Community care mooted for mentally ill

21:02, Jan 28 2013

More acutely unwell psychiatric patients are expected to be treated in the community to save money spent on expensive hospital-based care, mental health watchdogs believe.

Like all services offered within the Taranaki District Health Board, mental health services have also been under review.

It is believed the focus is to gradually cut the numbers of patients cared for in expensive inpatient beds, replacing their care with community-based services.

Taranaki Base Hospital's mental health ward, Te Puna Waiora has 23 inpatient beds. The average daily cost of caring for a mental health patient in the ward is $800.

Taranaki DHB funding and planning manager Jenny James has confirmed to mental health lobby group Like Minds that while changes are afoot there is no intention to cut funding or service provision.

Any changes would be phased in and changes would use all the funding, Ms James says in the latest Korero Mai newsletter.


Taranaki DHB mental health and addiction services receive $30.1 million a year, hospital general manager Rosemary Clements said.

In addition, close to $1m is paid for services offered to Taranaki patients outside the region.

Ms Clements said the mental health and alcohol and drug services residential review was completed in May last year.

"We are now in the process of the next phase of the project - implementation," she said.

Like Minds manager Gordon Hudson says rumours have been around for a long time that the ward would be downgraded or closed.

And community-based alternatives could be a good thing for patients if properly funded and staffed.

"We know that the best treatment for a person in crisis takes place in the least restrictive setting possible.

"The DHB just has to do it right," Mr Hudson said.

Mr Hudson said his group would support any such move "but we need to ensure the community-based services are both clinically well managed and accessible".

As a priority, acute crisis services should be bolstered throughout the region, Mr Hudson said.

"At the moment they are not very effective.

"Again, if we are going to take more challenging clients out of Te Puna Waiora there needs to be absolutely skilled staff available and a prescribed facility where those staff are available."

This would add to the safety of care and would mean a less restrictive and less traumatic setting for patients rather than being in a hospital ward, he said.

The recently established Taranaki DHB acute home-based treatment service, where patients were cared for within their own homes, had proved very successful and should also be expanded, he said.

"Significantly enhanced" quality crisis respite care would both be a priority and an attractive option, he added.

And there was also a need to have supporting GPs step up to better manage their mentally ill patients and ensure that they spent more time with them - but not at an extra cost to the patient many of whom were beneficiaries.

Asked how the success or otherwise of the move could be monitored, Mr Hudson said the mental health sector in Taranaki was "very close-knit".

"Everyone will be watching with interest and they will certainly be monitoring what happens."

Mr Hudson said he had consulted Taranaki mental health inspector Murray Cochrane about the proposals.

"He clearly has a watching brief and is very competent in that role," Mr Hudson said.

It was unfortunate that mental health was often the poor relation of health services and he believed Health Minister Tony Ryall had little interest in it.

But psychiatric illnesses struck 46 per cent of the population at one time in their lives.

Twenty-one per cent of the population would have a mental illness at any given time, Mr Hudson said.


Taranaki Mental Health Services Taranaki DHB mental health and addiction services funded $30.1m a year. A further $900,000 paid for services outside the region.

Average bed-day rate for inpatient services is $800.

Mental health ward Te Puna Waiora had 467 admissions last year involving 312 patients.

The ward has 23 inpatient beds and of those 15 are allocated for acutely unwell inpatients, 4 for older people and 4 for intensive care. The average stay in the ward is 14.5 days.

There are an additional 42 mental health beds in the community. Further beds are purchased on an as-and-when-needed basis.

Taranaki Daily News