Staff working at an overcrowded mental health unit at Whanganui Hospital have been head-butted, spat at, punched, received death threats and there's been one sexual assault.
Whanganui District Health Board members were deeply concerned to hear of the "bed crisis" at the hospital's Te Awhina unit at a committee meeting last Friday.
Board members were told there had been more than 20 assaults by patients on staff in the unit in the past year.
"We are alarmed by it. We take it pretty seriously," said the hospital's associate director of Mental Health and Addiction Services, Jeff Hammond.
"We investigate each one, we work with the police on it. Our staff safety is important.
"I think it's a reflection ... of society in general actually.
"We just notice there has been more assaults than usual. In the health game in places like ED [Emergency Department] from time to time ... we will deal with aggressive people. It's just there's been an increase in them, really."
There had been injuries, "not career-ending injuries", Hammond said, "but there've been bruises and concussions. There have been injuries where people have had to take time off work."
Despite the assaults, Hammond said there hadn't been much turnover in staff.
The DHB said it was likely the increase in patients and the seriousness of their conditions reflected an increase in the number of assaults on staff.
The unit is funded for 12 patients but had regularly been well above that and peaked on August 20 with 23 patients.
Patients were sleeping on couches and mattresses on the floor.
Hammond said whenever tangata whaiora (patients) spend time away from the unit, the bed they were in was immediately filled.
Other solutions involved getting lucky when another DHB or NGO such as Pathways had a spare bed they could use. But Hammond said that was rare.
"The whole system is stretched, they're stretched as much as we are.
"Taranaki DHB have held two for us in recent times. The fact is we've been ringing these DHBs every week but they've got no beds to offer us because they're under the same amount of pressure.
"Every week I receive [calls] from around the country - Lakes, Hawke's Bay, Midcentral [DHBs] - 'have you got a bed, can we send someone over to you?' That happens all the time ... the whole country's under pressure."
Hammond said discharging patients had become more difficult due to the squeeze on accommodation in the city.
"Obviously people seem to be under a lot of pressure in the community.
"It's harder for us to discharge people - it's harder for us to find the appropriate accommodation.
"We find it hard to place these people. Families are a little bit worn out and they will leave their family members in our care and want us to find alternative accommodation for them.
"I can understand managing someone with a mental illness is hard on a family ... it does put more pressure on our services."
The Te Awhina unit was also on track for a big increase in the number of times it had to restrain or seclude a patient compared with previous years.
Last year the unit used seclusion 854 times whereas this year that figure was already at 860. In 2017 the unit used restraints on 40 occasions and this year it had already happened 39 times and staff expect the next three months to be the busiest time of the year.
Hammond said staff were "gutted" about the increase in restraints and seclusions as they had a goal to not use them at all in the unit.
• This is the first of two stories about Te Awhina. Next week the Whanganui Chronicle will visit the unit and talk with the DHB's chief executive, Russell Simpson and Mental Health and Addiction Services' acting medical director Dr Jo Stephen-Tastard.