'Housing crisis' for mentally ill
A "social housing crisis" threatening to gridlock Canterbury's mental health system is forcing the region's health board to consider housing vulnerable patients in caravans and portacoms on hospital land.
"Unprecedented" emergency psychiatric presentations and a lack of social housing have left the Canterbury District Health Board (CDHB) acting as an accommodation provider, allowing mental health patients to overstay in hospital when they no longer need care.
Loath to discharge patients out to the streets, the CDHB's adult inpatient acute service has been running at nearly 95 per cent occupancy, which is clogging up resources and costing the health board "a fortune", chief executive David Meates said.
More than 130 mental health patients are either overstaying in inpatient units, overcrowding houses or sleeping rough, he said.
The "housing crisis" has directly cost the CDHB more than $800,000 and with mental health presentations significantly up, the health board has no choice but to take drastic action.
"If we cannot find a range of short-term options now, we may well be creating some of our own," Meates told the health board in a meeting this week. "There are major, major issues with social housing across the community and some solutions have been pitched over the next two to three years, but the dilemma is that the problem is today. The biggest issue is here and now."
The CDHB has been investing in non-health related matters to try to ease social housing pressure on patients "and we cannot afford to let this fail", he said.
But "every choice and option the CDHB makes has other consequences", such as pulling resources from healthcare.
Surplus CDHB land has been identified for housing homeless patients and the health board discussed joining Housing New Zealand and the Christchurch City Council to build short to medium-term accommodation.
"What people have struggled to understand is that you have got to wait for a crisis to emerge before people have a burning platform to address it. This is where we are heading - we have been talking about it for a while and now it is playing out," Meates said.
International post-disaster research shows antisocial behaviour and mental health or psychiatric presentations often peak in the third year of recovery and Christchurch is following the trend.
Psychiatric emergency services have been hit with a 35 per cent increase of new patients over the past two years, with an average of more than 400 people needing the service on a monthly basis.
The psychiatric service deals with acute mental distress and patients suffering from delusions, hallucinations and self-harm.
Child and youth community mental health teams have fielded a 40 per cent increase and adult community mental health teams have seen a 20 per cent increase over the same period. Many of these patients have never needed mental health support before and clinical data confirmed social stresses such as housing woes, relationship breakdowns and financial issues were driving the increase, CDHB specialist mental health manager Toni Gutschlag said.
Disaster mental health Associate Professor Sarb Johal said secondary stresses, such as housing, insurance, EQC and the "wearing effect" of living in a broken city were often a bigger strain on post-disaster communities than the event itself.
If demand on mental health resources continued to mount, the CDHB would be forced to "take some pretty drastic measures as the options don't exist in the community", Gutschlag said. "We are able to discharge these people but there is no safe housing option for them to go to. This is really worrying and we are already running really fast to try and keep up."
Residential mental health provider Stepping Stone Trust has a 90-bed service to help integrate patients back into the community and chief executive Glenn Dodson said a new phenomenon called "bed blocking" started occurring last year.
About 20 per cent of clients could not be moved on because "there was nowhere for them to go" which meant beds remained full and the CDHB was not able to discharge new patients to the service, he said.
CDHB member Jo Kane suggested immediately kickstarting an aggressive public campaign.
Fellow member Andrew Dickerson urged Meates to stand his ground and keep the social housing issue in the public spotlight "because there are others leading the recovery who will not wish you to raise this issue", he said.
"In other disasters the psychosocial issues were around significantly longer then the physical rebuild issues and given the rebuild in some of Christchurch's worst affected suburbs is moving at glacial speed, I see this issue has barely started and will be with us for many, many years to come," Dickerson said.
Canterbury's social housing supply was reduced by about 1000 properties due to the earthquake, Cera social and recovery spokeswoman Michelle Mitchell said.
The Ministry of Business, Innovation and Enterprise had invested $30 million in social housing for Canterbury and 11 new units would be completed by the end of March.
The council, along with government agencies, had met the CDHB to try to find solutions to this problem, including investigating partnership opportunities, a council spokeswoman said.
800,000: CDHB has invested more than $800,000 as a direct result of the "housing crisis".
130: More than 130 mental health patients overstaying in hospitals, in overcrowded accomodation or homeless.
35% increase of new patients since 2011 for Psychiatric emergency services.
40% demand increase for child and youth community mental health service.
20% demand increase for adult community mental health teams.
400 average of patients needing emergency psychiatric treatment each month.
94% adult inpatient acute unit occupancy in January 2014.