Stuff Digital Edition

Holding on to hope

In 2017, the Government promised to fix systemic issues plaguing the mental health system. Years later, clinicians say there are no tangible signs of improvement. In a Stuff investigation into the impact of long waits for treatment, Cécile Meier talks to those holding on to hope, and the overworked clinicians scrambling to get to them in time.

Max* grabbed a chef’s knife and dragged the tip across his hand. The 9-year-old said he wanted to die.

His mother, Charlotte*, had spent the previous six months trying to find mental health support privately for him in their hometown of Wā naka, but was turned down at every avenue.

The knife incident happened in July. Soon afterwards, Max was registered with the Southern District Health Board’s Child and Adolescent Mental Health Service (CAMHS). Months later, they are still waiting for him to start treatment.

‘‘We spend our days managing his crises, his moods, his emotions,’’ Charlotte says. ‘‘We watch him like a hawk so he doesn’t hurt himself. He has even asked why no-one can help him, why no-one wants to see him. He doesn’t know why he feels the way he does, and we haven’t been able to get answers.’’

Initially, the family were told the wait list was so long they could not even get a date for an assessment. If they needed help, they should ring police or the crisis helpline.

CAMHS gave the family a date for a first appointment in October. They were told Max qualified for the service, but would have to wait another six months to see a psychiatrist. Charlotte does not know whether Max has ADHD, autism or a clinical mood disorder, and she won’t know until a specialist assesses him.

Max, a bright, curious and articulate child, was bullied at school when he was 8. The family lived in Auckland then. Charlotte says the behavioural issues started soon afterwards.

Max became inflexible, and had repeated tantrums. He was moved to a different class but started having panic attacks. At night, he struggled to sleep. Charlotte would find him crying under his bed.

‘‘I want to knock myself out,’’ he once told Charlotte. ‘‘If I could just choke myself to death my thoughts would stop.’’

When the family sought help through their GP, the response bordered on farce. Auckland’s public mental health service said Max’s condition was not severe enough to qualify for help, and private providers turned him away because his condition was too severe.

In August last year, the family moved to Wā naka, hoping a more peaceful lifestyle would help Max settle down. Initially, it worked. But at the start of this year, the tantrums, tears and panic attacks returned. Max, initially frightened by the knife incident, did it again. When his parents hid the knives he would bang his head on the door or the floor. The crisis has started to affect his 8-year-old sister.

‘‘Sometimes she bawls her eyes out and says: ‘I will keep him safe, I will make sure he doesn’t play with knives.’ It is devastating for her.’’

The Southern DHB does not discuss individual patient care in the media, but mental health and addictions executive lead Gilbert Taurua says: ‘‘We are always concerned to hear of people who have not had a good experience . . . accessing care when they need it.’’

As of November, 143 children are waiting to be seen by CAMHS in the Southern DHB area. Children wait about 21 days between referral and first in-person contact (often an assessment, rather than the start of any treatment) and then another 25 days for the second face-to-face contact, Taurua says.

Wait times vary significantly between teams throughout the region, however, for a variety of reasons, including demand for services, staff workloads, and any vacancies or absences, he says. The board’s mental health and addictions system is implementing recommendations from a recent review.

Charlotte has not been able to work as much as needed, which puts financial pressure on the family. Her husband is keeping it together for the kids, but it has taken a toll on him too, she says.

Her mother has moved down temporarily to help out. ‘‘We are in crisis mode, and we are trying to get by. We are in a hopeless situation because we can only do so much as parents. He says he doesn’t trust us; he doesn’t trust the world any more because noone wants to help him.’’

Charlotte says Wā naka lacks access to mental health support. The community has rallied in response, with people supporting one another through social media and gatherings.

‘‘How we cope, I don’t know. Every day, we just wake up realising that this is our reality, and we need to do everything we can to get him and his sister through the day. We are absolutely exhausted.’’

Staff burning out

People who work in mental health usually have a passion to help others. Turning away people in need is the opposite of what they want to do, but the resources are so limited they have no choice.

The results of an Association of Salaried Medical Specialists survey of its psychiatry members was released to Stuff early for this project. They make for grim reading. More than a third of respondents reported high levels of burnout, with 41 per cent saying they always or usually end up covering other colleagues’ caseloads.

‘‘I love working with my clients/patients,’’ one said, ‘‘However, the current system is unsustainable. We do not have enough staff or resources to retain staff, the staff around me are burnt out, unmotivated, and it is painfully obvious.’’

Another said it was ‘‘very distressing to see very unwell patients who are unable to be admitted due to lack of beds’’.

Almost half the respondents said they would leave their current job if they could. In 2018, New Zealand had the lowest number of practising psychiatrists per capita of 11 countries, including Australia, the UK and Canada, the association said. Our system is heavily reliant on international medical graduates and their retention rates are poor.

‘‘Every week our small service hosts yet another farewell for a departing staff member,’’ one psychiatrist said. ‘‘I have never experienced such disillusionment in a workplace

. . . I enjoy the patient-contact work itself, but I think my health will deteriorate if I stay in my current job.’’

Almost all respondents (95 per cent) reported an increase in demand for specialist mental health services over the past three years, with 87 per cent saying the service they work for is not well-resourced. ‘‘My service has had no [staff] increase for over 13 years, but the rest of the hospital staffing has increased by 40 per cent,’’ one psychiatrist wrote.

Another said: ‘‘We now see lots of patients who come straight from prison, as forensic services are overwhelmed and they have usually been significantly traumatised in prison also.’’

Another survey, by the Royal Australian and New Zealand College of Psychiatrists earlier this year, drew some alarming responses about the state of child and youth services. ‘‘I know of inpatient units where patients are sleeping on couches, in lounges or in hallways due to the lack of beds. If that happened in oncology or cardiology, it would be front-page news and be seen as a public scandal,’’ a respondent said.

‘‘Having to restrict access over the last few years has been distressing. Young people don’t tend to ask for help more than once. So suggesting that they are not ‘bad enough’ to access mental health services sets up the wrong conversation,’’ another youth psychiatrist said.

Looming over all this is Covid-19. The pandemic has made it more difficult for DHBs to recruit mental health staff from overseas. The Canterbury DHB was short of 25 mental health nurses in September, meaning its existing nurses have to work extra shifts to compensate. The vaccine mandate has further affected staffing, with Christchurch’s child and adolescent service losing more staff who refused to be vaccinated.

Meagan McNamara is one of them. She says the impact of further shortages will be devastating on young people, who already face an 11-month wait with non-urgent referrals (after assessment). But the demand had been mounting long before the pandemic.

‘‘Mental health is the biggest health issue facing New Zealand outside of the pandemic, but it has been here for decades,’’ Mental Health Foundation chief executive Shaun Robinson says.

‘‘If we had ignored Covid and let it go rampant, we all know our system would have been completely overwhelmed. That is what has happened with mental health; it has been ignored for decades and . . . our system has been overrun.’’

Struggling to even get on the waiting list

Amal*, 24, has been waiting to see a psychologist for almost a year. The young professional from Nelson, who describes herself as a ‘‘high-performing depressive’’, attempted suicide four years ago. There is a history of suicide attempts in her family.

Amal found about a dozen psychologists in the region and contacted them over and over, to no avail. Every waiting list was full. Being repeatedly turned down brought a sense of hopelessness, she says.

‘‘If you keep asking for the same thing over and over and everyone is saying ‘no’ to you, you think: ‘What is the point of asking?’ It becomes: ‘I have to deal with this myself’, and that’s when things get scary.’’

Amal asked to use a pseudonym, due to the stigma around mental health. As a person of colour born in New Zealand to Asian immigrants, she feels that stigma compounded. She has battled subtle racism all her life.

Some of her family members don’t know about her mental health struggles. ‘‘The stigma of mental health is higher in a lot of Asian cultures. There is a pressure to succeed, and you are not told to check in with yourself and see how you are doing. This adds to the Kiwi culture of being strong.’’

After her suicide attempt, she was scared. She didn’t want to confront the problem. It was two years before the lie caught up with her. Her GP prescribed antidepressants and told her to see a counsellor. The medication helped for a while, but the

Charlotte* is desperate to get help for her son, who has been struggling with debilitating panic attacks and suicidal thoughts.

Insight

en-nz

2021-11-27T08:00:00.0000000Z

2021-11-27T08:00:00.0000000Z

https://stuff.pressreader.com/article/282020445564866

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