29 Feb 2024

'Very mentally unwell people' in homeless shelter amidst constant shortage of space in clinical care

4:01 pm on 29 February 2024
Joanne Turner, CEO of Te Whare Korowai Taangata o Kirikiriroa, Hamilton Christian Nightshelter Trust.

Joanne Turner says the homeless shelter she runs in Hamilton is being "taken advantage of" by overstretched mental health services. Photo: RNZ / Cole Eastham-Farrelly

A homeless shelter in Hamilton says it is being left to look after acutely unwell mental health patients because the city's mental health services are so stretched.

It claims one of its guests was left in a "zombie-like" state after being given medicine by mental health workers so they could remain at the shelter until seen by a psychiatrist.

Te Whatu Ora Waikato denies the allegation, saying it is not allowed to sedate patients in the community, although it admits its acute adult mental health inpatient facility typically operates at over 100 percent capacity.

'They have taken advantage of our service far too long'

Te Whare Korowai Taangata o Kirikiriroa - Hamilton Christian Night Shelter Trust chief executive Joanne Turner says shelter staff and other guests are increasingly put at risk by very mentally unwell people staying at the shelter who are not getting proper help from mental health services.

Calls to the crisis team over the last year for help with guests at risk of harming themselves or others are often fruitless, she says.

"Often we are told that they are just mildly unwell, or that this is their baseline, their normal…but they are hearing voices, seeing things, or being aggressive."

Instead, the crisis team advises the shelter to call police, she says.

"I hate calling the police on any of our guests. Because that's like the ultimate betrayal."

But it's often the only way to get someone the help they need, because police take them to hospital where they are often admitted, she says.

The shelter is having to pick up the slack where mental health services are failing, Turner says.

"They have taken advantage of our service far too long. We do not receive any funding to do any of this work."

Stylised illustration of person sleeping in hospital bed

Waikato's 60-bed acute adult mental health inpatient facility is generally full beyond capacity. Photo: RNZ

She says she has raised multiple concerns with senior Te Whatu Ora Waikato staff since August last year about the lack of timely help for its guests, but no support has been provided.

"They do make mention of being under-resourced, they make mention of having issues with staffing levels. I think each and every person who works with Te Whatu Ora absolutely 100 percent does their best. It's a systemic issue more than anything else."

Around 18 percent of her guests experience a mental illness that leaves them unable to manage by themselves in the community, she says.

"They're the most vulnerable, and they need the services that are supposedly there to cater to these vulnerable people to step up and do their job."

Read more from an RNZ investigation into the mental health system:

  • What ever happened to the $2b that was poured into mental healthcare?
  • How a $664m mental health scheme gave with one hand and took with another
  • The mental health workforce problem that won't go away
  • The rolling crisis in youth mental health
  • Te Whatu Ora Waikato says its crisis team is available, but if there is a risk of violence then police are involved as Health NZ staff cannot restrain people in the community.

    The hospital's 60-bed acute adult mental health inpatient facility, the Henry Rongomau Bennett Centre, has an occupancy rate "generally above 100 percent as we do not turn away anyone who requires admission to this acute service."

    It denies the shelter is being used as a clinical alternative to hospital or respite care.

    "The current housing crisis means that there are people residing in emergency and transitional housing in Hamilton, this will include people who also have mental health and addiction issues."

    'Zombie-like' patient 'left with shelter'

    Turner and Deirdre Slabbert, the shelter's mental health support and recovery facilitator, each describe an incident in January with a man they claim was medicated by Te Whatu Ora's crisis assessment team so that he could stay at the shelter until being seen by a psychiatrist. Te Whatu Ora says the incident "did not occur as the shelter staff described."

    According to Turner, the man became unwell in November and they could no longer manage him, but he was not seen by the mental health crisis team until early January. Two crisis team social workers came to the shelter and gave the man some medication, coming back the next day to take him to see the psychiatrist, says Turner.

    The medication left the man in a "zombie-like state," she says.

    "We see people that take synthetic cannabis every now and then and it turns them into a bit of a zombie-like state, and basically, that's what these medications do."

    Slabbert says she accompanied the man to his psychiatrist's appointment.

    She did not know what medication the man was given other than it was described as a PRN, or Pro Re Nata, a medical term used to describe short-term medicines given on an "as needed" basis.

    Slabbert says the man was so drowsy he could not communicate properly with the doctor at the appointment.

    "He was too sedated, according to the doctor, to even assess him or do anything."

    Slabbert says the doctor's own words were that he was 'too sedated'.

    The man was assessed as being okay to stay in the community and taken back to the shelter but his behavior escalated and they eventually had to ask him to leave, says Turner.

    "And that probably sounds really, really terrible but it's what we've been forced to do. They were still presenting as clearly quite unwell for us, and the risk was getting greater and greater. It was just too hard for us to manage."

    Te Whatu Ora Waikato told RNZ it investigated and "confirmed the incident did not occur as the shelter staff described."

    "Health NZ clinicians do not sedate people for the purpose of remaining in an accommodation setting and neither physical restraint nor sedation (for the purposes of restraint) are used by Health NZ Waikato staff in the community.

    "The only people that have the legal ability to restrain someone in a community setting is the police," a spokesperson said in a statement.

    Child Psychiatrist and Paediatrician Dr Hiran Thabrew

    Dr Hiran Thabrew Photo: RNZ / Cole Eastham-Farrelly

    Systems 'severely under-resourced'

    Royal Australian and New Zealand College of Psychiatrists chair Hiran Thabrew says formal sedation should only be used in hospital settings.

    "Active sedation within community settings is very unlikely to be accepted practice.

    "However medication may be used for reducing anxiety in multiple settings outside of hospital, including residential services and respite care.

    High doses of such medication could have a sedating effect, he says.

    It would be "gravely concerning" if mental health services were turning people away, especially homeless who were a vulnerable group.

    "About one in five will have psychosis, according to a recent University of Otago study and about 40 percent of deaths among homeless people are by suicide, according to a study in 2020.

    "So we know that they need access to mental health care that's high quality, inclusive and appropriate…but due to a shortage of beds we hear regularly that [mental health] units get overcrowded and psychiatrists and other mental health staff are having to compromise on the care they can provide.

    "Our systems are so severely under-resourced, generally, that we're having to prioritise some patients' needs over the other. And that's not acceptable."

    After RNZ made enquiries, Te Whatu Ora Waikato met with Turner on Wednesday. She says commitments were made to ensure there was better communication between both services and create clear escalation processes for raising any future concerns or issues.