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17 September 2008 @ 01:38 am
Te Whetu Tawera in the NZ Herald [this makes me so angry, I had to share it]  
Discharged mental patients have nowhere to go, say staff
4:00AM Saturday Sep 13, 2008
By Craig Borley

Seriously ill people are being discharged from Auckland's acute mental health clinic despite having nowhere else to go, mental health staff have said in a report.

The report, written by Auckland mental health staff to their union, the Public Service Association, spells out the gap staff believe exists between Auckland's acute mental health clinic's policy, and its day-to-day practice.

"There is an unwritten tenet within [the clinic] Te Whetu Tawera that short admissions are an indicator of competent practice/treatment and that lengthy admissions indicate the opposite," the report said.

Managers at the city's 58-bed acute mental health facility actively pressured mental health workers to discharge patients, despite knowing the discharges were often not in the patients' best interests, it said.

The rehabilitation facilities the discharged patients needed moving to were invariably full, the report said.

Such a practice was "high-risk" and compromised the welfare and safety of the patients, the report said, leaving staff expected to make "stupid" decisions that would be detrimental to their patient's health.

Auckland District Health Board's regional director of mental health services Ian McKenzie told the Weekend Herald the report was wrong to assert patients were being discharged with nowhere to go. Nor did he think there was a culture of encouraging short stays at the unit.

He said while there were issues to overcome in the city's mental health services, those issues had been clearly identified by a Ministry of Health review last year, which identified staff as the primary target for improving services.

The review's findings, released in February, said: "Rather than focusing on structural change we should be improving the competence of all our clinical staff."

Mr McKenzie said: "I don't think that it is the resources.

There are always resource constraints, because we're in a public health system. But I don't think the solution to the problem is more rehabilitation beds."

The report, and the testimony of an angry Te Whetu Tawera staff member spoken to by the Weekend Herald, backed up the report's conclusions.

The staff member said Te Whetu Tawera's clinical director had sent out directives to staff to clear beds of patients, as new patients needed to come in. One patient was discharged and told there was a year-long waiting list for the rehabilitation facility they needed. That patient subsequently took their own life, the staff member said.

Another had entered Te Whetu Tawera after a suicide attempt, made another suicide attempt while at the facility, and then entered into a suicide pact with a fellow patient.

Despite obvious signs of an intent to cause self harm, that patient was discharged to the street, staff said, and was found dead just a short time later.

ADHB director of area mental health services Dr Gregory Finucane said it was "incorrect to suggest that we are not taking the patients' best interests into account".

Mr McKenzie said Auckland was coming from a period of considerable mental health underfunding.

But that was changing, and the city now received about 80 per cent of what had been decided was its appropriate level of mental health funding. The goal was to reach 100 per cent.

"We believe that we're on the right path. In the Auckland region there's been quite rapid growth over the past five years, probably to the point where we have said, yes, we're growing about as quickly as we can."
chicinterrupted on September 16th, 2008 09:04 pm (UTC)
this is just a opinion (I have never worked within the DHBS) but it would appear that both sides of this article may be true. when it comes to residential there is a gap in the middle in which patients are left hanging whilst waiting fot a bed. some staff also need to be more adequetly trained (nurses in particular who only have to do 1 mental health placement, with no need of additional specialisation, in their 3 year training programme - note that this is a general statement but there are very good psychiatric nurses out there, just as there are some people from more intense trining programmes that need additional training). On one hand patent's seem to remain for months when they could be discharged earlier... on the other hand, people needing the bed are discharged too early with a limited care plan that is not adequete for their needs. the mental health system in need of reevaluation...