Eight beds have been temporarily closed at an Auckland psychiatric unit where a staffing shortage has become so bad workers fear for their lives.
"One of us will be killed. This is the theme of the conversations we have among ourselves, that one of us will be murdered, or a patient killed," said Donna Rendell, a Public Service Association delegate at He Puna Waiora.
The acute mental health unit is run by the Waitemata District Health Board at its North Shore Hospital in Takapuna. It had 35 beds but is now down to 27. It has 12 vacancies for nurses, from a total staff allocation of 86.9 equivalent fulltimers.
The situation at He Puna Waiora is symptomatic of wider concerns the union has about staffing shortages and workloads at inpatient units across the region.
The PSA says staff have been working double shifts and extended shifts and are burning out. Many have left because of safety concerns and the shortages have led to an increase in assaults by acutely unwell patients on staff and other patients.
The worst in recent weeks, said PSA organiser Brendon Lane, was when a patient hit a male nurse on the head with an oxygen cylinder.
"He had to go to hospital and be checked out and was off work for a while recovering from concussion.
"The situation at He Puna Waiora is symptomatic of wider concerns the union has about staffing shortages and workloads at inpatient units across the region," Lane told the Herald.
"We are calling on the Government to properly fund mental health services in Auckland, because there has been a huge increase in the number of people presenting to inpatient units and the general acuity [seriousness of mental illness] in the community but there has been no increase in staffing levels in inpatient units to match that."
Waitemata's human resources director, Fiona McCarthy, said the bed-closure decision was made "to ensure all inpatients receive an appropriate high level of care and to ensure appropriate workloads for our staff".
The DHB is working closely with non-government health services and other inpatient facilities "to ensure alternative care is available to those who need it".
Six new staff are in the process of starting work.
"We are actively recruiting and working with the PSA on roster arrangements while we fill the remaining positions as soon as possible."
"The DHB is recruiting additional suitably qualified staff to ensure a sustainable, long-term solution and we are making good progress."
She did not address the allegations of assaults, but said mental health staff often faced significant demands and challenging behaviours.
The DHB says its spending on psychiatric hospitals has increased 11 per cent since 2012; staffing levels have grown too.
Counties Manukau DHB's clinical director of mental health, Dr Peter Watson, said: "Like other DHBs we have particular work force shortages from time to time but we have active workforce strategies in place, including strong relationships with tertiary institutions to create a pipeline of health care workers."
Auckland DHB has not responded to the PSA's assertions.
Health Minister Jonathan Coleman is on leave but his spokeswoman noted funding for mental health and addiction services has increased from $1.1 billion in 2008/09 to more than $1.4 billion for 2015/16. The Budget in May included $12 million over four years for primary care and social services to enable people to access mental health help earlier. The three Auckland DHBs employ 38 per cent more fulltime equivalent doctors and 26 per cent more FTE nurses than eight years ago.
Coleman has said: "Youth access to mental health and addiction services has improved, and adult access rates have remained steady despite increasing demand."
The Government has resisted calls by the Green Party and others for a national inquiry into mental health services.
The Greens' call came after publication in April of what the party called a "damning review" of Waikato DHB's psychiatric care. The review followed a series of incidents, including the death of Nicky Stevens, who was found dead in the Waikato River in March after being released from the Henry Rongomau Bennett Centre at Waikato Hospital.
A review at Northland DHB found staff felt overworked, undervalued and unsafe at its crisis-driven Tumanako Inpatient Unit.
Northland and Waikato DHBs said they were addressing problems highlighted in the reviews.