Canty mental health workers face burnout
Young and idealistic, Daniel Burgess-Milne strode optimistically into Canterbury's post-earthquake mental health sector.
With four years of meditation study his only relevant experience, Burgess-Milne was prepared for a supporting role in a struggling system.
He worked long days for little more than minimum wage, dealing with suicidal clients and watched helplessly as fellow support workers relapsed into their own self-destructive behaviour.
Soon, his mental health was suffering too.
Five years on from the February 22 earthquake Cantabrians are dealing with a slew of mental health problems, placing immense pressure on those charged with helping them.
So what then, for those on the frontline of the soaring mental health rates?
Many forget that, while curing quake resident's ills, they have experienced the same trauma.
Stuff spoke to more than a dozen mental health workers about their work. Of that number, only four were willing to speak openly. Others would not speak for fear of retribution. One district health board nurse admitted "everyone wants to lose their jobs".
Each worker said their workloads were negatively affecting their own mental health. The three words used most often were "fatigue", "stress" and "burnout".
Burgess-Milne quit his job in May 2015 to move overseas. He returned after several months. He says the situation in the mental health sector has got worse.
"The biggest challenge is that everyone's burning out. I see people who have been in the industry for a while, putting up a defensive wall and their ability to connect with a client is very low," he says.
"Obviously it's part of the job and I accept that, but this is more than a fulltime job."
He likens his experiences as a community support worker to a war zone.
No-one was clinically-trained or taught restraint, he says, but they were constantly dealing with acute patients because other services were over-subscribed.
Teenagers in his care attempting suicide or self harm were not an anomaly. Some had to be talked out of suicide over the phone after escaping.
There were no pay rises. Burgess-Milne was paid $17.50 an hour.
The turnover of staff was higher than clients. In nine months, there was only one staff member who had been there longer than he had. One of his nine managers in three years was a mental health-whiz brought over from Australia.
She resigned after six months because of the extreme workload.
Staff members who once self-harmed were doing it again. One staff member with bipolar disorder became unwell again.
With resources stretched to its limits, medication was too often the go-to.
"All we are doing is stabilising people with high medication. There's no recovery, people are just drugged up. And we're not acknowledging the challenges."
Burgess-Milne returned to New Zealand after the suicide of his closest friend, and the unravelling of the man's family. The circumstances were tragic; a breakdown in communication between Hillmorton staff meaning his high suicide risk was not communicated to the family.
The man's sister is now struggling with mental illness. The death has had a ripple effect on the remaining family, and the parents had split.
"We as a society are not taught the skills to deal with mental health issues. It's not talked about, we don't know how to help them and then everyone around them just burns out."
The latest tragedy came recently when a close friend he had visited in Hillmorton for weeks committed suicide, soon after she was discharged.
This friend underpinned the emerging trend of people seeking mental health treatment, Burgess-Milne says.
"It was only four months from being functional to suicide. If you look at her life, there was very little signs of anything going wrong. This is a real anomaly, you do not decline that fast. But I don't think it's an anomaly anymore, and we don't know how to deal with it."
It is a sentiment echoed by most in the industry, and there is a well-versed concern that without more money, the situation will worsen.
A health professional supporting staff at the Canterbury District Health Board and the region's NGOs says the current state of the sector dismays her.
"I have never experienced, in all my years in the health industry, so many tired, fatigued, exhausted staff as I've experienced now," she says.
"It's no one thing. A lot of them are dealing with their own personal earthquake-related stuff, and their own change in terms of funding and looking after their families."
Distressed workers bring issues to work with them, she says, which in turn affects morale.
There was more out-of-character behaviour in staff, and some workplaces were better resourced to deal with it.
"My hunch is the DHB is doing the best it can with what it's got but it can't afford to have reduced funding because they have a workforce that is under immense stress."
Personally, she says there is an "over-arching sense in all of us of 'when is this going to finish?'".
There was no doubt secondary earthquake stressors were "making people sick".
The CDHB knows it as well as anyone else.
Since 2011, the CDHB increased its spending on counselling support programmes for staff by 40 per cent. On average, every person employed by the DHB now takes nearly one additional day of sick leave per year compared to 2011.
General manager people and capability Michael Frampton said the DHB was "concerned about the ongoing and cumulative impacts these challenges have had on our people's wellbeing".
"In addition, the wellbeing of our broader social services and community workforce remains one of our greatest concerns and is an ongoing risk in terms of the availability and sustainability of essential services across Canterbury."
The health board provides a range of wellbeing activities including yoga, free counselling and wellbeing workshops, which had "sustained demand".
At the Women's Centre, centre co-ordinator Ariane Hollis-Locke and manager Ardas Trebus are struggling to see a way forward. Green folders are stacked high beside Trebus' desk, stuffed full of funding applications. Eighty per cent of her time is devoted to finding money to keep the doors open, despite the fact the centre is already struggling to clear its backlog of clients.
Trebus hasn't had a pay rise in four years. Hollis-Locke has had small ones. The two positions share a wage of $65,000 between them.
Trebus experienced personal tragedy 18 months after the earthquakes when her partner died from cancer.
With nowhere to live, and the options scarce due to her "community organisation wage", Trebus found solace living in her friend's sleepout. She has been there since.
"It really doesn't stop," she says.
"It's become really hard, and really disheartening. So much is on our plate. For me in my position it's just plain trying to survive. It's unbelievably tiring on top of everything else."
The Women's Centre has moved twice after its building was ravaged by the earthquakes. The centre is lining up a third move for repairs.
It was "too much" to think about, and the stress was overwhelming.
"We've had so many counsellors going through their own rebuild, their own depression, and we're kind of holding that too. We're the ones who have to make it a good environment for them because they are caring for our clients."
One of those people is Hollis-Locke. She lives in Redcliffs, and is "moving slowly" in the rebuild process. Whenever it rains, the house leaks. They can't use some of the rooms due to mold and it's cold.
"We've taken the gib off the walls and ripped up the carpet to build a dam at the bottom of the stairs," she says.
"It's hard juggling the emotions that are coming in every day and what we've got at home."
New Zealand Nurses Organisation president Grant Brookes , together with several anonymous members, recently penned a blog post lambasting the state of the mental health sector.
Concerns raised by nursing staff were cuts to DHB work vehicles, taxis for clients, and an unwillingness of some employers to fill staff vacancies.
They were seeing a spike in rebuild workers seeking help for alcohol and drug problems, the referral rate to child and adolescent services had doubled, and there had been a "huge increase in presentations" to the Crisis Resolution Team.
"The long-term prognosis for mental health in the city is deteriorating," Brookes said.
The union was "concerned" about the levels of mental health funding, but also about the pressure on the emergency department.
However, members knew the issues were "bigger than the DHB".
"There is a feeling that Christchurch has been abandoned by the Government. There is a feeling that what's going on in mental health in Christchurch shouldn't need to be proved over and over again."
Health Minister Jonathan Coleman raised his concerns for the wellbeing of health industry staff while announcing extra mental health funding this week.
"I'm concerned because I know people there have worked in difficult services for five years."
He said it was up to the management to "deal with that appropriately". It was not known whether the funding would account for mental health staff and clients.
At the Familial Trust, recent Local Hero of the Year nominee Karen Watson is returning after a tough year personally and professionally. January was busier than ever. Burnout is more apparent than before. and now there are psychologists leaving town in droves because of stress.
"Everyone's fatigued in Christchurch, it doesn't matter if they're a client or a worker.
"Last year one of our staff members in particular was doing fulltime study and working full time with youth, so her mental health went down and she was struggling and that had a rippling effect on the rest of us."