Plans to shake up one of New Zealand’s busiest mental health services have prompted a backlash from staff, who say the proposed reforms could put more pressure on an overwhelmed and increasingly unsafe public system, the Herald has learned.
Psychiatrists, psychologists, nurses and social workers have expressed serious concerns about a proposed restructuring of community mental health services in the Greater Wellington region, according to interviews with staff and union representatives and a review of consultation documents that have not been made public.
The mental health workers say plans formulated by Te Whatu Ora Capital, Coast and Hutt Valley, which include dismantling the region’s central triage and crisis response teams, will not solve their most pressing issue — a desperate shortage of skilled and experienced clinicians able to support patients with severe mental illnesses.
The reforms could worsen staffing pressures by pushing already overworked and stressed-out clinicians to leave or reduce their hours, the employees warned. Staff turnover in the service is already unsustainably high, they said.
“We don’t need this bull***t,” said one employee. “We just need to be resourced to do our jobs.”
The problems in Wellington highlight the strain on specialist mental health services across the country at a time when growing numbers of people are seeking help for severe and complex psychiatric conditions and acute mental distress.
Years of poor planning, underfunding and understaffing produced a mental health system that is highly fragmented and confusing to navigate, with limited support for people in crisis, long waits for psychological therapies and overcrowded and poorly maintained inpatient facilities.
Although Labour had committed around $2 billion to improving mental health in successive budgets since 2019, relatively little of this was set aside for the specialist services that treat patients with the most severe conditions. And in the past few years, the Covid-19 pandemic has aggravated an already grave shortage of experienced professionals available to work in those services.
In Wellington earlier this year, one psychiatrist told local executives his workload had become so crushing it was threatening his own mental health, according to internal emails and meeting records seen by the Herald.
The psychiatrist, an American migrant, said resignations and illness had left him as the only senior doctor in the Wellington South community team, responsible for a caseload of around 450 patients that was meant to be shared between three psychiatrists.
In emails and meetings, the psychiatrist said the “dire” staffing shortages across the region were putting employees under intolerable strain and limiting their capacity to support the extremely vulnerable people in their care.
“It’s just not safe,” the psychiatrist told his bosses.
He said he had tried escalating his concerns numerous times but there had not been substantial changes. He believed there was an “abject level of indifference” at Te Whatu Ora regarding the views of doctors on the front lines.
In several meetings, local executives acknowledged the psychiatrist’s frustrations and said they were trying to hire reinforcements. One official said, “We’re in a time of recession right now as a service, and we can’t keep doing all the things that we would do if we were replete with staff.”
The psychiatrist recently returned to the US. “If I’m going to work in a s***show, I might as well do it closer to home,” he said.
Another psychiatrist in the region, who asked not to be named because they are still employed by Te Whatu Ora, said the community services are “grossly, grossly understaffed” and clinicians cannot sustain their workloads.
In those community teams, 28 per cent of psychiatrist roles are currently vacant, according to Te Whatu Ora.
The psychiatrist said they have often thought about resigning because of the stress they’re under, but they worry about how that will impact their patients and colleagues, given Te Whatu Ora would not easily be able to recruit a replacement.
“I’m so distressed at the thought of people having mental health problems and there [being] no doctor to help them,” the psychiatrist said.
Another doctor said the proposed restructuring would not alleviate these staffing shortages and could make them worse in the short term, by adding more disruption to a service that cannot cope with it.
“Seems like more rearranging of deckchairs instead of addressing the core issue,” that psychiatrist said.
Te Whatu Ora is planning to overhaul the Wellington region’s adult community mental health and crisis response services as part of a wider “change programme” that has been in development for several years.
The plans include potentially scrapping a central 24/7 telephone triage service, known as Te Haika, and the regional crisis response team. Twenty-eight jobs across the region are set to be disestablished and another 73 roles will have changed responsibilities or reporting lines, according to a proposal document that was leaked to the Herald last month.
The proposal envisages delivering services through an “integrated”, localised model spread across six community centres in Kāpiti, Porirua, Hutt Valley North, Hutt Valley South, Wellington South and Wellington Central.
But staff and union representatives say they have been given insufficient detail about how these changes would work in practice and why management believes they would lead to improvements in working conditions and patient care.
In the community teams, where clinicians say they are too short-staffed to handle the hundreds of people with profound and complex needs under their care, there is concern they would now have to provide after-hours and crisis response services with few additional resources.
In the crisis team, staff say a centralised unit of nurses and social workers that specialises in supporting people in acute distress is more effective, efficient and safer than devolving first-response services to community clinics that they worry lack the expertise and capacity.
“They’re just not addressing the problems and they’re not listening,” one employee said.
“Is this the time for a change process? No acknowledgment about how stressed we were all feeling,” said another.
Sarah Dalton, executive director of the Association of Salaried Medical Specialists, the senior doctors’ union, says mental health is one of the areas of the health system with the highest rate of vacancies among doctors.
“Instead of [health authorities] saying, ‘We know that we’re really short-staffed so we’re going to have to look at what services we can safely limit or how we manage this’,” Dalton says, “they go, ‘Let’s just do a service review or a model of care review.’”
“Which, in really crude terms, is [like saying], ‘We need a whole apple, we’ve only got half an apple, let’s try chopping it up in a different way and laying it out, and could that then turn into a whole apple?’ It’s never going to turn into a whole apple. It’s just a monstered half-apple that’s now mush.”
Dalton says psychiatrists are “incredibly frustrated” at the proposal and it won’t resolve a “hopelessly, hopelessly underfunded and under-resourced mental health system”.
Paul Oxnam, executive clinical director of Te Whatu Ora Capital, Coast and Hutt Valley’s mental health services, said in a statement the reforms were proposed after feedback from service users, staff and other “stakeholders” that the “current system is unsustainable and that we need to change our service delivery”.
“All proposed changes are evidence-based, data-driven, aligned with national priorities and designed to deliver better care,” Oxnam said. “We are unable to speculate about specific changes or effects, as we are still considering feedback and no decisions have been made. Any changes would be implemented gradually to support adaptation to new processes and minimise disruption to both staff and tāngata whaiora.”
“We understand change can be unsettling for staff – especially in the face of increasing demand for services – and we empathise with anyone who is experiencing concern or frustration,” Oxnam added.
A final decision on the proposal is expected to be made next month.
Alex Spence is a senior investigative journalist based in Auckland. Before joining the Herald, he spent 17 years in London, where he worked for the Times, Politico and BuzzFeed News.
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