31 May 2017

'Urgent' changes needed in mental health care

8:31 pm on 31 May 2017

New claims of a crisis in acute mental health services have followed a critical report by the Auditor-General.

A doctor with a stethoscope writes up a medical record

Photo: 123RF

A report by the Office of the Auditor-General (PDF, 2.7MB), tabled in Parliament today, focused on people with acute mental health problems who needed hospital care and support.

It found some hospital inpatient units had high occupancy rates - sometimes beyond capacity - and pressure on services could mean some people were discharged from hospital without a plan for their broader needs.

As a result, they risked failing to connect quickly with the services they needed, which could mean re-admission to hospital or increased demand on other health services.

Assistant Auditor General Mike Scott said the system was not working as it should.

"There are obstacles to this currently being done well. There are pressures that mean that discharge planning is not being done as well as it should be, in our view, and that's not just a health issue. It's an issue that involves the Ministry of Health, DHBs and other agencies."

A record number of people - more than 160,000 - used mental health and addiction services in 2015, with DHBs spending more than $200 million to provide care to mental health patients in hospitals.

The report found most people had at least a partial plan when they were discharged. However, the plans often failed to address needs for suitable accommodation, finances and support, and what to do if arrangements broke down.

Mr Scott said families and community groups were also often not consulted about discharges.

"We heard in some cases ... they are discharged to accommodation which is not ideal for them, and they don't have access to employment and education support to help them in getting a job and ... [help] them to live well in the community."

And no DHB had ever met the the target of providing a follow-up visit within a week to 90 percent of those discharged.

"They're not meeting that target, they're falling well short of it in some cases. They know that and I think you know they are seeking to improve things."

Nationally, DHBs followed up with only two thirds of people within seven days, the report said.

'The system is in crisis' - Public Service Association

The Public Service Association said people were being hustled back into the community as quickly as possible because others needed the beds.

National secretary Erin Polaczuk said this report backed what its members had been saying about services under growing strain.

"Too many in the acute units, there's too many in the inpatient units. They're pushing them back out into the community, and then of course there's pressure in the community services as well, so the whole system needs a review."

She said it was time for the government to acknowledge the problems.

"This is just adding to a chorus of people, patients, workers, practitioners, experts who say the system is in crisis, we need to do something now. It's absolutely under-funded also, and it's time for an inquiry into mental health."

Ministry says situation has improved

Health Minister Jonathan Coleman said the suggestion people were being pushed out to make room for others was concerning, but it was being addressed.

"That report is from 14 months ago. The Ministry of Health has been working ever since with DHBs in light of the findings that have been communicated by the OAG (Office of the Auditor-General). So there have been measures taken."

He said DHBs had plenty of money to care for people well.

The ministry said in a statement it accepted the report's recommendations, and things had improved.

"The Health Quality and Safety Commission quality improvement programme, beginning 1 July 2017, includes a focus on improving service transitions. This is one example of work which will help to improve some of the issues identified in the report.

"You will note the report makes specific recommendations around steps to improve discharge planning and discharges.

"From 2017/18 there will be additional requirements to report on discharge planning, with targets of 95 percent of people having a transition plan at discharge, and 95 percent of audited plans needing to meet the quality standard."

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