Burnt-out mental health staff raise 'horrifying' concerns about conditions at Christchurch's Hillmorton Hospital
Burnt-out mental health staff at Christchurch's Hillmorton Hospital say they come to work anxious and afraid for the safety of themselves and their patients.
Four specialist mental health services staff, speaking anonymously for fear of repercussions, shared their "truly horrifying" stories after it was revealed on Monday assaults by patients had escalated to an average of more than two a day.
Mental health units were "total chaos", and staff warned a major crisis was looming as experienced staff were leaving and new staff would not stay.
Staff sometimes had to lock themselves in their office to escape unwell patients acting out, leaving them unattended until support came.
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The worried staff said patients were "petrified" and routinely locked themselves in their room.
When physically imposing patients aggressively demanded to leave, staff had to let them walk out the door, then call police.
"We're not a punch bag," one said.
Such incidents had happened twice in the past six weeks, they said.
Three staff said they would not like their family members to be admitted to Hillmorton if they became unwell "because they wouldn't be safe".
Two recent serious assaults in the adult acute inpatient service had heightened anxiety.
An acutely psychotic patient arrived in the service this year after assaulting two mental health workers in the community. The next day, the patient "beat a nurse to the ground". The nurse was taken to the emergency department and was off work for five weeks.
Staff members raised concerns in writing about the patient the day after the assault, when the patient's doctor took them off medication. They felt their concerns were "ignored" for about a week until the same patient assaulted three more staff.
Labour's Canterbury issues spokeswoman, Megan Woods, said the staff members' experiences were "truly horrifying".
"This is how a $22.8 million hole in [mental health] funding plays out in people's lives. The Government is letting down Canterbury. There is a crisis and it's putting the workforce, patients and the wider community at risk. We have to take action."
Green Party health spokeswoman Julie Anne Genter said a nationwide review of the mental health system was "desperately and urgently" needed.
"Our mental health system is tragically so broken that it has become routine for staff to be assaulted at work."
Minister of Health Jonathan Coleman said the Canterbury District Health Board (CDHB) expected to spend about $153m this year on mental health services – an extra $30m compared to seven years ago.
Some CDHB staff said they were forced to neglect patients.
"If you're fearful for your own safety, feeling anxious all the time, you can't look after other people," one said.
They could do the basics, but had no time to talk to patients. They believed patients took longer to recover and were more likely to come back after being released as a result.
"We don't have time to reassure the old lady who feels very upset because she thinks her children have abandoned her.
"There is more to mental health than medication but we're not able to provide the care patients need and deserve."
Staff were so burnt out they had to call in sick to get respite.
"Five years ago, we would have never dreamt of doing that."
Despite punches, kicks or slaps from patients being a "daily occurrence", staff said they felt uncomfortable raising concerns to management because they were then singled out as "a moaner, a complainer".
They said they would need an increase in staff numbers across the board, with at least 50 per cent more nurses, to make units safe and functional.
"It's getting worse and worse. Something needs to change."
Mental Health Advocacy and Peer Support manager Sue Ricketts said staff were working in "very difficult and challenging conditions".
The CDHB's "enlightened move" a few years ago to treat more people in the community meant people admitted at Hillmorton now were "at the high end of acuity of psychosis or mental health complications due to substance use".
"Turnover of staff and use of agency nurses mean that the environment is not one where nurses can work therapeutically with patients to any degree. Often they are dealing with acute situations which involve action and reaction.
"The staff at Hillmorton are doing the best they can with the resources they have."
CDHB figures show the number of nurses working in specialist mental health services has increased by about 10 per cent since 2012, but the number of doctors and senior doctors have remained stable, despite the unprecedented increase in need since the February 2011 earthquake.
Mental health services were seeing about 700 more adults and 300 more children and young people each month than they were before the quakes, the CDHB said in January.
At a health select committee question session on Wednesday, acting CDHB chairman Mark Solomon said some patients had to be moved to other facilities some nights because there were not enough beds at Hillmorton.
The adult acute inpatient service was averaging up to 80 or 85 inpatients at a time, but only had 64 beds.
'IT'S NOT A GLAMOROUS JOB'
"Serious and worrying" things have happened in Canterbury's specialist mental health services, but all staff concerns are taken seriously, the CDHB says.
Mental health general manager Toni Gutschlag said the reported assaults were under formal investigation and management took staff concerns seriously.
"Staff are very stretched and we are concerned about staff being injured at work."
The severity of patients' conditions had increased post-quake, with only the most unwell people admitted to Hillmorton Hospital.
Staff were trained in safe practices and having to retreat to their office was rare.
They were right to let patients go when containment caused them to become agitated, she said.
Gutschlag was confident staff had never let someone go who could be a danger to the public. A kindergarten opened near the hospital 30 years ago, but there had been no incidents since.
"We put a lot of work into keeping our staff and the patients safe. People do a fantastic job in really difficult situations."
Christchurch's specialist mental health services were well staffed compared to other services across the country and turnover was low, she said.
"We would love more resources but we are confident our levels of sufficient to keep the services functional and safe. It doesn't mean incidents don't happen."
Any vacancies were hard to fill though, making recruitment a "big priority" for the CDHB.
"It's fair to say there is a shortage worldwide of experienced psychiatric staff. It's not a glamorous job.
"Even if the Government agreed to fund a 50 per cent increase in staff, we wouldn't be able to find them."
Various initiatives supported staff wellbeing, including on-site support and anonymous counselling.
The CDHB strongly encouraged staff to report incidents and raise any concerns they had.
There were other options if they were not comfortable talking to their manager, such as making an anonymous complaint.
"We're proud of what our staff do. We do acknowledge they could do more with more staff but we're getting our fair share of the CDHB's resources," Gutschlag said.