Children and teenagers could suffer life-long consequences because they're not getting timely and effective mental health treatment from public services that are stretched to the limit, a group of leading psychiatrists has warned.
Senior figures in the Royal Australian and New Zealand College of Psychiatrists are calling for urgent investments in the mental health workforce after a survey of frontline doctors revealed widespread concerns about the state of specialist mental health services run by the former district health boards.
Ninety-seven per cent of child and adolescent psychiatrists surveyed by the college said the services that treat young people with the most serious conditions have experienced an increase in demand in the past two years, according to a write-up of the survey published today in the Australasian Psychiatry journal.
Eighty-eight per cent of the psychiatrists say young people are often or very often unable to access adequate mental health treatment when they need it, according to the paper, which was obtained in advance by the Herald.
A large majority of the respondents said mental health services are not fit for purpose or heading in the right direction, despite commitments from the Government to improve it.
RANZCP surveyed 97 doctors, about 80 per cent of the child and adolescent psychiatrists practising in New Zealand. Most work in services run by the former DHBs, which are now part of the unified national health body, Te Whatu Ora/Health New Zealand.
"We have very complex young people with suicidal thoughts languishing on waiting-lists for treatment for seven months," said one psychiatrist quoted in the article.
Another respondent said children's services have been "utterly overwhelmed" by an unprecedented increase in referrals and the increased complexity and severity of the people they're asked to treat. "Clinicians are burning out and families are on unacceptably long wait lists."
The survey echoes the findings of a major ongoing Herald investigation that has exposed how specialist services around the country are at crisis point after a surge in people seeking help for mental health problems collided with a workforce crisis years in the making.
Over the past decade, a rising tide of mental distress has resulted in more young people experiencing problems such as depression, anxiety, and self-harm. The trend was already concerning before Covid-19 but has been amplified by the pandemic, according to clinicians and health officials.
Specialist mental health services run by the former DHBs, which handle around 51,000 patients every year, are too underfunded and understaffed to keep up with the growing demand, according to a ministerial briefing obtained by the Herald.
Child and adolescent services have long been under-resourced even compared to the rest of the mental health sector, receiving funding of $3600 per patient compared to $5800 per patient in adult services, according to Ministry of Health officials. Their workforce is under "significant and increasing pressure", with drastic shortages of psychiatrists, psychologists, nurses, and other skilled staff.
The Herald's investigation found that the pressures on frontline services have become so great in the past year that many extremely unwell children and teens have been forced to endure long waits for treatment, received inadequate care, or missed out entirely. It documented several instances in which managers were warned that short-staffing was endangering the safety of vulnerable patients.
Frontline staff are experiencing heavy caseloads, high stress, and low morale. Some have become so disillusioned and burnt out that they've left the public sector, and health authorities have struggled to replace them.
Psychiatrists – medical doctors responsible for overseeing treatment and medication for people with serious mental illness – are typically at the top of the hierarchy in mental health services, but they are in short supply, particularly in the child and adolescent field. New Zealand has only one child psychiatrist for every 100,000 people, researchers say, about a quarter of the number recommended in the UK.
Historically, New Zealand has been heavily reliant on bringing in psychiatrists from other countries (about 60 per cent of the workforce were trained overseas) but international recruitment has become even more challenging and competitive since Covid-19.
The number of child psychiatrists trained domestically has not increased in recent years despite the rising demand, RANZCP said. They want more training places for skilled clinicians, better pay and conditions to retain staff who are already employed, and an overhaul of specialist services to make them more effective and efficient.
Labour made mental health one of its top policy priorities when it returned to power nearly five years ago and has so far committed around $2 billion to mental health-related initiatives, including workforce development. But it chose to prioritise early intervention in primary care and put relatively little of that money into expanding the specialist services that treat people with the worst conditions.
Dr Hiran Thabrew, a child psychiatrist and researcher at the University of Auckland, one of the paper's authors, says he has seen no sign of a central plan to expand the psychiatrist workforce. "That's not changed at all. In fact it's been quite the opposite. It's been almost like a relative neglect, because there's been such a focus on primary care."
In a statement, Health Minister Andrew Little said: "This Government takes the mental health and wellbeing of New Zealanders seriously, including our youth, that's why we are building a whole new mental health system.
"It important to acknowledge that while we have recruitment campaigns underway that include a focus on the mental health workforce, shortages in this area do predate the arrival of Covid-19 and to train for these roles at the specialist end can take seven to 10 years.
"We are working with the workforce we have and building on what we've got.
"In Budget 19 we invested $77 million for mental health and addiction workforce development initiatives, and as part of Budget 22's $100 million specialist mental health and addiction package, we provided another $10 million to develop our specialist services workforce."
The latest budget also included $18.7 million for specialist child and adolescent services, which officials say will allow them to see 1300 more people by 2025, Little added.
"Three years in we know there's more to do, but building reliable services take time and we're going as fast as we can."
Philip Grady, interim director of mental health and addiction commissioning at Te Whatu Ora, the new national health body, says the work underway to grow the workforce includes plans for more psychiatrists.
"As part of this programme, Te Whatu Ora is working to grow the pipeline of doctors into psychiatry to both improve availability and attract more specialists into this area."
Help us investigate
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 child and adolescent mental health services, as a patient, caregiver or staff, and have information that would help us understand the pressures on services, please contact Investigations Editor Alex Spence at firstname.lastname@example.org. We will not publish your name or identify you as a source unless you want us to.
Where to get help
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
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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.