One phrase you come across a lot in the health sector is ‘ambulance at the bottom of the cliff’.
It’s an easy metaphor, communicating an idea that crops up a lot: trying to solve or mitigate a problem, but only once it’s already reached its zenith.
It’s easy to see this as a consequence of poor planning. And it’s true, to extend the metaphor, that in an ideal world, if you take all due diligence, hopefully you won’t need that ambulance.
But the thing is, sometimes, you do. And in the mental health sector, New Zealand’s ambulances aren’t in the best shape.
A recent, five-part investigation by Newsroom into the state of mental health units for people with acute, severe mental health issues, has revealed a sorry state of affairs, with over-crowding rife, old and dilapidated buildings, and eye-watering price tags to repair and replace this crumbling infrastructure.
On today’s episode of The Detail, Emile Donovan sits down with investigative journalist Oliver Lewis to talk about some of the major themes in the series, and the difficulty of future-proofing in this area.
For one piece, Lewis spoke to a woman called Jayne (not her real name), who spent time in the decades-old facility at Hillmorton Hospital in Christchurch.
“There was no heating ... [there was] decrepit or damaged furniture in the wards ... it felt to her more like a prison or a holding cell than a place of healing.”
And Hillmorton isn’t an outlier: a 2019 stocktake of 24 units – about half the total number in the country – showed nearly a third were in ‘poor’ or ‘very poor’ shape, meaning they required urgent repair or replacement.
“A number of units had vermin issues ... some of it reads like Dickensian poetry ... that’s perhaps not what you’d want if you’re acutely unwell.”
Many DHBs’ mental health units were over 100 percent capacity for weeks on end – despite optimum capacity being 85 percent.
This led to many units having to place patients in inappropriate quarters, like seclusion rooms or meeting rooms, sometimes for days on end.
Lewis’s investigation included a visit to Tiaho Mai, a brand-new mental health facility at Middlemore Hospital in Auckland.
“The previous facility was at its extreme end of life, it was in a state of disrepair.
“Two weeks after they moved into the new building, part of the roof of the old building collapsed due to rain.
“I just don’t really understand why we allow ourselves to get into that position, where infrastructure get so badly run down, despite knowing it has terrible effects on people receiving care, before we do anything to fix these issues.”
Lewis says despite the poor condition of the buildings, staff at these mental health units care deeply about their work, and many who use the services are very happy with the treatment they receive.
But he says allowing the dilapidated state of many of these buildings to continue unabated poses a moral hazard.
“This is a cliche now, but there’s a line about how society must be judged by how it treats its most vulnerable.
“This is exactly the population that quote could be referring to.
“These people are being detained in facilities that aren’t good enough.
“It’s just not a therapeutic enough environment for some of New Zealand’s most unwell people.”