New figures show big rises in crisis mental health referrals at many of the country's hospitals, and some health workers are describing it as dangerous.
Data released to Nine To Noon under the Official Information Act from Auckland District Health Board shows an almost 300 percent increase in crisis mental health referrals over five years to 6121.
It could partly be due to a change in the way the health board counts referrals, to include more internal referrals, but even if the total for the previous year is taken, it still shows an increase of 108 percent on four years prior.
Other DHBs experienced massive rises as well - West Coast referrals jumped 226 percent, Bay of Plenty 210 percent and Canterbury 84 percent.
Auckland mental health worker Andy Colwell said those working in the services nationwide had reported difficulties in coping with the rising demand.
Mr Colwell, who is also the co-convenor of the Public Service Association's mental health committee, said mental health workers throughout New Zealand reported in a recent survey that the rising demand was causing them to be stressed.
"There's not enough staff, there's insufficient psychiatrist cover, equipment is not up to standard, the number of calls are unmanageable, staff working both paid and unpaid overtime to complete the work, travel time is onerous, they don't believe it has improved patient care."
Some staff members said in the survey the workload was hard to sustain and expressed disillusionment. They wanted to leave district health board because of the amount of work they had to do.
One of the main pressure points is acute mental health inpatient units, which were almost always full, Mr Colwell said.
"People have to be discharged from hospital because people have to go into hospitals. So often decisions are made not just around clinical decisions but are made because of the fact that somebody actually has to leave hospital. So on some occasions you have to find the least unwell patient to leave hospital."
Mental health services had been significantly under-funded, he said.
"We're under a massive pressure. Staff actually, I think, are really struggling from time to time. I have a friend, a colleague, who's been off work for a number of months now due to the stress of the job."
The Ministry of Health said it was doing its best to respond to growing pressure on mental health services.
"In recent years there has been increased recognition of mental health issues and the importance of individuals seeking help. The Ministry of Health recognises that there is growing pressure on the sector as it works to meet rising demand for mental health services," said Director of Mental Health Dr John Crawshaw.
"The ministry is engaging with the sector on this, and work is under way to better understand these pressures and what is driving them."
The government has increased mental health and addiction services funding from $1.1 billion in 2008/09 to more than $1.4 billion for 2015/16.
Auckland University of Technology dean of health services Max Abbot said there were major challenges, but there was also a lack of adequate information.
"We no longer have the Mental Health Commission, which to some extent acted as an independent watchdog; the NGO sector is largely dependent on government for funding, and is limited in its capacity to be an independent advocate."
Professor Abbot said things were better than "institutionalism" 20 or 25 years ago.
"I think people would be generally agreed that there's been a real growth in crisis activity. In Auckland there's been about a $40 million increase in funding over five years, but that's during a period of significant population growth. It probably at best has kept up. Clearly there are cracks showing."
A "very wide-ranging" look is needed at the sector, including an independent commission of inquiry, Professor Abbot said.
Calls for inquiry dismissed
Health Minister Jonathan Coleman dismissed calls for an inquiry.
"This is a difficult area with a passionate and dedicated workforce," he said.
"More New Zealanders are getting access to the services and support they need, faster. However, we can't be complacent, we need to maintain momentum."
Meanwhile, a mental health researcher at Canterbury University, Julia Rucklidge, said the increasing rate of referrals was frightening.
It showed traditional treatment methods, not just in New Zealand but in the Western world, were not working, she said.
"The way we've been addressing mental health in our frontline form of treatment is medication and if you've got an increasing number of people being referred, and an increasing number of medication prescriptions, you have to wonder if that's the best method," she said.