Nearly 500 people are waiting for face-to-face mental health support in the Bay of Plenty District Health Board area, prompting fears lives may be at risk.
The Mental Health Foundation said some who were "significantly distressed" could "lose their lives" if they did not get the support they needed.
But the Bay of Plenty District Health Board said face-to-face support was not the only, or necessarily the most appropriate, treatment for everyone and it prioritised those with urgent needs.
Providing support for mental health and addiction needs that was not face-to-face had been "vital" during Covid-19 to support safety for all, the health board's business leader for mental health and addiction services Jen Boryer said.
Data obtained from the health board under the Official Information Act showed as of April 29, 488 people referred to mental health and addiction services in the Bay of Plenty had been triaged - sorted by priority - but not yet seen face-to-face.
A caveat to this data was that non-face-to-face contact may have occurred after triage to support their needs and some referrals may not have been closed.
Data also showed two patients had died between 2017 and 2021 after they were triaged but before receiving mental health treatment.
The average wait time for first face-to-face appointments has also increased each year in that period, as had admissions to the adult inpatient mental health unit in Whakatāne - Te Toki Maurere.
Admissions to Tauranga's Te Whare Maiangiangi decreased each year.
Mental Health Foundation chief executive Shaun Robinson said one person waiting for an appointment was "one too many".
When people were "significantly distressed" and did not get support, in some cases, people could "lose their lives".
"It's just not good enough."
He said health board services were "pretty much slammed" with demand, which made him "very frustrated and angry" for people who needed support and their families.
Robinson said there had been "decades and decades" of neglect of mental health in New Zealand.
He acknowledged the Government's investment in providing mental health services "earlier" - before people became extremely distressed.
"However, it's not enough, it's not comprehensive and it's not well planned. And it's not funded enough."
He said there needed to be an "integrated" implementation plan and an investment strategy to go alongside it, as mental health was the biggest health issue in New Zealand next to Covid.
"Every indication is that the Covid-19 pandemic is actually exacerbating mental health demand."
Boryer said triage was a "process of prioritisation assessment" to ensure tāngata whai ora [people seeking health] were responded to in an "appropriately timely manner" by appropriately qualified staff.
"This means that anyone with urgent needs will be identified and can be seen quickly – sometimes within a couple of hours or less."
She said some people may be recorded as waiting for face-to-face appointments due to wait times for some therapies due to staff shortages.
Others would be accessing support in other ways, which still met their needs, such as telephone support or community groups, and some were waiting for their own availability or preference for an appointment.
Some would only have just been referred at the time of the report, so the only opportunity for assessment had been triage at the time. Others would be "system data errors" who were not referrals waiting for face-to-face appointments.
She said face-to-face appointments were "not always the best and most sought-after support" so all opportunities to provide support were being explored.
"Alternative options are also a core need in relation to offering support tailored to the need of the person.
"We are constantly re-evaluating and developing our services and this includes how support is provided to people so that they can receive this as quickly as possible."
The health board was also looking at recruitment and retention strategies for therapies with staff shortages.
Boryer said Covid had a "big impact" on wait times for services due to workforce levels from not being able to employ overseas staff or recruit "appropriate experienced staff".
Asked why adult inpatient unit admissions in Whakatāne had increased, Boryer said there were fewer alternatives to admission and community support in the Eastern Bay of Plenty. Other factors were related to the "socioeconomic determinants of health and the changing nature of drug use".
Bay of Plenty Therapy Foundation chairman Andrew Todd said Covid-19 had created uncertainty and social anxiety and had "amplified" mental health challenges.
"People are social creatures - to be kept apart impacts our wellbeing.
"If I felt sad before the pandemic, depression set in as I lived through it, if I felt anxious before the pandemic, panic became more prevalent."
Todd said rising house prices had created "significant financial pressures" due to rental increases or houses becoming unaffordable.
"This can impact wellbeing through anxiety (how can I afford this?), depression (I can't see a way forward) or grief (my hopes and plans have been dashed)."
The impacts of such difficulties impacted mental health service logistics but therapeutic support could not be achieved "quickly to meet demand".
In the neighbouring Lakes District Health Board, data obtained under the Official Information Act showed as of May 2, 72 people were waiting for mental health treatment, evenly split between adults and children or adolescents.
Ministry of Health deputy director general of mental health and addiction, Philip Grady, said an important part of improving the system was ensuring people had a wide range of support.
That included face-to-face as well as telephone services, online support, or through community groups, he said.
"I don't think you'd find anyone working in the sector right now would say things are where they need to be.
"There is definitely pressure on specialist services, and our work to ease this pressure includes investing in growing the mental health and addiction workforce and working with DHBs to address areas that contribute to demand on specialist beds."
DHBs including Canterbury, Waitematā, Counties Manukau, Waikato and Auckland were providing or supporting people into community-based "acute alternatives" to inpatient services.
A total of $472.3 million had also been invested into projects through the Government's Mental Health Infrastructure Programme.
"We know there is more work to do, and part of this work is ensuring people get access to support early, before their needs and mental distress becomes acute."
Health Minister Andrew Little said the Government was "building a whole new mental health system because we take the mental wellbeing of New Zealanders seriously".
"Many parts of the health system have been underfunded for so long there is a lot of catch up to do. We have prioritised mental health but know there is still more to do in this area.
He said the 2018 He Ara Oranga report found the largest gaps in mental health services were in the primary and community sector, so that was where the Government made "the biggest investment in mental health in New Zealand's history" in Budget 2019.
He said it was still too difficult for some families to get help, in part due to too little support to stop problems escalating.
There were now real services to help stop more people from falling through the cracks, he said.
"We've put mental health help at local doctors and schools around the country, as well as universities, online, on the phone and through smart apps. This means more people are being seen and referred to the help they need.
"The latest data I've seen shows 80 per cent of people had their first face-to-face contact with mental health services in the first three weeks, and 94 per cent of people were seen within eight weeks."
He said there was still a lot to do for people with the highest needs.
"Fixing these services is the next step."
Where to get help
If it is an emergency and you feel like 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
Depression helpline: Call 0800 111 757 or text 4202
For children and young people
Youthline: Call 0800 376 633 or text 234
What's Up: Call 0800 942 8787 (11am to 11pm) or webchat (11am to 10.30pm)
The Lowdown: Text 5626 or webchat
For help with specific issues
Alcohol and Drug Helpline: Call 0800 787 797
Anxiety Helpline: Call 0800 269 4389 (0800 ANXIETY)
OutLine: Call 0800 688 5463 (0800 OUTLINE) (6pm-9pm)
Safe to talk (sexual harm): Call 0800 044 334 or text 4334
All services are free and available 24/7 unless otherwise specified.
For more information and support, talk to your local doctor, hauora, community mental health team, or counselling service.
The temporary alcohol-free area was first introduced in December 2018.