‘Soul Destroying’: Aotearoa’s Mental Health System No Longer Fit For Purpose And Delivering Substandard Care

Ahead of the general election next month, The Royal Australian and New Zealand College of Psychiatrists (RANZCP) is calling on all political parties for urgent, concrete reform and action, ensuring the mental health care and addiction system can meet the current and growing needs of the community.

An alarming report from the coal-face of Aotearoa’s mental health crisis describes a mental health and addiction system that’s under pressure, under-resourced and under-delivering for New Zealanders.

The study of 540 psychiatrists by RANZCP published in the Australian & New Zealand Journal of Psychiatry revealed the vast majority of psychiatrists - the people on the frontline providing care - believe the nation’s mental health system is not fit for purpose, and not heading in the right direction.

The psychiatrists who participated in the study assessed the system on a number of fronts:

Resourcing: 94% believe the resourcing of inpatient and secondary mental health and addiction services is not fit for purpose

Structure: 82% state the structure of the system is not fit for purpose

Funding: 88% believe funding into the system is not fit for purpose

Demand: 90% who work on an acute on-call roster report that demand in their after-hours work has increased or increased a lot

Complexity: 88% who work on an acute on-call roster report that complexity of people’s needs after-hours has increased or increased a lot

Workforce: Nearly two thirds (60%) report staffing levels have decreased or decreased a lot

Ahead of October’s election, the Royal Australian and New Zealand College of Psychiatrists (RANZCP) is calling for urgent and concrete action and reform.

“People experiencing a mental health crisis cannot be given enough help, or the right help, in a system that’s operating at crisis-point,” said Dr Hiran Thabrew, Chair of the RANZCP Tu Te Akaaka Roa, New Zealand National Committee.

“About 1 in 5 New Zealanders will experience mental illness each year, but each year, demand is rising – particularly for our most vulnerable.

“Over the last decade, moderate-to-severe mental illness has risen by nearly 40%, affecting around 5% of the population. That’s around 256,000 New Zealanders.

“Demand is growing, and demand will continue to grow. But the system isn’t keeping up.

“On a practical level, bed shortages mean acutely unwell people risk not being admitted, or discharged too early. Going longer without help increases the chances of a condition getting worse, being harder to treat, and taking longer to recover, creating a cycle of crisis-driven reactive care.

“In short, people in crisis cannot be served by a system operating in crisis.”

Those on the frontline have described their distress at the lack of capacity to provide adequate support to people in crisis.

One Aotearoa based psychiatrist commented: “Being on call is now the worst part of my job and it makes me consider resigning my job. The main problem is the lack of inpatient beds that are available. It is knowing what would be a good thing to do and being unable to do it, and then making an alternative plan that you know is a bad one but you have no other options - that is soul destroying.”

Another added: “It is extremely stressful to consistently be having to provide substandard care for people in need, not to mention the lack of recovery time before returning back to work for your day job. I have begun to dread being on call.”

The RANZCP is calling on all political parties to make mental health a priority for the next parliament.

RANZCP is calling for commitments to:

Urgently address the workforce shortage

Invest $60 million investment over six years to support 60 new psychiatry trainees through the system and into practice.

Support the 260,000 New Zealanders suffering from moderate-to-severe mental illness with the greatest need:

Increase future mental health budgets to meet population growth and the rising cost of existing services by $7.7 million per year, equating to $25m over three years

Commit to the spending previously announced - provide the mental health budget for mental health services.

Commit to making evidence-based decisions:

Invest $27 million over three years for a survey to provide a comprehensive understanding of the mental health and wellbeing of New Zealanders

Establish a clinical quality registry program to monitor the quality of mental healthcare

Funding to establish systematic, regular collection of workforce data.

Aotearoa’s rates of mental health-associated disability sit among the highest in the world, and serious mental health and addiction issues are estimated to cost the Aotearoa economy $12 billion a year (New Zealand Ministry of Health, 2017).

“The human and economic cost of in-action is dire and expensive,” said Dr Thabrew.

“The risks of failure to provide adequate mental health care include more chronic illness, intergenerational trauma, death, preventable incarceration and homelessness, which compound the pressure placed on other parts of the system, which are already stretched.

“Bad mental health policy is bad for the economy. “From a clinical, policy and ultimately human perspective, we must act now.”

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