Parents outraged after crisis nurse accuses suicidal teen of ‘game-playing’ and ‘manipulation’

An 18-year-old taken to Christchurch Hospital ED in distress was accused by a crisis resolution worker of acting depressed and suicidal to upset his parents. A week later, a Health NZ lawyer sent the young man a formal letter admonishing him for recording the nurse’s comments. Alex Spence obtained a copy of the recording.

The parents of an 18-year-old boy have demanded an explanation from Health NZ-Te Whatu Ora after a mental health nurse accused their son of acting depressed and suicidal to upset his parents when he was taken to Christchurch Hospital’s emergency department in distress.

“I think there’s a lot of game-playing and I think you’re doing this to manipulate your parents,” a crisis resolution nurse told the young man soon after meeting him for the first time, according to a recording of the conversation obtained by the Herald.

The parents say they were also shocked that Health NZ sent their son a legal letter soon after the encounter that accused him of “uncalled for aggression” because he recorded the nurse’s comments and warned him that this had been documented in incident reports.

The young man was taken to Christchurch Hospital ED by ambulance in distress. File photo / George Heard

The parents say their son was genuinely suicidal and remain gravely concerned for his safety. They fear that being accused of attention-seeking and aggression could make their son less likely to contact emergency services if he has another mental health crisis.

The family wants Health NZ to remove the allegations from its records so that the young man’s treatment is not impacted in the future. They have contacted the Health & Disability Commissioner to make a formal complaint. The Herald has chosen not to identify the young man or his parents to protect the privacy of an adolescent with mental health difficulties.

Health NZ would not discuss the nurse’s comments but said it was sorry the interaction had caused the young man and his family distress and that the parents have been “offered the opportunity to discuss their concerns in more detail with the clinical team”. It said it would review the process leading to sending the legal letter.

Shaun Robinson, chief executive of the Mental Health Foundation, said: “The whole situation is appalling. I feel very bad for the young person who was treated this way. When you go to ED when you are suicidal, you are already in massive distress and many systems have failed if you are going there to try to get support. To then be faced with a hostile staff response is terrible.

“The thing that enrages me the most is the response of [Health NZ] sending a legal warning to the young person because they had filmed the way they had been treated,” Robinson added. “The young person was just sticking up for their rights in the best way they knew how.

“For [Health NZ] to go straight to risk mitigation and covering their butts rather than thinking, ‘We’ve got a distressed young person who is highly at risk, what can we do to help them?’, it just shows how the system is completely failing young people like that.”

The parents’ concerns echo those of other families who claim they have struggled to access timely and adequate crisis support from a mental health system that is underfunded, understaffed, and overwhelmed by surging numbers of people in acute distress.

Every year, thousands of Kiwi teens are taken to hospital EDs because they are self-harming or suicidal. Although the staff who attend to them are typically highly dedicated professionals operating in difficult circumstances, service users say there are also occasions when people who seek help encounter resistance, hostility, and indifference from health workers.

The teenager in this case has been treated for depression and anxiety for several years. His parents say he has no history of being aggressive or hostile to his clinicians.

In February, the young man became extremely distressed at the family home and was taken by ambulance to Christchurch Hospital. After waiting in the ED, he was assessed by one of the hospital’s crisis response staff who had not met him before.

The conversation lasted about five minutes and took place in a private room without his parents or a support person present. The teenager claims he told the nurse he was a danger to himself and needed to be hospitalised for his safety. The nurse said there were no beds available in the psychiatric unit.

At that point, the young man began filming the conversation on his phone.

When the nurse told the teenager that he was “game-playing” and “doing this to manipulate your parents”, the young man responded, “Oh yeah? I’m not actually depressed?”

“I don’t think you are,” the nurse said.

“I don’t think you really understand what you’re saying,” the young man said.

“How old are you?” the nurse asked, then told him he had been doing this work for years.

The nurse added: “I get the sense you have an attitude. I think you’re trying to call the shots and I think you’re probably loading the bullets and sitting back and watching your parents get distressed. It’s called manipulation.”

The video shows the young man was argumentative and uncooperative during the exchange, though he did not raise his voice and there is no sign of physical aggression.

When the nurse got up to leave the room to speak to the teenager’s parents, the young man said he had recorded the conversation. “You’re going to get fired,” he told the nurse.

The teenager’s parents, who were waiting outside the ED, say their son then ran off from the hospital in a highly agitated state. Soon after, he phoned his mother to say he was planning to take his own life. The parents found him before he was able to act on those intentions.

A week later, a lawyer from Health NZ sent the teenager a letter admonishing him for recording the conversation without the nurse’s permission, which is against Christchurch Hospital ED policy but not illegal.

“Your behaviour was unacceptable and caused the staff distress and interrupted their assessment of you,” wrote Health NZ’s principal legal counsel for South Island regions.

“I trust that this letter makes it clear to you that Health New Zealand has no tolerance for such behaviour and appropriate incident reports have been recorded.”

The letter did not refer to the nurse’s conduct.

The parents say they are worried that having an accusation of aggressive behaviour on their son’s record could impact the way health professionals treat him if he is taken to a hospital in crisis in future.

They claim the legal letter was heavy-handed, added to their son’s distress, and could make him feel mistrustful of the only services that are available to help him when he is in crisis.

They believe the situation should have been addressed by his clinicians rather than a Health NZ lawyer.

Dr Sigi Schmidt, chief of psychiatry at Health NZ Canterbury, said he recognised the challenges faced by families supporting people who are experiencing mental illness and suicidal thoughts.

“I apologise to this young man’s family for the fact that some of their son’s interactions with our services have caused them distress,” Schmidt said, although he would not discuss specific details because of privacy constraints.

Schmidt said Health NZ does not have guidelines or protocols governing assessments of distressed adolescents but that clinicians tailor their approach to each patient depending on how they present on the day and an assessment of their risk of self-harm or suicide.

“I appreciate it can be upsetting to families when they feel a clinician is not taking the risk their teenager presents with seriously,” Schmidt said.

Schmidt did not answer questions about whether it is a standard or appropriate practice for crisis-response staff to dispute whether a patient is genuinely suicidal in a first assessment.

“In general terms, a mental health assessment involves asking questions, exploring the current challenges and difficulties and any situational factors that may be relevant,” Schmidt said. “We acknowledge that these questions may be difficult to respond to or challenging, particularly when someone is distressed.

“We expect our clinicians to undertake assessments in a professional manner, working with the person and their whānau to identify the most clinically appropriate next step.”

Schmidt said up to 10 similar letters were sent to other mental health patients in the South Island in the past two years who “displayed aggressive behaviour and made threats to our staff”.

“Health NZ does all it can to protect staff, and a letter sent after an aggressive encounter where threats are made to staff is a useful way to remind people that we expect our staff to be treated with respect,” Schmidt said, “particularly staff who regularly experience abusive behaviour.”

In this case, the letter was sent “after a query from a clinician, who raised concerns including the matter of filming without consent”.

He added: “We acknowledge the distress caused by the letter and will take this opportunity to review the process in these circumstances.”

Robinson said the teenager’s experience shows the need for more staff with experience of mental illness in EDs. Last month, the Government announced it would put peer support workers in four big hospital EDs this year to assist people in a psychological crisis and relieve pressures on medical staff. It plans to expand the initiative if it is successful.

Mental Health Minister Matt Doocey claims that improving the crisis-response system is one of his top priorities. He is aware of the circumstances of this case but said it would be “inappropriate” to answer questions about the nurse’s comments or the legal letter.

Alex Spence is an investigative reporter and feature writer focusing on social issues. He joined the Herald in 2020 after 17 years in London where he worked for The Times, Politico, and BuzzFeed News. He can be reached at alex.spence@nzme.co.nz or by text or secure Signal messaging on 0272358834.