Not enough beds, not enough staff: Auckland DHB mental health service in crisis
12 Dec 2019
Staff shortages mean Aucklanders in need of urgent mental health support can face significant waiting times when they call for help, and DHB workers say it puts lives in danger.
A recent mass meeting of Public Service Association members in ADHB’s Urgent Response Service and Planned Acute Care team was held to discuss the problem, and the decision was taken to issue a public cry for help.
Social worker Andy Colwell is co-convenor of the PSA Mental Health and Addictions Committee, and has been employed in the sector for almost twenty years.
He and his colleagues say they face an unprecedented level of demand.
"There are more people with crisis situations of increased acuity than there used to be. More people are coming to us and we just don’t have the means to help everyone as soon as is safe," he says.
"There has been a significant increase in methamphetamine abuse, as well as in dependency on alcohol and other drugs. That said, drug and alcohol abuse is a symptom of becoming unwell and not necessarily the cause of it. Aucklanders struggle with enormous stress, whether they’re homeless, on a benefit, a student dealing with massive rent increases or a full time worker struggling through relationship breakdowns and financial hardship."
There are not enough inpatient beds available in Auckland. As a result, people in crisis sometimes spend over 24 hours waiting for a space where they can receive appropriate treatment.
This leads to some unwell people being held in police cells for significant periods, limiting options for patient care and stretching police resources.
Crisis team staff are neither willing nor able to leave patients unattended in these circumstances, and so are forced to work punishingly long hours that impact their ability to provide care.
"We’re employed to work 40 hours a week, but almost everyone is working beyond that," says Mr Colwell.
"I’ve known colleagues to work 15-hour days, multiple days in a row. In another case, someone did a double shift and then after that finished they had to sit in the cells all night with someone waiting for an inpatient bed. They ended up working from 8am until 5am the next day."
The PSA has formally complained to the Chief Executive of Auckland DHB about the situation, noting that staffing levels were determined following a series of reviews four years ago.
Staffing levels have not been updated since, despite the increased number of referrals to the service and the increased severity and complexity of patient needs.
Mental health staff can finish a shift at one site then have to drive across Auckland to do overtime at another, and fatigue is a serious problem.
"We rarely take meal breaks, but that isn’t enough to make a difference," says Mr Colwell.
"It’s frustrating and worrying to wait 12 or 14 hours for a patient to get a hospital bed. We are a committed and dedicated workforce, but the lack of resources is compromising quality care."
The Urgent Response Service on average receives between 50 and 60 calls per shift, and sometimes up to 100.
With staff stretched thin there is sometimes only one person answering the phones, and at times it is impossible to ensure every call is promptly answered.
For those in serious enough need to call the Urgent Response Service, this presents a very real risk of harm.
The shortages lead to flow-on effects in other parts of the system. Nursing and allied staff find it difficult to meet the professional requirements of their roles, such as supervision and training.
"It’s important to recognise the additional funding and serious attention provided to mental health by the Labour-led government, but we cannot ignore voices from the coalface reporting urgent situations needing an immediate response. We have proposed to Auckland DHB that they schedule an urgent meeting with PSA delegates from each of the service centres," says PSA National Secretary Kerry Davies.
"By sitting down for a frank discussion of the problem, hopefully a concrete short-term solution can be found. In the longer term, PSA members need to see their skills and expertise utilised through direct input of front-line staff in the implementation of the Mental Health Inquiry’s recommendations."