Surge in mental health services due to hit as people experience the third wave. Photo / 123rf
Surge in mental health services due to hit as people experience the third wave. Photo / 123rf
A psychiatrist is warning a "third wave" surge of people needing mental health services due to the Covid-19 lockdown is about to hit in New Zealand.
It comes after dire concerns from a string of health care workers who spoke before the Epidemic Response Committee (ERC) on Wednesday, including the head of the Dental Association revealing one person was in intensive care due to a life-threatening infection.
Key issues raised included:
• Patients referred to hospital with cancer and other potentially urgent conditions being sent back to their GPs because of the pandemic.
• Close to 20,000 New Zealanders missing out on dental care each day, with about 45 per cent of practices considering letting staff go.
• GPs bracing for a "tsunami" of patients who'd put off seeing a doctor and pulling the rug on the payment which could see some practices financially compromised.
• A $22 million funding package to desperate general practices for the second half of lockdown being blocked by the Government.
• Aged care facilities having to quibble with district health boards to get PPE and sufficient testing.
Now, Campbell Emmerton, a consultant psychiatrist and medical director at Auckland's Re-centre, told the Herald that social experience shows it takes a few weeks for circumstantial distress to turn into anxiety and depression.
"Though we have already seen a huge influx in anxiety and stress, most patients have had prior mental health illnesses. We are yet to see people using our services whose lives were fine before the lockdown.
"But we know that the third wave of social impact is about to hit - it's when people's experience of distress begins to ramp up and become a lot more complex."
Emmerton wanted to encourage New Zealanders not to be afraid to seek help through online consultations- as many mental health centres would still be closed physically under alert level three.
"Online consults will become the new normal."
Campbell Emmerton, a consultant psychiatrist and medical director at Auckland's Re-centre, warns "third wave" brings a surge in mental health demands. Photo / Supplied
He said it was completely natural to feel distressed.
"It's really important that people accept and acknowledge when they are feeling that way and not try to suppress, avoid or drink it away - those are common ways of not engaging with those feelings.
"We encourage people to admit to themselves if they feeling down so they can then act on that."
Emmerton said despite the spike in demand - especially from the business sectors, e-consults had still not been widely accepted.
"Some people are worried about the security, particularly their confidential matters or personal data being recorded online like demographics and location."
Mental health was just one of many areas of the health sector under significant strain.
It's also been revealed patients referred to hospital with cancer and other potentially urgent conditions were now being sent back to their GPs because of the pandemic.
NZ Medical Association chairwoman Kate Baddock, a GP in Warkworth, told the ERC that patients who needed colonoscopies and other investigative treatment were being declined by hospitals.
In the letter to the Health Minister David Clark, seen by the Herald, Health and Disability Commissioner Anthony Hill said the consequences would be particularly serious for patients where early diagnosis and treatment was key to survival, including cancer and coronary disease.
"Deferring or declining patient referrals which would be accepted under normal circumstances and have followed appropriate health pathways carries potentially serious consequences for patient safety," Hill wrote.
He said a solution was imperative so that resulting health risk stayed visible to the system.
"Referring patients back to primary care, who were accepted for surgery that has subsequently been cancelled, is not appropriate."
Flu vaccine debacle
On Tuesday, the Herald revealed a $22 million funding package to desperate general practices for the second half of lockdown had been blocked by the Government.
Baddock said they needed the funding decision reversed by the end of the week or practices and doctors would be out of work.
She also said issues with the roll-out of flu vaccine meant her practice went without for 10 days while they had 4000 vulnerable people they needed to vaccinate.
"The flu vaccine was a complete debacle - there's absolutely no doubt about that," Baddock told the committee.
Dire state for dentists
Meanwhile, dentists were also facing a "looming crisis" with close to 20,000 New Zealanders missing out on dental care each day due to Covid-19 restrictions.
Dr Katie Ayers, the president of the New Zealand Dental Association, told the ERC she was aware of at least one person currently in intensive care for the management of life-threatening dental infections.
She said the profession was in a "dire state" due to a lack of government planning, support and virtually no available PPE.
"The extreme uncertainty for us is a lack of ready guidelines setting out what dental treatment should look like at each alert level.
"This means that planning is unable to begin. There is currently no indication when dental practices will be able to reopen and a workforce of over 10,000 is essentially sitting without work."
Ayers said there was a looming public health crisis, with one out of eight practices already having laid off staff and up to 45 per cent being forced to consider doing the same.
The Ministry of Health's National Clinical Director, Oral Health, Riana Clarke, said that after the nation went into level four lockdown, the Dental Association and ministry issued a joint statement advising that elective and non-essential dental care must be suspended immediately.
Subsequent guidelines state only urgent and emergency dental care can be delivered during alert level four. The guidelines also state that oral practitioners have a duty of care to support their patients, and to put in place triaging arrangements that will allow their patients to access urgent and emergency dental care if required.
The Ministry and the Dental Council are currently finalising guidelines for oral health services at Alert Level three which will be published shortly.
"The view of the Ministry and the Dental Council is that dental care must be limited to urgent and emergency care at Alert Levels 3 and 4," Clarke said.
"This is due to the high risk nature of dental treatment.
"It often involves the use of aerosols, usually for a prolonged period and with the operator being in close proximity to the patient, who would not be wearing a mask."
Frustrations from aged care sector
Chief executive of the New Zealand Aged Care Association, Simon Wallace, said it "seems crazy" that they can't test 700 people being admitted to rest homes each week when there's capacity to do so.
He said people being admitted might not have a sniffle or a sore throat, but they have many underlying health conditions and were at risk.
"If the likelihood is low but the severity is high like it is with Covid-19 why would you not test?," Wallace said.
"We just don't understand the rationale for not testing."
He said aged care facilities had to agitate DHBs to get PPE at the start of the crisis and while the situation had improved greatly, there were still pockets still struggling to get the supply they need.
Facilities shouldn't still have to quibble with health boards to get PPE, Wallace said.
