24 May 2024

Mental health patients being turned away or discharged early due to high demand

5:00 pm on 24 May 2024
Medical equipment

Te Whatu Ora says the northern region's occupancy rates for its mental health and addiction beds was the typical situation across New Zealand. (file image) Photo: RNZ / Samuel Rillstone

Hospital beds for mental health patients are so in demand people are being turned away from wards or discharged suddenly.

Figures released by Te Whatu Ora Health New Zealand for its northern region show close to 100 percent of the beds were filled all the time over a three-month period.

The organisation said this was typical of the situation across New Zealand, although it could not provide nationwide figures.

New Zealand has about 1309 funded mental health and addiction hospital beds, and the demand for them has never been higher.

Among them are 905 funded acute mental health beds.

Yellow Brick Road charity chief executive John Moore said families were expected to cover the shortfalls due to the overwhelmed service.

"As well as picking up people as late as possible, they [services] are discharging them as soon as possible.

"So families, particularly in the last 12 months, have been telling us that discharges have been happening suddenly and that they don't feel equipped to care for their loved one that's coming out of hospital."

Having family members take on the role of healthcare provider could damage relationships and not help the people who needed it, Moore said.

"We don't want families being clinicians. We want families being families, and supporting their loved ones to have good lives, not to avoid risk and take ownership of their behaviour."

Yellow Brick Road, which helps the family members of people in mental distress, would like to see more investment in preventative and community-based services.

But, clinical and hospital services needed investment too, Moore said.

'Pressure on inpatient wards to send people home earlier'

Association of Salaried Medical Specialists chief executive Sarah Dalton.

Association of Salaried Medical Specialists executive director Sarah Dalton says some people who are acutely unwell sometimes end up in the emergency department for longer than a day. Photo: RNZ / Nick Monro

Association of Salaried Medical Specialists executive director Sarah Dalton said staff retention rates were compounding the problem of excess demand to create a situation unsafe for patients and staff.

"It also means there's pressure on inpatient wards to send people home earlier than they should so they can have these bed spaces for people who are acutely unwell.

"But, we don't necessarily have sufficient staff available to give good support in the community for people who are being sent home early."

If mental health wards could not be staffed adequately, people who should be there could instead be sent to other hospital wards. That was a risk for themselves and others, Dalton said.

The association's members were disappointed to see this week's announcement that the government would fund mental health charity I Am Hope for $24 million over four years, when there were not adequate staffing levels in acute mental health facilities, she said.

At a time when more staff were needed than ever before, high attrition rates, especially for psychiatrists, meant some facilities had to reduce the number of beds available.

"It means some of these people who are acutely unwell are left in an emergency department, sometimes for longer than a day.

"I have heard stories of patients who need access to an inpatient mental health bed being in emergency departments for two or three days even. That's an extreme case."

Figures reflect pressures other regions face

Checkpoint asked Te Whatu Ora for the occupancy rates of mental health beds nationwide for August to October last year.

Te Whatu Ora said that could not be done and, five months after the request, it said it could only release figures for the northern region, covering Northland and Auckland. It said those figures reflected the pressures other regions faced.

The northern figures showed occupancy in acute adult facilities generally more than 95 percent, and sometimes over 100 percent.

Dalton said it was not good enough for Te Whatu Ora not to have readily available nationwide figures.

"They absolutely should be able to deliver that information and the fact that they're not is an indictment."

At hospitals across New Zealand, including in Palmerston North, Waikato, Christchurch and Tauranga, new or upgraded mental health facilities were being built, but Dalton said it was not clear if they would be staffed appropriately.

'We end up turning people away'

Starship Hospital

A doctor based at Starship Children's Hospital in Auckland says he often noticed the effects of overcrowding. Photo: RNZ / Cole Eastham-Farrelly

The Royal Australian and New Zealand College of Psychiatrists (RANZCP) national committee chairperson Dr Hiran Thabrew, who is based at Starship Children's Hospital in Auckland, sees the effects of overcrowding.

"I'm on-call on the child and youth roster in the northern region and I certainly note that most nights I'm on-call I'll be told there's only one bed left, or two at most.

"We end up turning people away because there's not enough room to accommodate anyone who absolutely does not need a bed."

Demand for mental health and addiction services had increased 73 percent in 10 years, yet New Zealand had low numbers of beds compared with other OECD countries, Thabrew said.

Child Psychiatrist and Paediatrician Dr Hiran Thabrew

Dr Hiran Thabrew. Photo: RNZ / Cole Eastham-Farrelly

Facilities were more full than the desired 80 percent, an industry standard which was regularly beaten by at least 10 percentage points.

"People are presenting more in crisis, but also they are being discharged earlier than they should be because of demand for a limited number of beds for other people as well.

"So, it's partly about the difficulty of getting into services, but also not being allowed to remain in hospital for long enough."

RANZCP had called on the government to fund more training psychiatry positions, increase services to match population growth and do a stocktake for up-to-date information on mental health services.

Te Whatu Ora specialist mental health and addiction director Karla Bergquist said, in a statement, it was working to standardise nationwide reporting of occupancy data, with a new system likely to be in place from July.

Different districts now had different ways of collecting occupancy information and Checkpoint's request for nationwide figures would have required collation from 79 inpatient units and two residential eating disorder services.

"Our staff are well equipped to manage high occupancy, which occurs on a regular basis, and patient and staff safety is always our top priority," she said.

"Most districts have acute flow-escalation processes which are increasingly reviewed regionally. Use of additional staff can be considered for high occupancy and acuity."

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