The Henry Rongomau Bennett Centre at Waikato Hospital.
By Lucy Xia of RNZ
A mental health nurse working at Waikato Hospital says there’s a shortage of community beds to discharge patients to, while acute mental health wards are running at 140% capacity.
Health New Zealand (HNZ) said there had been a reduction in occupancy at the hospital’s Henry Rongomau Bennett Centre acute mental health inpatient unit, until recently.
This month RNZ revealed that a ward full of patients at Auckland’s North Shore Hospital could not be discharged because they had nowhere to go for non-hospital care.
The mental health nurse, who did not want to be named and was speaking in their capacity as a Nurses Organisation union member, said while over-capacity has been a longstanding issue, the situation was getting “increasingly worse”.
They said some mental health patients were sleeping on mattresses on the floor in interview rooms, seclusion rooms and sometimes in other wards because of the lack of beds.
“In mental health [wards], we’re struggling with getting good sleep … we’re trying to deal with anxiety or manic symptoms, and not having your own bedroom or a routine area to rest all impacts that recovery process,” they said.
They said patients were getting agitated and were frequently violent – some had been dealing methamphetamine on the wards.
Last month, a person was allegedly attacked at Waikato Hospital. Two sources told RNZ the victim was a staff member on the mental health wards.
The nurse said one of the key factors contributing to problems transitioning patients to the community was a lack of beds in mental health and addiction residential services.
They said patients often did not have a supportive household to go to after leaving hospital, and needed facilities that had 24/7 care and oversight for their medications.
Many facilities were already full and had a waitlist, respite services were maxed out, and there was also a lack of emergency housing options, the nurse said.
RNZ asked some of the major providers of mental health and addiction residential care in Waikato about current demand and waitlists – including Pathways, Manaaki Trust and Ember Korowai Takitini – but none would comment, and one referred RNZ back to Health NZ.
Labour’s mental health spokeswoman, Ingrid Leary, said what was happening in Waikato showed underfunding in both the public health and community provider systems.
The Public Service Association (PSA) – the main union for mental health nurses – said community mental health was resource-short, with workers having their pay equity claims scrapped by the Government, and a shortage of beds and purpose-built facilities.
“Major investment and commitment is needed by the Government in community mental health,” PSA national secretary Fleur Fitzsimons said.
She said there was a “culture of fear” among many community providers that they would be punished by HNZ or the Government if they spoke out about the reality they were facing.
Fitzsimons said she wanted HNZ and the Government to be clear with providers that they could present their realities, so New Zealand could know how many beds it was short of.
Mental Health Minister Matt Doocey said in a statement that he recognised the “significant pressure” on inpatient facilities, and that he had “tasked all of the regional executive directors with improving the flow of patients and quality of care”.
He had no direct comment for RNZ’s questions about the occupancy of Waikato Hospital’s acute mental health wards and the shortage of mental health beds in the community.
Doocey’s press secretary said the minister had not prevented anyone from speaking publicly, and Doocey said he encouraged everyone to raise any issues with him – either personally or publicly.
HNZ’s mental health and addictions lead for Te Manawa Taki (the central North Island), Vicki Aitken, said “any decision to make comment to media is one for our community providers to make and is not for Health New Zealand to speak to”.
She said it had been working with community partners over the past year to improve the flow of patients to community settings, but admitted that the acute wards still experienced spikes in demand.
Aitken said the demand for acute mental health services in Waikato continued to increase, because of factors including meth abuse and “wider system issues”.
She said occupancy at the Henry Rongomau Bennett Centre acute mental health inpatient unit was at times an issue, but added that there had been a reduction in occupancy until recently.
Aitken said a new acute adult mental health facility in Waikato – with 64 beds – was on track to open in September next year.
The facility would have four more beds than the existing Henry Rongomau Bennett Centre, which would be replaced.
In 2019, 35-year-old Joe Carter had been sleeping on a mattress on the floor of a windowless room in the Henry Rongomau Bennett Centre at Waikato Hospital when he went out for a walk and later committed suicide.
He had been moved between wards and put into a converted interview room because the centre was at 120% occupancy.
Meanwhile, the mental health nurse said short staffing and the shortage of senior nurses were exacerbating the situation, and they were struggling to cope with the criminal behaviour on the ward.
“We have people that are admitted with being intoxicated with meth, and they’ve also been dealing in the community … to help pay for their habit, and they end up attempting to deal on the ward as well to other people that are meth users as well.
“If they get to go on leave they’ll try and bring it back, they get visitors, they’ll try and bring it in whatever they’re carrying when they’re visiting, everything has to be checked,” she said.
The nurse said they had been told by management that the standard procedure when they saw such behaviour, and when they were assaulted, was to file a 105 police report – which she said was a long form they struggled to find time to fill.
She said the police often dropped off people on substances, who were admitted because of risky behaviour – “Quite often police don’t stick around, they’re just here to transport,” she added.
Police have been implementing their phased withdrawal from mental health callouts, with a 60-minute limit on patient handovers at emergency departments, taking effect nationwide as of June.
The nurse said staffing was further stretched because of an average of several staff on the acute mental health wards taking ACC leave because of injuries caused by patients – including head injuries and some unrecoverable injuries.
HNZ’s Vicki Aitken said any illegal drug use on premises would be reported to police immediately and police are “promptly involved” in instances where there had been assaults on staff.
She said the acute mental health wards were fully staffed and HNZ was in the process of recruiting more permanent staff.
“When there are roster gaps or a need for additional staffing due to demand we bring in appropriate casual staff,” said Aitken.
– RNZ