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Auckland’s crumbling mental health services

Auckland's mental health services are groaning under increasing demand. Are we at “crisis” point and is it time for an inquiry?

Calls to crisis teams are rising, and there was an almost 600 percent jump in one year in the number of days when there there were no spare beds available at the adult inpatient units.

In 2014/15 there were only seven days when there was no space at Auckland District Health Board (ADHB) facilities, while in 2015/16 there were 54.

This meant new referrals might have to be turned away or existing patients discharged early.

The figures, provided to the Labour Party under the Official Information Act, also show the number of call-outs for adult mental health services has continued their steady march upwards.

In 2010/11 the ADHB responded to 863 callouts, up from 1719 in 2014/15 and 2018 in 2015/16.

In his most recent annual report, Dr John Cranshaw, the director of mental health, said 162,222 people, or 3.5 percent of the population, were seen by mental health or addiction services.

Surveys undertaken by DHBs showed an 82 percent satisfaction rate with mental health services.

Funding for mental health had risen from $1.1 billion in 2008/2009 to $1.4b in 2015/16, Cranshaw said.

But Labour’s mental health spokesman David Clark said that funding increase had been far too low to deal with the increasing demand.

Labour's line is that the Government has underfunded health by $1.7b and Clark believes mental health services have been the first to suffer.

“The system is creaking at the seams and every DHB is making cuts to try and live within the budgets they’ve been set and unfortunately mental health services are often the first to feel those cuts.”

The situation was most acute in Auckland, and he had heard stories of patients being turned away and higher levels of sick leave being taken by stressed staff.

He again called for an inquiry into the mental health system and said it would be one of the first moves he would make if he became Health Minister following the election.

“The trend has been there for a while but the real personal horror of it strikes me again and again. These are real people who are suffering in our community and it can happen to anyone.”

In response, current Health Minister Jonathan Coleman said it was “complete nonsense” to claim $1.7b had been cut from the health budget.

The Government’s investment in health was a record $16.1b this financial year, which included an increase in mental health funding.

He said there had been a clear increase for mental health services both in New Zealand and across the world, with 20 percent more people seeking treatment than five years ago.

Coleman said people's needs varied and to respond to that there was a focus on increasing access to services, although there was always more that could be done.

“Mental health spending by DHBs is ring-fenced, this means a DHB can never spend less than the previous year on mental health services.”

We just can’t cope

Andy Colwell said working in the mental health system in Auckland was a balancing act.

As the Public Service Association’s mental health committee convenor, Colwell believes the system is nearing breaking point.

Occupancy was on the rise and staff were working in full-capacity units where the service model was based on lower numbers.

This made it impossible to do the job properly and led to burnout and a higher turnover rate, he said.

With increasing patient numbers there were often difficult choices about which patients would have to leave the unit, which meant a flow-on of extra work for community health staff.

The problem was a lack of funding as more people accessed mental health services and Auckland struggled with an increasing population and rising house prices, Colwell said.

“That all adds up to an increase on mental health services and we just can’t cope.

“It is certainly a funding issue, to put it succinctly the demand or supply of services is not matching the demand and we are underfunded and under resourced."

This is disputed by ADHB’s mental health and addiction services director Anna Schofield, who said funding had increased from $125m in 2011/12 to $144m in 2015/16.

Changes to the way community acute services were organised had also led to a "sizeable" increase in referrals in 2015.

There was undoubtably increased demand as Auckland grew and more people sought help, but ADHB had improved to better serve the population, Schofield said.

“While it is not unusual for some units to reach capacity it would be misleading to represent this as unmet need.

“Patients not cared for in the inpatient setting may for example be cared for with individualised care packages that enable care at home or with their family.”

Where to get help:

- Lifeline: 0800 543 354 (24/7), Youthline: 0800 376 633 (24/7), text free to 234 (8am-midnight) or live chat (7pm-11pm)

- Kidsline: 0800 54 37 54 (24/7; Kidsline Buddies available 4pm-9pm)- Suicide Crisis Helpline: 0508 TAUTOKO / 0508 828 865 (24/7)

- What's Up: 0800 WHATSUP / 0800 942 8787 (1pm-10pm weekdays, 3pm-10pm weekends) or live chat (5pm-10pm)- Healthline: 0800 611 116 (24/7)

- Samaritans: 0800 726 666 (24/7)- Depression Helpline: 0800 111 757 or text free to 4202 (24/7)- If you feel you or someone you know is at immediate risk, call 111.

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