Cassandra Fausett, a 17-year-old from Auckland, experienced a devastating spiral into serious mental illness. Photo / Supplied
Cassandra Fausett, a 17-year-old from Auckland, experienced a devastating spiral into serious mental illness. Photo / Supplied
Warning: This article discusses suspected suicide.
A confidential review by Counties Manukau’s mental health service of the care it provided to a teenager who died by suspected suicide found several weaknesses in its operations, including “substantial and longstanding” workforce pressures, the Weekend Herald has learned.
Cassandra Fausett, 17, target="_blank">died in September 2019 after more than two years under the former district health board’s specialist child and adolescent (CAMHS) mental health division. A review of Fausett’s care was started soon after her death but has not been made public until now.
The reviewers’ 11-page report identified six “areas of unsafe system operation”, including a lack of continuous oversight by a senior clinician, inadequate communication with Fausett and her parents, limited respite facilities for young people at times of crisis, and chronic staffing issues.
The document is dated January 2021 but was only provided to her parents, Caroline and Steve, last week. Caroline Fausett said she was disappointed with the report despite the critical findings and baffled that the health authority took so long to share it with them.
“This is nothing,” Caroline said. “You can’t tell me three years and this is what they came up with.”
The parents shared the report with the Weekend Herald because they want to highlight problems in the system. “I’m trying to get things to change so that other people don’t go through this,” Caroline said.
But she added that the process had left her disillusioned and unconvinced that health authorities and the government understand the impact the system’s deficiencies have on the people who rely on it.
The review was limited in scope but highlights serious issues affecting children’s mental health services nationally. Last year, a Herald investigation revealed that children’s services across the country are underfunded, overstretched, and struggling to recruit and retain experienced staff — resulting in unsafe caseloads, compromised treatment, and patients being turned away.
Ayesha Verrall, the health minister, said the government is investing in early intervention services in primary care and schools that it hopes will eventually reduce demand on specialist providers. She said that last year’s Budget allocated additional funding to support people with acute needs, which included $18.7 million over four years for CAMHS.
“However, there is still more work to do,” Verrall said.
Fausett had complicated mental health problems that included obsessive-compulsive disorder, anorexia, and possibly autism spectrum disorder, and she endured numerous hospital admissions and suicide attempts in the two years before her death.
She needed a “bespoke care pathway” overseen continuously by a senior professional, according to the four-person panel that reviewed her treatment.
Instead, the reviewers said: “Different professionals came and went. The quality of connection that CF experienced with different clinicians providing her care varied significantly. All significant clinical interventions and therapies were tried, but the lack of continuity of staff compounded the challenges that CF, her parents and her treating team faced.”
The report acknowledged that Fausett’s parents experienced “significant and at times overwhelming stress” when their daughter was in crisis and that CAMHS provided limited options for family respite.
“Services need to continue to improve the range of information and supports offered to families of people experiencing severe emotional dysregulation and clinical complexity, especially during crises,” it said.
Across Counties CAMHS, the reviewers said, a major restructuring and chronic workforce shortages limited the ability of staff to do much more than react to crises.
“Workforce issues are substantial and longstanding in CAMHS,” the report said. “The review team recognise that this was a workforce under stress, with a relatively junior workforce and with high demand. This combination is unfortunately evident in many CAMHS throughout the country.”
On October 1, the Weekend Heraldpublished an extensive report on Fausett’s experience with serious mental illness. In that article, her parents raised numerous criticisms of the mental health system — disconnected services that are confusing to navigate, constant turnover of professionals, poor communication, lack of safe alternatives for people at risk of suicide — that echoed those of dozens of other families and service users in our year-long investigation.
At the time, Counties (now part of Te Whatu Ora/Health New Zealand) declined to comment on Fausett’s care because of privacy considerations but said it was ready to share the findings of its review with her parents.
The former DHB said it had “dropped the ball” in not discussing the findings of the review with Fausett’s parents sooner, partly because its processes had been disrupted by Covid-19.
Fausett needed a 'bespoke care pathway' overseen by a senior clinician, according to the review panel. Photo / Supplied.
On October 13, Counties’ clinical leadership met Caroline Fausett and briefed her on the review’s findings. Caroline said after that conversation she felt encouraged by the executives’ comments, but wanted to read the report herself, which she was not given at the meeting.
On October 25, she emailed one of the managers requesting a copy of the report and their notes from the meeting and was told they would be sent “in a few days”.
However, Caroline said she did not hear from Counties again until this month after the Herald contacted it for an update.
Last week, Caroline was asked back for another meeting with senior management, where she was given a copy of the report for the first time. She shared it with Steve, who said he had not had any discussions with the service about the review’s findings.
“Te Whatu Ora Counties Manukau apologises unreservedly for the delay in providing a copy of the report to Cassandra’s parents,” Charles Tutagalevao, general manager of mental health, said in a statement.
Changes have been made to ensure that families are kept in the loop after serious incidents, he added.
In the report, the reviewers made five recommendations for improving Counties’ CAMHS, including developing a formal process to identify patients with “enduring elevated risk” and allocating a senior clinician to oversee their care; improving case review procedures; and ensuring families are involved in developing care plans.
Tutagalevao said all five recommendations have been implemented.
He said the staff vacancy rate in Counties’ CAMHS has improved since 2019 and currently stands at 25.7 per cent. “There is much work underway to address workforce pressures... and we have seen a positive start to 2023 with the recruitment of newly qualified nurses.”
Fausett’s parents said they were surprised at the report’s brevity. They were disappointed it did not include several specific issues they believe were crucial to Cassandra’s experience in the service — including the management of her medications and their interactions with the service’s crisis-response team — and that it seemed to rely on clinicians’ notes that they believe were not always complete or accurate.
“I don’t think they’ve taken on board what we were trying to say,” Caroline said.
Caroline said she had high expectations that the review would lead to meaningful changes but now thinks the process was a “complete and utter waste of time”.
“I have no confidence that change is going to be made,” Steve said.
Tutagalevao said Counties is trying to arrange another meeting, with both parents, early next month. “We will be open to discuss any specific concerns Steve and Caroline have about the report at this time,” he said.
The parents said they are also concerned that a separate investigation into Fausett’s death by the Coroner’s office appears to be no closer to completion.
Caroline said they had not heard from the Coroner’s office for more than two years and had no idea whether its inquiry was progressing.
Coroners are required to investigate every suspected suicide but families often wait years for inquests to be completed, which can be stressful and traumatising for people already struggling to come to terms with tragedy.
“It’s a complete box-ticking exercise,” Steve said. “If they can’t bother doing it in a timely fashion, don’t bother doing it. The longer it goes on, the less relevance it has to anything.”
“It won’t effect change, it takes too long. So what’s the point?”
The Coroner’s office did not comment. But after an enquiry by the Weekend Herald this week, Caroline Fausett said she was contacted by the office and informed that the coroner investigating Cassandra’s death has left to become a District Court judge.
A new coroner will be assigned to the case, which will be the third change in three-and-a-half years. There was no update on when the inquiry is likely to be completed, Caroline said.
“Work is underway to review the processes for investigating deaths by suicide,” Verrall, the health minister, said.
Children’s services in crisis
Child and adolescent mental health services, known as CAMHS or CAFS depending on the region, are the specialist services operated by Te Whatu Ora/Health New Zealand which treat around 50,000 Kiwis under 20 every year who are deemed to have a severe mental illness. Last year, an investigation by the Herald revealed they were struggling to cope with a rising tide of distress after years of underinvestment and poor planning by successive governments.
Among the findings of our investigation:
The number of young people seen by CAMHS rose by 35 per cent in a decade but funding increased by only 25 per cent, according to Ministry of Health documents. Children’s services received about $3600 per patient, compared to $5800 per head spent on adult services, even though their work can be more intensive and complicated.
Vastly more children and teenagers are experiencing a mental health crisis, but parents said there is a stark lack of support for people who are so acutely distressed that they are a danger to themselves. Hospital emergency departments and police have effectively become the first responders for many people in crisis.
Shortages of psychiatrists, psychologists, nurses and other skilled staff had reached breaking point in some places, forcing services to raise thresholds for admission and restrict the care they provided. Inexperienced staff were being thrust into difficult roles with inadequate support and some complained of burnout.
Only 39 per cent of CAMHS patients were seen within 48 hours, compared to 63 per cent of patients in adult services, and nearly a third of younger patients waited more than three weeks for an initial appointment.
Antidepressant prescriptions for children and adolescents had more than doubled in the past decade, while the evidence-based talk therapy that is considered the gold standard treatment for patients of that age was hard to access or unavailable in many places.
After one of the stories in our series, Andrew Little, the health minister at the time, acknowledged: “It’s under huge pressure. There are areas where I know young people in particular are struggling to get the specialist attention that they need, waiting a long time to get it. That is in crisis. Child and adolescent mental health services are in crisis.”
Jo Chiplin, interim director of mental health commissioning at Te Whatu Ora, said there are “significant pressures on many mental health and addiction providers”, including children’s services, and the health body is “working hard on a number of initiatives to train, retain and grow the overall specialist mental health and addiction workforce”. In the past three years, $87 million has been committed to workforce development.
In last year’s Budget, the government committed $18.7 million to expanding CAMHS to support about 1,300 more young people annually. Chiplin said: “Considerable work has gone into identifying priority areas for funding in the first two years, and this work is now completed... The funding available will be used to expand CAMHS services in four priority districts and to provide enhanced support for young people with mental health concerns who are under the care of Oranga Tamariki. Announcements will be made in due course.”
Where to get help
If it is an emergency and you or someone else is at risk, call 111.
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 Mental Health Foundation has more helplines and service contacts on its website.
