Whanganui Hospital's Te Awhina acute mental health inpatient service (left) provides the best of care says a recent patient. Photo / Bevan Conley
Liz Wylie talks to a Whanganui woman who has been on the inside of acute mental health support services and gets a professional view on where the new Government's promised health spending might benefit the community.
One day in September Georgina tidied her house, wrote letters to her family and crushed up a cocktail of pills to swallow.
"I don't know where my head was at," she says now.
Georgina's friends and colleagues knew she had been under a fair bit of stress – family concerns, the recent death of a beloved pet and financial worries were all preying on her mind.
Usually very upbeat with a default setting of positivity, no one, including Georgina, realised she was not coping with the strain.
"Looking back it was like someone else did those things, and afterwards I felt like I had been away on another planet."
Although she was expected at work that day, her hours are flexible so her employer was not too concerned when she had not arrived by lunchtime and was not answering her phone.
Fortunately a family member drove past her house on that day in September.
He noticed her car parked in the driveway on a day when she should have been at work.
An ambulance was called and after receiving emergency treatment at Whanganui Hospital, Georgina was transferred to Te Awhina – the hospital's inpatient acute mental health service.
"They didn't pump my stomach – it was too late for that.
"They hooked me up to a drip and I probably spent about five hours in the main hospital."
After she was seen by the hospital crisis team, Georgina was transferred to Te Awhina.
"Suddenly I had this incredible feeling of being in a very safe place.
"The staff, the atmosphere of the place, the room was all fantastic.
"Nothing was too much trouble to the staff – a nurse was always on hand and when there were shift changes everyone knew who I was."
Georgina said the way the staff worked was very cohesive with nurses often working in pairs and there were UCOL student nurses on hand as well.
"The facilities were wonderful – the kitchen was always open so you could make yourself toast and cups of tea and there is a fabulous library full of books which I'm told are donated by Whanganui Library.
"Some of the patients there had nowhere permanent to live and the social worker was there to help people with housing, financial and social problems.
"He was wonderful too – nothing seemed to be too much trouble and he called on community agencies to help people too.
"Going there saved my life – I have no doubt about that."
During her two-week stay at Te Awhina, Georgina caught up on the sleep that had been eluding her during the previous weeks.
"I felt very comfortable and I could lock my door from the inside so only the staff had access."
Georgina had just one complaint about Te Awhina – there were not enough beds.
"There were three occasions when I had to leave my bed during the night because there was an acute admission and no available beds.
"The staff were very apologetic about it and on each occasion a nurse had to walk across the hospital grounds in the dark with me and escort me to a bed in another ward."
Georgina said the acute admissions had come from regions like Raetihi, Hunterville, Taihape, Waiouru and Bulls.
Te Awhina had 15 beds in 2010 before the Health Minister of the day Tony Ryall announced that the number would be reduced to 12.
The reduction was based on a calculation of the population of the region and the percentage of people likely to need the service.
In line with this calculation, the reduction in bed numbers coincided with increased capacity in the community to work with people with mental illness.
The reduction was followed by a $3.2 million upgrade of Te Awhina completed in 2013.
The facility received a new reception, new staff room, whanau room, meeting room, air conditioning, and ensuite bathrooms for patients' bedrooms.
Since it was built in 1981, the facility had been given just one upgrade in the late 1990s when Lake Alice Psychiatric Hospital near Bulls closed.
The design process for the latest refurbishment was long, detailed and included input from patients, their families and Te Awhina staff.
New Health Minister David Clark recently visited Te Awhina and the new coalition Government has promised a mental health inquiry within its first 100 days of office and has pledged an $8 billion funding boost for health spending over four years.
I asked Dr Gordon Lehany, clinical director of mental health and addiction service development for Whanganui District Health Board, whether he thinks more beds for Te Awhina should be a priority for the service.
Dr Lehany said he was very pleased to hear that Georgina's experience at Te Awhina was mostly positive.
He was concerned that she had to be moved during her stay but said he is not sure whether more beds are the solution.
Having taken up his position in June this year, he said he is still finding his way in Whanganui.
"Occupancy at Te Awhina has increased in the past year and it is difficult to pinpoint the reasons.
"It does seem to be related to housing problems and other community factors that affect people's well-being."
Dr Lehany said he trained as a psychiatrist in Edinburgh when the Scottish mental health model was making the transition from an institutional to a community based model.
"The community model keeps developing and the structure is about providing stepped care – a pyramid of care where outcomes for individuals are much better if they can remain in the community and receive good support at a primary level."
Dr Lehany said if people can go to their GP with mental health concerns as they do with diabetes or a heart condition and get referrals to community agencies or specialist care, that will help to lower the number of hospital admissions.
"I did ask the team what they think funding priorities should be and there was a consensus that primary care should be a priority.
"Amount of resource is important, but so too is how the resources are being spent.
"There is a new regional framework for Alcohol and Other Drug Services and we are undertaking a review of what services we have and how they fit into the new framework."
Dr Lehany said he and his team will have a clearer idea of where services sit (and funding issues) once they have more thoroughly reviewed where they are.
"The impending implementation of the Substance Abuse Compulsory Assessment and Treatment Act will also have an impact on our service, but at this stage we do not know what that impact will be.
"There is also a tendering process beginning, which Whanganui is part of, to purchase regional rehabilitation beds.
"At the moment the details are confidential, but this is an important development."
He said there is also a focus on educating lay people in the community to assist their friends, colleagues and family members to access the support they need.
Dr Lehany is also chairman of strategic planning which includes management of the Rising to the Challenge initiative.
"We work on projects that build resilience in the community such as the Navigator Programme for young people.
"This is a programme of training for high school students, aimed at increasing understanding and awareness of mental health issues, and providing skills in supporting friends who may be experiencing emotional or psychological distress.
"More funding for primary care would make a big difference but if it should transpire that additional beds are needed for acute patients – I hope we can provide those as well."
Georgina's story highlights the understanding that any one of us may suddenly find that our lives have become unmanageable.
The Whanganui region has lost 12 people to suicide in the past year and it is to be hoped that the initiatives Dr Lehany has spoken of and the Government's inquiry into mental health services will provide the right support for people in distress.
Dr Lehany gives his assurance that anyone needing acute mental health support will be admitted to Whanganui Hospital regardless of the number of beds.
'I would love to go to the Olympics one day.'