A manager at a Bay of Plenty DHB mental health service has quit less than seven months into the job – but not before writing a scathing internal report outlining a "toxic" work environment.
The 19-page document, obtained by the Bay of Plenty Times Weekend, says staff describe the workplace culture within the Maternal, Infant, Child and Adolescent Mental Health Services (MICAMHS) unit as "negative, anxiety-provoking and a place where you just 'shut up and put up'".
The report claims that some staff said they had difficulty sleeping. Others reported feeling ill at the thought of coming to work and what they had to face. There were also staff members who had expressed a decline in their own mental health because of work pressure and were accessing independent psychological support, the report says.
The report was written by Michelle Jones, the outgoing service manager of the unit. The document covers allegations relating to institutional racism, waitlists, a "particularly difficult transfer" of a client, and the ongoing impact of work pressures on staff.
According to her LinkedIn page, Jones was brought on board in May this year. She sent an email to staff on November 6, which the Bay of Plenty Times Weekend has sighted, announcing her resignation and that her last day would be Friday, November 15.
Jones attached a copy of her report to that email and said she had already given it to the district health board's chief operating officer, Pete Chandler.
In a written statement yesterday, Chandler said the report was "an internal and unofficial perspective put together by one person who is leaving the organisation".
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Jones writes in the report that she finds it increasingly difficult to look her staff in the eye and talk about solutions and support "when I do not have faith that relief will come".
"In my opinion the human-cost of what is happening in MICAMHS is unacceptable and contradicts the CARE values of the DHB and I would like to believe that at some level this will be recognised and acknowledged instead of being minimised and blatantly ignored."
Some of the concerns and issues raised in the report include:
• Staff expressing "great distress and anger" at having high and/or complex caseloads.
• Multiple clients being allocated to individual clinicians because of pressure placed on the service not to have a waitlist; "this, in turn, contributed greatly to a mass decline in coping ability in the adolescent team with some staff needing to take time off to deal with their stress".
• Long delays in the DHB recruitment process where at times it has taken weeks for staff to be recruited or offered contracts.
• A psychology waitlist that dates back to May for the child team and February for the adolescent team.
• A belief that institutional racism "is at play here in the DHB"; "Our current workplace environment is not appropriate for our Māori whānau and we have had feedback from community agencies, kura and whānau that they are struggling to get tamariki mokopuna and rangatahi into MICAMHS".
In the introduction of the report, Jones says she has been "confounded" that some staff members had been employed who did not have the basic clinical competencies required for working in a secondary mental health service, and specifically within a child and adolescent mental health service setting.
"Whilst it is nationally recognised that recruitment is difficult, it is unhelpful and unethical to recruit staff just to put 'bums on seats'," she says further into the report.
She also claims the lack in basic skills requires "so much more time, support and implementation" from other staff members at the service.
"Add this to burgeoning caseloads, lack of institutional support and an increasing amount of compassion fatigue and you have the recipe for a perfect storm in terms of an increasingly negative workplace culture."
Jones says in another section of the report: "It is difficult to encourage the development of a healthier workplace culture when the institution we are ensconced in is by nature focused on meeting targets by any means and there are levels of hierarchy that ensure this happens."
Throughout the document, she makes it clear her issue is not with her staff.
"They are an incredibly talented and passionate group of professionals who give 110 per cent every day," Jones writes.
"I feel humbled by their general tenacity and also their tolerance for an environment and culture that is doing them harm. I am deeply disturbed that these people are expected to function at this level and not complain and I am frustrated by the fact that there is an institutional culture that supports this problematic system to limp along."
She also says she is "desperately hopeful" the DHB will lobby at the highest level for financial relief, "in order to provide the resourcing and support required for the MICAMHS service to operate ethically and safely".
Jones concludes her report by saying it is her belief that if "robust solutions" and access to funding is not made available to the service, "then there is a real risk of a further decline in the hauora [wellbeing] of the staff".
She claims there is evidence that indicates the service is not a healthy environment for staff to maintain their own wellbeing "let alone anyone else's".
"There is also a culture of compliance from some DHB staff who despite the environment being so toxic continues to perpetuate said culture by enabling the broken system to continue to limp along."
The Bay of Plenty Times Weekend has attempted to contact Jones for comment.
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Another staff member at MICAMHS, who spoke on the condition of anonymity, claimed the situation was even worse than described in Jones' report.
The staff member said the service was at a "crisis" point.
"There comes a point that you can't do it any more. There are too many broken people, both in our community and amongst the staff who continue to leave in droves.
"We feel for our community and that's part of the distress. We know that they are being short-changed."
The staff member said the service did not have the resources to adequately help highly distressed families and faced significant staff recruitment and retention issues.
"I have seen some extremely capable and competent people break. You get to the point where resilience does not matter."
They believed management was increasingly aware of the issues but provided "Band-Aid" solutions, claiming financial restraints.
"We're so desperate we want a Band-Aid, but [it's] for a broken leg," the staff member said.
"We're constantly told all mental health services are like this and there is no funding."
Chandler said in the written statement the district health board was working through the report to establish which issues were valid and needed management support to address.
"These will be included in our development plan for the service if not already identified."
He said there were "some truly amazing people" in the MICAMHS team who went above and beyond daily "because of their total commitment to the needs of children in our community".
"The needs here in the Bay of Plenty are very significant and the staff have to deal with a high number of referrals for children and families with complex social needs," he said.
"This year we are seeing a notable increase in the complexity and volume of children needing care across all of our services and are currently looking at this as a priority. Specifically within MICAMHS, the team are on the frontline of intense and complex needs which is putting huge pressure on them. This takes its toll and over recent weeks we have commenced a process of working with the team to address a range of needs and issues that they have raised."
Chandler said two years ago the district health board started to transform its Mental Health and Addictions Services, "and the new management team are making excellent progress in the areas we have prioritised to date".
"However, we have a huge amount to do and this will take time. Our MICAMHS team is one of two areas of priority focus in the year ahead and we will be providing specialist support to care for the carers, reviewing resource needs and looking at the best models of care which are able to accommodate the growing needs of the Bay of Plenty."
The district health board also sent through a separate written statement yesterday that it said was from "a representative cross-section of MICAMHS staff".
The statement read: "We at MICAMHS want to reassure our whānau that we work with that we continue to be the passionate and dedicated clinicians they have always known. Our clients and their whānau remain our priority, and we do not want them to be distracted from their therapeutic journeys.
"The issues raised in the report were intended to be a part of improving the service we provide. We do not think it is helpful if this debate continues in the public arena. Like any whānau we have issues that we need to work through as a whānau. We continue to be committed to providing the best care and advocacy for our clients."
• If you or someone you know are affected and need help please phone the BOPDHB Crisis Line on 0800 800 508 (Tauranga) or 0800 774 545 (Whakatāne), or Lifeline on 0800 543 354.
Maternal, Infant, Child and Adolescent Mental Health Services (MICAMHS)
• Provides comprehensive mental health assessments/treatment for children and adolescents between the ages of 0-18 who have moderate to serious mental health problems.
• Includes a youth drug, alcohol and addiction team – SORTED.
Source: Bay of Plenty District Health Board