Mental health service failings a tragedy 'waiting to happen'
A review done three years ago on the mental health service at Palmerston North Hospital highlights almost identical issues to a recent review and tragedy has been "just waiting to happen", a nurse who previously worked in the ward says.
The Manawatu Standard revealed on Saturday details of an investigation into the MidCentral District Health Board mental health service sparked by what it described as "two apparently self-inflicted deaths" of a similar nature in April and May.
The deaths raised concerns about underlying problems within the service. Several failings, including a passive, complacent culture, a lack of leadership, a lack of clarity in processes, a confusing service structure and inadequate facilities were uncovered in Ward 21 in a draft of the external review obtained by the Standard.
Julie Hopcroft, who worked in 2011 and 2012 as a nurse in the STAR1 ward, which is the mental health ward for people 65 and over, said the service lacked leadership and was a "crass environment" to work in where patients' care was compromised.
"It comes up again and again in these reviews on lack of leadership," Hopcroft said.
"This has been basically waiting to happen . . . you can see the tragic outcome."
Hopcroft, who resigned from MidCentral in December 2012 and no longer works as a nurse, said she had concerns over a particular patient's care and made a complaint to the DHB at the time.
She said she was stopped from actively being a good advocate for the patient and felt the issue was still unresolved.
The August 2011 review report, obtained by the Manawatu Standard, said senior medical staffing was "probably insufficient" to meet the service requirements of the DHB population.
"Currently they are struggling to meet current clinical demands and the service lacks appropriate clinical and systems leadership," the report said.
It was recommended the clinical director of mental health "urgently address the current lack of systemic leadership". The report also noted nursing staff levels were too low for the work demands and an inadequate senior nursing allocation.
MidCentral DHB specialist community and regional services operations director Nicholas Glubb said the review findings and recommendations were carefully considered and key actions agreed at the time.
A more robust clinical leadership was established with the clinical director of mental health taking responsibility for the psychogeriatric service and leading recruitment of a psychogeriatrician, Glubb said.
"A psychogeriatrician was recruited, who resigned in late 2013. Since April 2014 a consultant psychiatrist has provided consistent clinical leadership within the unit, and for the delivery of patient care."
Glubb said staff in the psychogeriatric service had at times expressed concerns regarding the service's capability, particularly to support patients with complex needs.
"Where this has arisen it has been addressed with staff by the clinical leadership of the service on a case-by-case basis. This has taken the form of a supportive approach to staff, including meetings with staff, revision of care plans . . . and the development of strategies to meet the needs of complex patients."
He said the DHB was not aware of any outstanding or unresolved concerns.