The Dominion Post - 2021-11-26


Desperate for help

In Depth

Anna McConnell was sitting in her mum’s car, clutching a plastic bag in case she needed to throw up. Wringing her clammy hands, she felt like she had forgotten how to breathe. The air was going in, but it was like there was no oxygen in it. It was the first time she had left her house in weeks. It was August 2019, and the then 20-year-old was waiting to go into an assessment for one of the 10 beds in Auckland’s only medical detox service. Earlier that day, she’d had two shots of vodka. When she began drinking years earlier, alcohol had helped control her panic attacks. Now she hated every drop. The Community Alcohol and Drug Services key worker whom Anna first saw in June had explained to her parents that Anna needed to maintain her drinking until she could go into medical detox, because alcohol withdrawal can be dangerous. So she was supplied with up to 24 standard drinks of vodka a day instead of drinking whatever she could get her hands on in secret. Anna does not remember how she made it inside the building for the assessment that day, but does recall what happened inside. She answered questions, showed the clinicians her tracking notebook for her alcohol intake, and then the bad news came. It could be months before a detox bed was free. Anna’s story barely hints at the chronic problems plaguing the mental health system, including staff and bed shortages, protracted waiting lists and haphazard record-keeping. About 4920 Kiwis were waiting to access public mental health and addiction community services in March, according to data provided for this story. This excludes those who were turned away because they were not deemed severe enough. Some district health boards (DHBs) say they turn away half the people who are seeking help after an initial assessment. The other half might then have to wait days, weeks or even months to be seen by the relevant service, which will decide whether they are a good fit. And then they wait again to begin treatment. Lack of data DHBs must get 80 per cent of people referred for nonurgent mental health or addiction services seen within three weeks. On paper, it looks as though most meet this target. But talking to people with lived experience of mental illness and those who work in the services, it quickly becomes evident the statistics are misleading. The Ministry of Health defines waiting times as the length of time between the day a person is referred and the day they are first seen by the service. That first interaction is usually an assessment to see if the service is a good fit. Many patients face weeks, if not months, waiting to start treatment. To more clearly understand how long people wait, Stuff asked the 20 DHBs to provide average wait times between assessment and start of treatment. Only six did. The remaining 14 either said they did not record data in this way, or provided wait times from referral to the first face-to-face contact, rather than from assessment to starting treatment. Stuff also asked for the longest time someone had waited in the past six years. Half the DHBs did not answer that question. The longest recorded wait time was 526 days in Taranaki. Auckland’s longest wait time was seven months. ‘‘Think of it like ordering food from McDonald’s,’’ says Dr Marthinus Bekker, a clinical psychologist who previously worked in the public mental health system. ‘‘They are required to take your order within a predetermined amount of time to meet certain targets, but after you’ve ordered, you are moved to the waiting bay to wait for your order. So technically you’ve been helped, but you still haven’t received your food.’’ When it comes to people needing the most urgent care, DHBs say there is no wait to get admitted as an inpatient. But with most mental health hospitals operating at or above capacity, the bar to be assessed as urgent is incredibly high, and patients are often discharged before they are ready. As a result, it’s common for people to be sent home from the emergency department (ED) after a suicide attempt. ‘A desperate cry for help’ Anna started having panic attacks at age 12. She still struggles to talk about one of the worst ones. It came during a ballet competition. She was shaking with anxiety before going on stage but pushed through and started dancing. As her routine went on, Anna couldn’t breathe. She started dry heaving. Finally, it became too much. She ran backstage to throw up. ‘‘I believed that I had to keep facing the fear and continue until it was so physically bad that I dry-retched or vomited.’’ Her parents arranged for her to see a psychologist and a psychiatrist privately, but her anxiety kept rising to the point she was unable to go to school in years 11 and 13. In October 2016, she had a string of panic attacks where she threw up repeatedly. She was unable to leave home and needed a safety person at all times. ‘‘I just have no idea what would happen to me if I didn’t have my family.’’ That period took a toll on her friendships and put a huge strain on her family. Anna became increasingly isolated and started drinking to cope. Her family tried to get her into Auckland’s Kari Centre, which helps people under 18, but there was no space. Anna’s story illustrates the complexity of the issues plaguing the system. She was not left to her own devices, but it took her a long time to find the right services. On paper, she waited six weeks from referral to Auckland’s medical detox to assessment, and another six weeks until she was admitted after someone cancelled their stay at the last minute. In reality, she had been waiting years to access the right help, and had become so anxious she could not leave her house and her drinking became a toxic addiction. In March 2017, Anna attempted suicide. She was treated at ED overnight and referred to the Kari Centre in the morning. She had her first appointment there three weeks later. Auckland DHB’s Tracy SilvaGaray says the Kari Centre team has worked hard to reduce wait times, and there is now no wait list to be seen. After nine months of family and individual therapy with a psychologist, and with the constant support of an occupational therapist, Anna was doing a lot better. She could leave the house on her own and had resumed her studies. But six months after she turned 18 in July 2017, she was kicked out of the centre and told she was no longer unwell enough to qualify for adult mental health services under the public system. ‘‘Everything went downhill from there.’’ Waiting – but not on paper One in five New Zealanders live with mental illness and addiction, and it’s estimated that nearly half the population will live with mental distress or addiction at some point. About 4 per cent of Kiwis will need specialist mental health and addiction services. In 2019-20, that translated to 184,711 people, according to Ministry of Health data. Just like finding out exactly how long people wait to receive treatment, finding out exactly how many people die each year while waiting is difficult, as the information is not consistently recorded. Only seven DHBs provided that number for the past six years. The total was 29. Two DHBs declined to provide the information because the number was too small. Eleven said they did not record it all. To find out more, Stuff analysed the 486 coronial reports completed in 2020 where the death had been determined as suicide, illegal drug overdose, medication overdose, or alcohol poisoning. The vast majority of the deaths in this group (470) were deemed suicides. People die by suicide for complex reasons. About 60 per cent of cases had no interaction with a mental health and addiction service in the previous 12 months, the government said in 2017. However, Stuff’s analysis found nearly 70 per cent had a history of mental health or addiction issues. Of those, threequarters had come into contact with mental health services at some point in their lives. Reading each person’s story, it became clear there was a yawning gap between the number of people formally recorded as waiting to access help (15 of the 486 reports we analysed) and the number of people trying to get help without being recorded as such. Scores of people had wanted to access a psychologist, a Mā ori provider, or a specific detox programme, but were turned away due to lack of capacity or long wait times. They were referred to less appropriate services instead, meaning they were not considered to be on a wait list, but had not been able to get the right help either. Numerous coronial reports mention people being dropped from services after missing appointments or not picking up the phone. And this brings us to the core of the problem: these people are slipping through the cracks and are either officially or unofficially trying to get help when they die because our mental health services are nowhere near resourced enough. Those working in the public and private mental health sectors say demand is so great that it’s impossible to give everyone the help they need. A system built to fail for some Anna found help before it was too late. After she was kicked out of the Kari Centre in 2017, she managed to finish high school from home with the help of a peer support person. But by 2019, her anxiety had crept back to severe levels, and she had turned back to alcohol. In June 2019, she mustered the courage to get help. She was referred to Auckland’s medical detox, Pitman House, run by Waitematā DHB. She had to wait another 12 weeks, but her weeklong stay there was life-saving. Currently, 47 people are waiting to be admitted to Pitman House for medically managed detox. It takes an average of 21 days for admission, a Waitematā spokesperson says. Anna has now been sober for two years, but doesn’t want to pretend she has been cured. ‘‘Wellbeing is not a destination, rather it is something that we are constantly working on, and the system doesn’t reflect this.’’ Anna was wary of sharing her story because she knows she is one of the lucky ones. The system favours people like her, she says, because it is built on cultural foundations that are familiar to her as a Pā kehā . She has a supportive and financially stable family. She lives in a big city, close to health services. But despite her privilege, even she has faced roadblocks and long waits for help. If the system is hard to navigate for her, then it’s pretty much impossible for someone living in poverty, without family support, and without the cultural understanding of services built for white people. ‘‘The sad reality is that the system is rigged in my favour.’’ We Need to Talk is an investigation into impact of long waits to access mental health and addiction treatment. This project was created with financial support provided by a nib Health Journalism Scholarship. TOMORROW: Holding on to hope


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