13 Dec 2021

'Terrible gaps' in mental health system for youth and children

10:01 am on 13 December 2021

Many district health boards have longer waitlists for youth and children seeking outpatient mental health services than adults. The Mental Health Foundation says it's an "absolute crisis" and the Children's Commissioner says it's a breach of their rights.

No caption

Photo: RNZ / Vinay Ranchhod

More than 2000 youth and children around the country are waiting for appointments for mental health assessments with district health boards (DHBs). There are 273 in Waitematā waiting for their first appointment, 189 in Southern, 164 in the Nelson/Marlborough region, 125 in Taranaki and a staggering 459 in Waikato and 463 in Canterbury. These are the young people whose referrals have been accepted. Many have had theirs rejected, some time and time again.

DHBs say Covid-19 has driven a surge in demand, and they are struggling to meet it. Wait times in Auckland have been exacerbated further by Covid-19 restrictions, with DHBs finding it difficult to arrange clinical appointments over the phone or Zoom. Counties Manukau says young people are increasingly presenting with "significant self-harm and suicide ideation", pushing out the wait time for "non-urgent" referrals even further.

Mental Health Foundation chief executive Shaun Robinson said the waitlists and wait times are a symptom of a system which has been neglected for decades.

"I think people are being faced with horrific decisions where they have to triage, they have to choose. They're so overwhelmed they're having to make decisions they shouldn't have to make," he said.

"I just feel heartbroken for many people when they are reaching out for support and they're caught in these terrible gaps in the system."

The office of the Children's Commissioner said it was a breach of a young person's rights.

"Children and young people have rights, including under the UN Children's Convention, to the very best standard of health, and access to care when they need it. This is not happening for all mokopuna," a spokesperson said.

"We believe that denying young people the support they need to be mentally well is both a breach of their rights, it also damages their opportunity to have a full childhood."

Robinson said the onset of a lot of mental health problems occur early in a young person's life. They are navigating relationships, trying to find jobs, establish careers and think about their futures. Stress and anxiety associated with the pandemic, climate change and poverty are huge contributing factors, as are the impacts of colonisation and racism.

"And then you add into that the scarcity of professionals for the DHB services, and particularly the scarcity of paediatric psychologists, psychiatrists, professionals who specialise in dealing with children and young people, and this is why you're seeing this pattern."

It is estimated, based on previous research and data, about one million people a year experience a significant mental health challenge, Robinson said.

"That makes mental health the biggest health issue in the country next to Covid-19. I don't think that's ever really being recognised," he said.

"I mean, I still have conversations with politicians, when they go, 'I find that hard to believe'. And it's like 'well, I think that's the root of the problem, then, isn't it?'."

Waiting for help

RNZ asked every district health board in the country to provide it with the number of people on its outpatient waitlists, for adults and youth and children.

The following had longer wait lists for youth and children

  • Canterbury DHB had 463 youth/children. No adults on general waitlist, but 192 waiting for specialist services
  • Waikato DHB had 459 youth/children and 114 adults
  • Taranaki DHB had 125 youth/children and 58 adults (up from 85 and 45 two months ago)
  • Hawke's Bay DHB had 16 youth/children and nine adults
  • Nelson/Marlborough DHB had 164 adolescents aged 13-17 and 100 adults waiting for psychology appointments
  • Waitematā had more youth/children than adults waiting for their second appointment

Others had numbers which were close in range, such as the Wairarapa/ Hutt Valley/ Kapiti Coast service which had 95 youth and 100 adults on its outpatient waitlist.

The only DHB in the country with a waitlist for inpatient youth mental health services was Canterbury, which has three local people and four from the regions waiting. All other DHBs said they either didn't have anyone on the waitlist, or they don't have a waitlist.

Canterbury DHB specialist mental health services general manager Greg Hamilton said there was increasing demand on the Child, Adolescence and Family (CAF) services, with 4284 children and young people referred over the 12 months to the end of October.

"Staff have worked hard to respond to the increase in demand, however the average wait time for non-urgent cases has increased," he said.

Of those referred, 80 percent received their first contact within three days, and over the past three months, the average time referrals waited for their first face-to-face appointment was 26 days.

Taranaki DHB mental health manager Wendy Langlands said one of the reasons why her DHB had more youth/children waiting for help was due to the service model, with one team for youth/children and three for adults. They had recently secured an additional employee for the youth/child service.

"We know there has been an increase in the prevalence of mental health issues amongst children and teenagers throughout New Zealand, in fact rates have doubled in the last few decades," Langlands said.

"There has been a lot of research and speculation about contributing factors to this, but we've documented a combination of the following factors here in Taranaki; poverty, social media exposure, global warming concerns and Covid-19 uncertainty."

DHBs also told RNZ collating information from family and school prior to assessments sometimes adds to delays. Patients are triaged when they are referred to a service, and "time and urgency needed to respond is determined accordingly".

Investing in youth services

The Ministry of Health said DHBs were responsible for funding and planning services to meet the needs of their local population, but it had been working alongside them to increase funding and improve services.

The ministry said it had widely invested in youth mental health services since He Ara Oranga - Pathways to Wellness was published in 2018.

Investments included: Expanding and enhancing school-based services, expanding services for tertiary students, Rainbow young people and funding digital and telehealth services.

In addition, funding had been injected into primary mental health and addiction services in general practice, Kaupapa Māori and Pacific services in the Access and Choice programme, and into workforce development.

"In addition to wider health reforms and the Access and Choice programme, we are transforming Aotearoa's approach to mental wellbeing so that all people are supported to stay well, and have access to help that works for them, when and where they need it. This takes a united effort with many agencies, sectors, communities and people working together over time," a ministry spokesperson said.

"By intervening earlier through Access and Choice and school-based mental wellbeing supports, we want to decrease the amount of specialist intervention required by young people. This is a long-term goal."

Mental Health Foundation chief executive Shaun Robinson said he believed Labour was genuine when it said it wanted to make things better in mental health.

"But I think they picked up the rock of mental health and found so much squirming underneath it, that it's way worse than they imagined."

Everything the government is doing is good, but it is no way enough, he said.

"… And the whole response was starting so far behind the eight-ball that everything the government's doing just appears to be getting nowhere, because the problem is so big."

Where to get help:

Need to Talk? Free call or text 1737 any time to speak to a trained counsellor, for any reason.

Lifeline: 0800 543 354 or text HELP to 4357

Suicide Crisis Helpline: 0508 828 865 / 0508 TAUTOKO (24/7). This is a service for people who may be thinking about suicide, or those who are concerned about family or friends.

Depression Helpline: 0800 111 757 (24/7) or text 4202

Samaritans: 0800 726 666 (24/7)

Youthline: 0800 376 633 (24/7) or free text 234 (8am-12am), or email talk@youthline.co.nz

What's Up: online chat (3pm-10pm) or 0800 WHATSUP / 0800 9428 787 helpline (12pm-10pm weekdays, 3pm-11pm weekends)

Kidsline (ages 5-18): 0800 543 754 (24/7)

Rural Support Trust Helpline: 0800 787 254

Healthline: 0800 611 116

Rainbow Youth: (09) 376 4155

OUTLine: 0800 688 5463 (6pm-9pm)

If it is an emergency and you feel like you or someone else is at risk, call 111.

Get the RNZ app

for ad-free news and current affairs