More than 130 staff members have left the Bay of Plenty District Health Board's mental health and addiction services department in the past five years – with 107 resigning.
Staff turnover reports from the DHB, released under the Official Information Act to the Bay of Plenty Times Weekend, paint a local picture of what some say is a nationwide staffing issue.
A New Zealand health recruitment expert says she has seen a "steady increase" in demand for mental health staff nationwide and believes Bay of Plenty's turnover numbers will be in line with other DHBs around the country.
However, the figures also come on the back of a damning internal report into Bay of Plenty's mental health and addiction services department, revealed in late-August, which led the DHB to commit to changing the "low-trust, punitive workplace culture".
The DHB acknowledged at the time that the department had been under significant pressure due to the growing volume and complexity of the work, suboptimal accommodation and difficulties recruiting expert staff.
There was also a high level of risk of harm to staff working in inpatient and community teams from assault by unwell clients, and a high degree of public criticism of the mental health system.
The internal report said a commitment was being made to improve safety, culture and wellbeing.
Department head Dr Sue Mackersey then resigned in September.
The staff turnover rate for Bay of Plenty's mental health and addiction services department last financial year was 14.85 per cent – more than double the rate of 2013/14.
The 2017/18 period also had the highest number of resignations – 33.
There are 283 people employed in that department, not including temporary staff, casuals and resident medical officers.
Just eight of the 107 resignations over the past five years were people working in administration and management.
There were 49 resignations in nursing, 45 in allied health and five in medical.
Prudence Thomson, founder and co-owner of Accent Health Recruitment, has been recruiting medical staff for more than 20 years, including in the mental health sector.
"It's no surprise that there is a high turnover," she said.
Thomson said there has always been demand for mental health psychiatrists, psychologists and nurses.
But that demand has been increasing for several reasons, including the growing and changing population and an increased awareness of mental health issues.
More people were now seeking help than in the past, she said, and changes in society like increasing pressure on people, an aging population, and drug use, were also having an effect.
Thomson said unless there was good staffing, there was going to be more turnover.
She said it was a "vicious cycle".
"In that if there's not enough mental health staff on the ground, people are going to leave."
Paul Mathews, lead organiser for the New Zealand Nurses Organisation in Tauranga, said high turnover of mental health staff was a nationwide issue stemming from the sector being significantly underfunded and under-resourced for quite some time.
He said it was not just about patient-to-nurse ratios, but about having the right service in the right place for the right type of patient.
Mathews said work definitely needed to be done around crisis intervention and response, where people need intensive support immediately.
"Methamphetamine, for example, is getting to be a bigger and bigger issue around here. You've got people who are in a psychotic state because of that; they front up at the mental health unit."
He said more preventative work could also stop people from getting to that stage.
Bay of Plenty District Health Board acting chief operating officer Bronwyn Anstis said the DHB had a range of strategies in place to support staff retention.
Those strategies included addressing inappropriate behaviour through a "Speak Up Safely" programme, annual staff engagement surveys, and efforts to improve staff communications.
The DHB was also developing a leadership/management development framework, she said, which goes live this month.
Anstis said there was a continued emphasis on risk, health and safety and the DHB was working to mitigate the risks involved with violent patients.
It was also working with its union partners on a range of programmes, including burnout awareness.
There was a continued commitment to matching patient demand with staff capacity, she said.
When asked what some of the main reasons were for staff turnover in the mental health and addiction services department, Anstis listed five:
• Transfer to another part of the DHB
• Opportunity with another employer
• Moving overseas
• Retirement and early retirement
• Workplace-related issues
The Bay of Plenty Times Weekend also requested staff turnover rates from nine other DHBs.
The most recent and average rates for those nine mental health and addiction services departments ranged from about eight to 15 per cent.
A national Mental Health and Addiction Inquiry, which held consultation meetings around New Zealand earlier this year, will report to the Minister of Health by the end of this month.
Staff turnover in Bay of Plenty District Health Board's mental health and addiction services department over the past five financial years
• 2013/14 - 7.22 per cent
• 2014/15 - 4.97 per cent
• 2015/16 - 8.26 per cent
• 2016/17 - 9.38 per cent
• 2017/18 - 14.85 per cent
Number of people who have left
• 2013/14 - 20 (17 resigned)
• 2014/15 - 17 (13 resigned)
• 2015/16 - 23 (21 resigned)
• 2016/17 - 28 (23 resigned)
• 2017/18 - 44 (33 resigned)