Heather Roy's Diary

Occasionally the odd document falls off the back of a truck. Such documents are just about always intriguing and frequently newsworthy. They tell you about things that aren't supposed to get out - not yet anyway, if ever. A couple of those documents came my way this week.

Hodgson's Choice

The first was a letter from Waitemata District Health Board's General Manager to Primary Health Organisations telling them to expect 800 patients to be dumped back on their doorstep by 30 September. It also tried to explain how having to implement the Labour governments policy of keeping no-one on a waiting list longer 6 months was a good thing. Nobody was convinced, hence the leak.

The comment in the letter "these numbers are not for public release but to quantify the impact for primary care providers" showed that the DHB was stuck between a rock and a hard place. Its options were to cull the waiting lists by 800 or lose $3 million in funding. It's not just Waitemata DHB that is affected. The other 20 DHBs will all be facing Health Minister Pete Hodgson's 'choice' - patients or funding - right now. In effect General Practice has become the holding pen for patients to wait and deteriorate before being referred back to hospitals for specialist care. Hodgson's Choice is unfair to patients, unfair on DHBs and the only party to benefit is Labour. The Labour party is only interested in making waiting list figures look good by massaging the statistics.

Utopia Achieved?

On 1 August the Minister of Health announced Te Kokiri - a ten year plan for Mental Health. A plan isn't such a bad idea given that $999 million will be spent on mental health specialist services in the 2006/07 financial year - about one tenth of the total health budget.

My second leaked document foretells some seriously scary planning however for mental health services in the Central Region (Hawkes Bay, Wairarapa, MidCentral, Whanganui, Hutt Valley and Capital and Coast DHBs). This draft document outlines the vision of mental health and addiction services for 2016.

It makes such statements as:

"In 2016, the mental health and addiction system will be completely person centred. It will be flexible enough to meet people's unique needs but structured enough to ensure that services are delivered safely and within a comprehensive systemic framework."

Introductions suggesting a utopian future are common in Ministry of Health documents but it does leave the impression that optimism is achieved by looking away from problem situations. I became seriously concerned later:

"earlier access to appropriate services will facilitate an increased uptake and dissemination of web-based medicine, telepsychiatry, and telephone based support"

The idea of "telepsychiatry" seems more "Star Trek" than hospital. Dr Bones McCoy may have been able to make any diagnosis by using portable scanning equipment but New Zealand doctors are likely to have to see their patients before making a confident diagnosis. This is likely to be the case in 2016 and beyond. Beam me up Scotty.

"In 2016, the approach to residential services will be substantially different. There will be few residential beds and services will focus on meeting the support, clinical, and intersectorial needs, enabling service users to remain living in the community and in their own homes."

The principle of community care has been a good one where it represented real advances in treatment. The problem is that the reduction in number of patients in psychiatric hospitals resulted in little cost saving so a programme of closures ensued. This produced an unholy alliance between therapeutic radicals and fiscal conservatives to close all psychiatric facilities. This happened just as the recreational use of drugs such as amphetamine was on the rise. The end result is that obviously mentally ill people now live on the streets. Instead of admitting the size of the mistake, government policy is making things worse.

"Intensive care facilities would only be considered as a last resort and be utilised for very brief periods of time. The principle of service provision in the least restrictive environment will be upheld by having unlocked units."

My understanding is that at present there are too few secure beds as opposed to too many - the implication in this statement. Of all the mental health tragedies in recent times the constant criticism by official inquries, media and the public is that patients are not restricted enough. Secure facilities are already scarce and protect both patients and the public.

Only half a page in this 70 page document has been dedicated to 'Service users under the jurisdiction of the criminal justice system' despite an estimated 15% of prison populations suffering a mental illness. Here the patient gets locked away in a much harsher environment than a hospital. The author of the report is presumably not worried about prison inmates and the state of their mental health because they come mainly under the justice budget.

And then the report returns to the Star Trek telepsychiatry...

"Community crisis services will be available at all hours to people with mental illness or addictions in the community ... these services will ensure access to excellent crisis counselling and psychiatric services as needed and include access to peer supports throughout the crisis period. 24-hour crisis telephone help-lines will also be available.."

The general theme in this leaked report seems to suggest that there will be little mental illness by 2016. It reminds me of the Russian Revolution where the revolutionaries thought there would be no mental illness in a perfect Marxist-Leninist state - utopia indeed.

Ends

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