Southland’s mental health service: ‘Damning’ review released, staff say workplace ‘toxic’, dread going to work

An internal review of Southland’s community Mental Health, Alcohol, and Intellectual Disability Services (MHAID) was commissioned in March by Te Whatu Ora’s Southern Directorate Leadership Team. Photo / Allison Beckham

A “damning” internal review into Southland’s mental health service revealed a “toxic” workplace, where staff dreaded going to work amid claims of bullying and feeling burnt out.

The Association of Salaried Medical Specialists says Te Whatu Ora needs to either urgently hire more staff or consider closing the 16-inpatient-bed facility down, in the wake of a “complete failure to properly resource services”.

An internal review of Southland’s community Mental Health, Alcohol, and Intellectual Disability Services (MHAID) was commissioned in March by Te Whatu Ora’s Southern Directorate Leadership Team.

It followed concerns raised by clinicians regarding workplace culture, communication, working relationships, models of care, and the impacts of workforce shortages.

A summary of the review’s findings has been released to the Herald under the Official Information Act.

The report, dated July 12, involved interviewing more than 30 staff in relation to the Invercargill Acute Mental Health Unit, a 16-18 inpatient bed facility on the Southland Hospital Site and the wider MHAID service.

The summary was divided into five main themes - culture, working relationships, current model of care and service delivery, clinical governance and clinical and professional leadership as well as general concerns.

Staff interviewed said the culture and “poor relationships” within the inpatient unit had an impact on the patients and their whānau, which was “unsustainable”.

“Many staff said they felt ‘burnt out’ and dreaded coming to work each day.”

The workplace was “frequently described as toxic”, which staff believed had become worse in the last one to two years.

Relationships between clinicians were “strained”, and many staff felt their opinions were “undervalued and ignored”.

“Staff described a lack of respect generally for other’s professional opinions and often raised concern that their own observations, clinical judgement, and input into Multi-Disciplinary Team (MDT) meetings were ignored, questioned, or marginalised.”

There were also claims of bullying within professional groups and between professional groups.

Staff vacancies “further exacerbate” the difficulties for staff and patients, the report said.

Since late 2022/ early 2023, there had been “no clear medical leadership” at the inpatient team or at the Invercargill services level.

Some staff also said they “feared coming to work”, due to the risk of physical assaults from patients, but also “dreaded the atmosphere between colleagues”.

Occupancy of more than 100 per cent in the inpatient unit had also been a “longstanding problem”.

“The daily morning meeting on the unit is intended to help manage patient flow and discharge and help manage occupancy. Staff report this meeting is not working well, that communication between clinicians can be unprofessional and attendance is now poor.”

Illicit drug use was a growing concern for staff, who felt “overwhelmed and unable” to manage the risk of use of drugs, or the flow of drugs into the ward.

Association of Salaried Medical Specialists executive director Sarah Dalton. Photo: RNZ / Nick Monro

“They believe there are no consequences for consumers using illicit drugs. There seems to be a lack of leadership and support regarding the effective management of the use of illicit drugs on the unit.”

The review had a number of recommendations including an “urgent need” for increased physical presence of “experienced and effective” senior clinical leadership across the Southland service. Senior medical leadership was “particularly critical”.

A decision also had to be made about the number of inpatient beds available, and a process needed to be developed to keep to the maximum occupancy.

A “restorative process” was also needed in particular for nursing staff, senior medical officers, and management.

“There has been harm to staff, and this is unlikely to respond only to improved processes in the future. Any harm needs to be addressed specifically.”

Association of Salaried Medical Specialists executive director Sarah Dalton told the Herald the review was “damning”.

“Unfortunately, it’s not unique to mental health in New Zealand.

“Persistent and routine understaffing and under-resourcing of secondary mental health services around this country mean that what is happening in Invercargill is in some ways representative of the state of mental health provision in this country.”

One of the key findings in the review that concerned Dalton was how “abandoned and ignored”, staff felt.

“There’s no way a service should get to this point without meaningful responses being taken from people that are further up the tree.

“To be blunt it’s just a complete failure to properly resource services. What happens is there’s not enough money, there’s not enough staff, it’s hard to recruit and instead of being honest about that and looking at what it would take to increase staffing to safe levels people much around and try to imagine different models of care.”

She believed closing the in-patient unit needed to be considered.

“Maybe the more logical thing to do would be to say it’s really tragic for Invercargill but we can’t run face-to-face acute inpatient services anymore down here because it’s not safe for staff, therefore it’s not safe for patients,” she said.

“It’s really grim, and I don’t suggest this in a flippant way, but I don’t know how you can continue to insist that you’re running a 16-18 bed unit when you don’t have people to staff it because that’s not safe, it’s almost as unsafe as not having it there in some ways.”

Closing the unit would mean people would need to be treated outside of Invercargill, likely in Dunedin or Christchurch.

A Te Whatu Ora spokeswoman told the Herald the district leadership team and wider Te Whatu Ora Southern Leadership team was “very committed to moving forward and improving” Southland Hospital’s MHAID service.

“We know it has been a very tough time for our staff and we want to acknowledge this. We appreciate staff raising their concerns and taking part in this review process,” the spokeswoman said.

“We acknowledge there have been many challenges for this service for several years in particular the impacts of the COVID-19 pandemic and ongoing staff vacancies across the health care system and the effects these have had on our staff. We have acted quickly to improve the service, staff wellbeing and experiences, and relationships within the service and the wider MHAID community.”

Multiple initiatives had been implemented since the review, including an additional position of a nurse consultant role to provide further clinical leadership.

Establishing processes around “improved flow”, particularly when the inpatient unit reached 16 was also underway, as well as a review of people who had been in the inpatient unit for extended periods.

“A restorative process is underway including clear performance management processes, encouraging staff to speak up with concerns, EAP staff support and a staff team day. The district leadership team is working to rebuild collegial relationships as we look towards further developing the Multi-Disciplinary Team process.”

Te Whatu Ora Southern was “very concerned” about staff vacancies and the impact it had on providing mental health services.

“We are actively recruiting to fill our vacancies. Staffing vacancies are a national issue and not specific to Southern.”

Currently, there were three Senior Medical Officers, a total of 2.8FTE, down from 4.4FTE in June.

“We are currently exploring the most effective way of using our resources as we recruit.”

Health Minister Ayesha Verrall declined to comment as it was an “operational matter”.

Sam Sherwood is a Christchurch-based reporter who covers crime. He is a senior journalist who joined the Herald in 2022 and has worked as a journalist for 10 years.