnecessary anguish because they can't get help for their loved ones. The mental health crisis is also putting huge strain on communities, charities, GPs, schools, police and other public services that have their own resourcing problems.
Staff on the front lines are doing a heroic job, but they're exhausted.
Caring for people with a serious mental illness requires a lot of skill, experience and tolerance. It's not an easy job at the best of times.
Because services are so stretched, clinicians are often carrying much bigger case loads than the recommended levels. They regularly work overtime and double shifts. They're spending more time with patients in crisis, which is time-consuming, stressful and catastrophic if something goes wrong. In some places, inexperienced staff are being put into situations they're not equipped for, without adequate supervision.
Many clinicians have opted to leave mental health services for high-paying, less stressful jobs in other public bodies or private practice. Some went to Australia instead. Those who remain feel increasingly "hopeless", according to one clinical psychologist, because it seems increasingly harder to provide the treatment their patients need – and because they don't feel the government or their bosses in regional health authorities are truly listening to their concerns.
"There just doesn't seem to be a way out of our current situation," the psychologist says.
This is a crisis has been brewing for years.
Covid-19 added to the strain on mental health services, pushing more people into distress and compounding the workforce problems, but it didn't cause this crisis. The alarms have been blinking red for a long time.
In the mid-1990s, the landmark Mason inquiry identified workforce constraints as "probably the most significant concern in the mental health sector", and called for an urgent national strategy to get sufficient numbers of psychiatrists, psychologists, nurses, social workers, occupational therapists and other professionals into the sector.
Over the next few decades, however, successive governments - led by National too - failed to develop an adequate pipeline of homegrown talent, while also not doing nearly enough to reduce the demand on services. The number of people seeking mental health treatment rose steadily but services remained fragmented, disconnected, inconsistent, underfunded and understaffed. District health boards relied on the goodwill of staff to do more with less and recruited heavily from overseas, but international recruitment became much harder after the pandemic.
Labour gets it, to some degree, and has initiatives under way to expand the workforce.
Jacinda Ardern's administration made mental health the top priority in its much-hyped 2019 "Wellbeing " budget and it has committed about $2 billion to mental health-related initiatives, including workforce development. On Friday, Little announced a new initiative that he promised will put more "boots on the ground", a regulatory change that will allow counsellors to work in clinical roles in public services for the first time.
Health officials say they've created around 990 frontline mental health jobs in primary care settings in the past few years, and added about 710 new graduate nurses to specialist services. In internal briefings obtained by the Herald, they told Little they're working on a range of other "innovative" measures to expand the workforce that will relieve the pressure across the system.
But the government needs to do a lot more.
The Herald interviewed dozens of clinicians, support workers, managers and others across the sector who welcomed the increased focus this government has brought to mental health but say its big ambitions haven't yet improved conditions on the ground. On the contrary, they say, pressures at the hard end of the system have got worse.
Labour chose to prioritise setting up early intervention for people with milder conditions in primary settings, a gap that needed filling, but clinicians in specialist services say this came at the cost of improving other parts of the system.
While ministry officials work on out-of-the-box measures to bring new recruits into the sector, experienced staff are continuing to leave because they're so fed up. In the past two years, 1778 nurses left the sector, an "exit rate" of close to one in five, according to Nursing Council figures. The exodus drains from the system vital skills and expertise that can't easily be replaced.
"We're going as fast as we can," Little told the Herald, but senior figures in the sector are running out of patience. They want urgent measures to stop existing staff leaving – including paying them better. More broadly, they want clear, ambitious plans to improve services, including an overhaul of the training regimes to develop a better pipeline of homegrown psychiatrists, psychologists and other specialists.
It's a project that will take many years, perhaps decades, and it will require sustained attention and investment from future governments beyond this one.
This story is part of a series examining the state of mental health services and how to improve them. We need your help to continue our reporting. If you have experience of mental health services, as a patient, caregiver, staff or manager, and have information that would help us understand the pressures on them, please contact Investigations Editor Alex Spence at alex.spence@nzme.co.nz. We will not publish your name or identify you as a source unless you want us to.
If it is an emergency and you or someone else is at risk, call 111.
For counselling and support
Lifeline: Call 0800 543 354 or text 4357 (HELP)
Suicide Crisis Helpline: Call 0508 828 865 (0508 TAUTOKO)
Need to talk? Call or text 1737
Depression helpline: Call 0800 111 757 or text 4202
For children and young people
Youthline: Call 0800 376 633 or text 234
What's Up: Call 0800 942 8787 (11am to 11pm) or webchat (11am to 10.30pm)
For help with specific issues
Alcohol and Drug Helpline: Call 0800 787 797
Anxiety Helpline: Call 0800 269 4389 (0800 ANXIETY)
OutLine: Call 0800 688 5463 (0800 OUTLINE) (6pm-9pm)
Safe to talk (sexual harm): Call 0800 044 334 or text 4334
All services are free and available 24/7 unless otherwise specified.
For more information and support, talk to your local doctor, hauora, community mental health team, or counselling service. The Mental Health Foundation has more helplines and service contacts on its website.
Glen Wright continues to deny the offending and claims the victims conspired against him.