Mental health patients are not the cause of pressure on EDs but have added to it. Community mental health services are hugely stretched and inpatient facilities for those with the most serious and acute problems are frequently overcrowded. That often leaves people who are suicidal, psychotic, or severely distressed waiting many hours and even days in EDs.
In the case reported by the Weekend Herald on Saturday, three patients were “marooned” in the Auckland Hospital ED for 58, 65, and 94 hours in late March before spaces could be freed up for them in Te Whetu Tawera, the hospital’s 58-bed acute mental health unit.
The extraordinary delays were revealed in an email from a senior doctor to the hospital’s leadership team, which was obtained by the newspaper.
While the patients were stuck in the ED, staff twice called a “Code Orange” - an emergency call for security back-up - because of “agitation and self-harm”, and a hospital employee was assaulted, the email said.
Vanessa Caldwell, the Deputy Health and Disability Commissioner, said: “We acknowledge ED, staff, and mental health crisis teams do the best they can in these circumstances. However, EDs are noisy, chaotic, and busy, and are not the best environments for long stays for people presenting in significant mental distress.”
“We acknowledge the system is under enormous stress with growing demand and workforce capacity issues. However, it is important that people are treated appropriately and with respect throughout their journey in the health system.”
Caldwell added: “We urge Te Whatu Ora [the national health body] and the Ministry of Health to ensure there is a robust plan to address capacity and the fitness of mental health inpatient facilities. Any redesign of EDs in the future must take into consideration appropriate facilities to better meet the needs of people presenting at their most vulnerable.”
The problems of overcrowded inpatient units and people in mental distress getting stuck in ED have been on the radar of hospital authorities and regulators for years.
In the email in March, the doctor said they had escalated concerns for several years but “an effective organisational response to improve things has seemingly never been generated”.
Doctors say the problem is getting worse and needs urgent action across the health system to rectify.
It is adding to wider pressures on EDs. Staffing shortages have become so critical in some places that wards are struggling to deliver an adequate level of care, avoid harmful mistakes, and protect staff and patients from abuse and violence.
The Health and Disability Commissioner said the number of complaints by patients about waiting times in EDs has more than doubled in the past few years, from 24 in 2020 to 41 last year.
So far this year it had received 22 by the end of April. It is not possible to tell how many of these complaints relate to mental health patients, the watchdog said.
The Ombudsman could also investigate the issue of mental health patients being marooned in ED, in its role as the monitor of anti-torture rules governing places of detention. A spokesperson for the office said it has long been aware of overcrowding in mental health units and “will continue to consider the impacts of over-occupancy on tāngata whaiora”.
Worksafe, the health and safety regulator, could also intervene on staff safety grounds, although it said the HDC was the best agency to respond in this case.
In response to our story on Saturday, Te Whatu Ora Te Toka Tumai Auckland, the health authority that operates Auckland Hospital, said demand for healthcare is high across the region and hospitals are dealing with more acutely unwell people with complex conditions, which can lead to bottlenecks in ERs at peak times.
“We do our best to admit patients quickly,” Mike Shepherd, the head of hospital services in Auckland, said. “However, we acknowledge that some service users, like the three whaiora [mental health patients] in this case, wait longer in the ED than they, or we, would like and we apologise for this.”
“The experience of these patients is not acceptable,” Health Minister Ayesha Verrall said. The Government is trying to relieve pressure on psychiatric units by providing more options both for people experiencing a crisis and those who are ready to be discharged after treatment. It is also developing initiatives to recruit and retain more mental health workers, the minister said.
Help us investigate
The Herald will continue reporting on the crisis in New Zealand’s health workforce and we need your help. Do you have information on this topic? Have you or someone you know missed out on treatment because of capacity problems? Are you a hospital employee working under difficult conditions? Do you have documents that can help us shed light on these issues?
We want to speak to as many people as possible who have experience in the system, to ensure our reporting is thorough and accurate. You can reach Investigations Editor Alex Spence by email (alex.spence@nzme.co.nz), secure Signal messaging (0272358834), or post (The New Zealand Herald, Private Bag 92198, Victoria St West, Auckland CBD 1142). We can’t reply to all submissions because of the volume we receive. We will not publish your name or identify you as a source unless you want us to.
