23 Feb 2021

Ex-DHB psychologist claims chronic failings in mental health services

From Checkpoint, 5:27 pm on 23 February 2021

A health professional who has been on the front line of the mental health crisis in Aotearoa says the sector is "chronically underfunded" and fears dire consequences if it continues.

Dr Marthinus Bekker left his job as a clinical psychologist at Auckland District Health Board this month.

He told Checkpoint staff burnout and growing wait lists are major issues that need immediate attention.

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Photo: RNZ / Richard Tindiller

Dr Bekker spent six years helping a skyrocketing number of at-risk young Aucklanders.

"Mental health services are doing more with less. We were getting often, month-on-month, more referrals than we ever had before. Yet the amount of clinicians to see those stayed the same," he said.

Resourcing and burn-out issues faced by Dr Bekker and his colleagues were not exclusive to his former workplace, he said, but they were realities for public mental health services across New Zealand.

Dr Bekker left the Auckland DHB earlier in February. He had been in a specialist team helping young people who were self-harming and suicidal.

Before leaving, he surveyed his colleagues using a scale known as the Copenhagen Burnout Inventory.

About 75 percent of those surveyed scored above a high cut-off for burn-out, he said.

Dr Bekker and his colleagues used to run a 24/7 phone line to help chronically suicidal or self-harming young people use skills to deal with their emotions.

"To run an on-call service like that you need a significant, substantial amount of staff to do that, and that has been more challenging. In the last couple of years, we have lost staff in that team and got to the point where we had to actually put a halt on the phone altogether… We didn't have enough people to be on that roster."

He said accessing public mental health services depended on the severity of a mental difficulty.

DHB-run services, he said, were only funded to deal with moderate to severe difficulties.

Other services, like Fresh Minds and school guidance councillors, are left to care for young people who do not meet that threshold.

"Getting into public services has gotten to the point where, at times our waitlist has been in excess of four to five months. These are young people that have, at least on a quick overlook of the case, been though to likely meet our criteria."

That is young people, dealing with heightened mental difficulties, waiting nearly half a year to access public mental health services.

At any one time, the wait lists for services would consist of well more than 100 young people.

"These are often young people with significant anxiety, significant depression, that is impacting on their lives in various ways. And quite often risk to themselves as well."

Dr Bekker said that often pushed people to seek private care, but it could be expensive, sometimes costing as much as $180 to $225 an hour.

His insights are no surprise to Mental Health Foundation chief executive Shaun Robinson.

He said Budget 2019's headline-grabbing $1.9 billion for a Mental Health Package had in reality made no difference for those working on the front line.

"Nothing has got better on the ground for them. Turnover of staff and burn-out of staff is enormous. We are hearing reports of people being in cots in offices because there's no space on wards," he said.

"The situation is absolutely dire and remains in crisis."

Robinson has accused the government of being too slow to implement 38 He Ara Oranga Mental Health Inquiry recommendations, released in 2018.

Two years on, he said there was no plan for how those recommendations would be put into practice.

The Ministry of Health had also stopped reporting on the state of mental health services in New Zealand, meaning there was no monitoring of what was on offer and how effective these services were, Robinson said.

Dr Bekker said if New Zealand's mental health services remained under-resourced, more clinicians would move to private practice, making public services harder to access.

He feared if the underfunding continued, there could be far more serious results.

'Things are improving' - Health Minister 

Health Minister Andrew Little told Checkpoint he was hearing from mental health service workers and recipients on a regular basis, "and the message I'm getting is actually things are improving".

"We have a four-year programme that we're rolling out, we are as at the end of December, 18 months into it. We'll be two years into it at the end of June, but it was a four-year programme. One of the big challenges we've got is adding to the workforce, and that is going to take time," he said.

Implementation of the recommendations in the He Ara Oranga report into mental health had started, Little said, but would be completed across the four-year programme.

"We have a plan for each element of the He Ara Oranga report," Little said, but acknowledged that there was not a complete long-term plan for mental health services in New Zealand.

"That's an issue that will be picked up by the permanent Mental Health and Wellbeing Commission. It is a priority for them but it's a priority for the Ministry of Health to continue the work to engage with sector to put that plan together."

Building up the workforce takes time, he said. "You have to make a start, and the problems identified … won't all have been alleviated in the 18 months that we've actually been putting money into the recommendations up to now.

"Is it still urgent? Absolutely, it is. And are people still struggling and suffering to get the help they need? Yes, they are. We've made a start, the work is underway. We've still got a ways to go. And it will still be a top priority for us to get that stuff done."

Little said they were at the start of a process to rebuild a system "that had been rundown over many, many years".

The money for mental health that was pledged in 2019 was there and would not be distributed anywhere else, he said.

"Covid-19 is adding new pressures and new issues in terms of our mental health services and treatment, new demands for people who are feeling isolated, people who are feeling anxious. And we've got to make sure that those services and treatments are there too.

"But what we do in mental health won't be distracted by the rollout of the vaccination programme for Covid-19 or other health reforms that we know we have to do."

Phone line running again - Auckland DHB

In a statement, Auckland DHB said the Kari Centre phone line was temporarily paused but was now back up and running again.

It said a mental health crisis line had continually run 24 hours a day, seven days a week.

Mental Health and Addictions co-director Tracy Silva Garay said the safety and wellbeing of staff and the people they cared for was the highest priority.

"We take our obligation to them very seriously," she said in a statement.

She said as a result of Covid-19 lockdowns, some people had been waiting longer for mental health care appointments than the DHB would like.

She said the Kari Centre had been adopting new ways of working, including using telehealth, which had been helping to make services more accessible for people, as well as reduce wait times.

The DHB is also in the process of recruiting 13 new staff to work at the Kari Centre.