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Patients with severe mental health problems are reportedly waiting for up to 72 hours for care in the South Auckland region because of a shortage of staff.
The region’s 24-hour crisis response team is short of four full-time doctors and three nurses, and is struggling to recruit people because of strict limits on new hires.
Locums are being used to fill the gaps, but only one of them is full-time. It is understood that some nurses are routinely working 60-hour weeks.
Health NZ - Te Whatu Ora confirmed that Counties Manukau’s Mental Health and Addiction service was affected by high demand and vacancies, but said it was not aware of specific instances of delayed treatment for acute cases.
Counties Manukau’s mental health crisis team responds to acute calls, such as suicidal patients or those in severe distress.
The team triages these patients and makes a decision about whether they require treatment and if this should take place in the community or in hospital.
Ashok Kumar, health team leader at the Public Service Association (PSA), said frontline workers had reported that a shortage of doctors and nurses meant there were delays for acute care. In the worst cases, these delays could be between 48 hours and 72 hours, staff had claimed.
The shortages also meant more pressure on staff, he said, and nurses and social workers were being placed in unsafe working conditions with very sick patients. “The situation is quite dire.”
The crisis team’s usual workforce is one full-time doctor within Middlemore Hospital’s emergency department and three full-time doctors in the community. They are assisted by a team of nurses and social workers, and are covered by registrars overnight and on weekends.
At present, there are no permanent, full-time doctors employed within the team. It is instead staffed by one full-time locum and a handful of part-time locums. Those locums provide the equivalent service of 3.5 full-time doctors.
In some instances, the team was unable to provide a doctor within the emergency department.
“What that does is delays the intake of patients,” Kumar said. “Because only section 10 [detaining patients] can be done by doctors. That puts huge pressure on all services because everything just gets pushed back.”
The team had eight vacancies for registered nurses and was given approval by Health NZ to fill five of those roles.
Kumar said nurses in this field usually required five to seven years’ experience, but all of the new hires were graduates. This placed additional pressure on senior staff who had to train and supervise them on top of their existing workload.
Health NZ - Te Whatu Ora general manager mental health and addiction at Counties Manukau, Suzanne Kerruish, said the service was experiencing high demand from people with “increasingly complex needs and acuity”.
“However, we are not aware of any specific instances of significant delays of care for acute calls. We are constantly reviewing and reprioritising the acute caseload to ensure that we are seeing people most in need in a timely way.”
Kerruish confirmed there were vacancies for psychiatry and nursing positions and said the team was actively recruiting for these roles. Recruitment for acute services was a key priority, she said.
While some of the nursing roles had been taken by graduates, she said more experienced clinicians were being sought for the remaining spots.
Kerruish said some less urgent patients had been reprioritised because of high demand. Temporary weekend clinics were being set up to offer additional appointments for new and follow-up assessments. Additional psychiatrist-cover has also been put in place over weekends.
Under a national hiring policy introduced by Health NZ, health managers must apply every Wednesday for the roles which they want to fill. Regional panels then determine the following Wednesday whether any of these roles can be filled.
The PSA said that process meant it was taking longer to fill important roles, such as those on the acute mental health team.
The shortage had a number of knock-on effects. Patients with moderate mental health issues, who had planned appointments, were being displaced by more urgent, acute, cases.
Patients who were unable to be seen quickly were presenting at the emergency department, which was already under severe strain from a rise in respiratory conditions during winter.
And the co-response efforts, in which the crisis team assist police with mental health callouts, was also being affected. Counties Manukau is one of six regions in which police co-ordinate with the acute mental health team.
Mental Health Minister Matt Doocey and Prime Minister Christopher Luxon announcing new mental health targets at Middlemore Hospital last month. Photo / Dean Purcell
Faster access to primary and specialist services is one of five new targets set by the Government for the mental health sector.
Prime Minister Christopher Luxon and Health Minister Dr Shane Reti have highlighted the enormous growth in nursing recruitment in the last year, while also noting the nursing gaps in some areas - including mental health.
Isaac Davison is an Auckland-based reporter who covers health issues. He joined the Herald in 2008 and has previously covered the environment, politics and social issues.
