Estimates Debate - Mental Health

Kia ora koutou,

In looking at the mental health portion of Vote Health, I believe the Government has to take a whole lot more seriously the signs of crisis that are evident in regards to psychiatric services, in some parts of the country at least.

I was not at all comforted by answers I received in the House on Tuesday this week from Minister Jim Anderton to questions I posed around recent events involving Auckland’s and Wellington’s acute units.

For a start, I find it astonishing that Capital and Coast Health announced last week that they have postponed indefinitely plans to replace Ward 27. This is four years after the DHB promised in 2004 that plans for a new ward would go ahead urgently.

In recent years the ward has been renowned for its overcrowding and staff retention problems – and for a number of serious incidents including patient injuries and deaths. For example, Chad Buckle died after walking out of the ward with no one apparently noticing his departure. Most recently there has been the tragic case of Nicole Maconaghie, who died in June, not long after being discharged from ward 27.

Her mother said, and I quote from the ‘Herald on Sunday’, “I was told $80,000 had been spent on her and ‘we can’t account for any more money’ she just has to get on and live the best life she can.” Her mother is further reported as saying she tried to tell those caring for her daughter that she would not be able to look after herself, but quote: “I felt like she was disposable from the doctor’s point of view.”

I am sure the hospital and DHB will contend that the family’s statements are not accurate and that their apprehension of the situation is all wrong. But whatever the exact details in this case, I believe there is an underpinning truth to it - that this DHB’s acute unit, like some others, is often under stress; that staff do at times push people out into the community when they are perceived to have stayed too long; that there is an inadequacy of care once they’re out there in the community; and that there is a reluctance to listen or to really hear the voices of family members when they are desperately trying to tell staff about the situation for their loved one.

The reason that both the Minister and Capital and Coast Health give for not building a new unit when one is so manifestly needed appears to be that a new ten bed house for people with acute mental illness will open in Wellington this year.

Using this as an excuse for not building a replacement unit is ridiculous – both are needed.

Turning now to the Auckland DHB, I believe the crisis there is even worse.

The Te Whetu Tawera unit at Auckland is chronically overcrowded and/or has patient numbers at their maximum. There have been a number of deaths associated with the unit in the past year.

There is pressure on staff to discharge people who are still very unwell.

There is an inability to discharge people to adequate step down or rehabilitation accommodation and health services.

Waiting lists for the one inpatient rehabilitation unit in the city at the Buchanan Clinic are long, and of course, sadly, many people will never access the benefits of its care.

There are allegations by staff that there is an inability within Te Whetu Tarewa to keep male and female patients sexually safe, and that there are cases of sexual abuse within the unit.

There is an apparent lack of recognition of the true levels of need in the Auckland DHB district, and that there must be more resourcing appropriately spent to even begin to make the systemic changes needed.

The Minister is correct that there has been work done on a Proposal for Structure Change within the ADHB Mental Health Services. I don’t know if the document resulting from this review is the one he referred to in the House this afternoon as ‘injuncted’, but from what I know of the review, if it is indeed the one to which he referred, it is very unlikely that its recommendations will in any way, shape or form go to meet the concerns surrounding both operational and resourcing issues.

I call on the Government to take some responsibility for what is continuing to happen in our mental health services. There is not enough resourcing. Mental health continues to be the poor cousin of physical health. The problems are systemic and acute. DHBs should not be left unaccountable in any genuine way for the deficits in their approaches. People with or recovering from mental illness – and their families, and the staff who care for them – deserve a whole lot better than this.