Bradford Sue: Debate on Crown Entities Public Organisations and State Enterprises 
Text is incorporated into the Bound Volume 
Bradford Sue: Debate on Crown Entities Public Organisations and State Enterprises 
[Sitting date: 10 June 2003. Volume:609;Page:6104. Text is incorporated into the Bound Volume.] 
SUE BRADFORD (Deputy Musterer—Green) 
: 
 Despite the best intentions of the Minister of Health and many others within and outside Government it continues to be apparent that many of the public institutions that care for people with mental illness are in crisis if not total meltdown. Newspaper articles over the last 24 hours make chilling reading. First the  
Dominion Post 
 reports that Wellington Hospital is to increase security after one of its patients walked out of its acute unit and into the tiger cage at the zoo leaving the patient fighting for his life and zoo staff and visitors including young children shocked to the core. An independent report released yesterday indicates a number of problems at the unit including overcrowding poor layout and too few staff. I congratulate Capital Coast Health on its forthright apology for what happened and on its plans to improve the situation. 
However it worries me that at the heart of its response is a statement that talks about investigating whether six new beds for committed patients can be acquired somewhere in the district. That health board should not be having to investigate the possibility of gaining new beds. It should simply be able to decide that it needs them and work with as much alacrity as possible towards acquiring them. In this case as in many others when it comes to increased numbers of beds the need is obvious and desperate and has been for a long time. I hope the day will come soon in mental health management when boards will be able to make decisions within a known and adequate framework of funding and staffing without endless prevarication and bureaucracy surrounding the application of resources. 
Another newspaper article this morning—this one in the  
New Zealand Herald 
—warns 
that police in west Auckland are reaching the point where they may refuse to hold mentally ill patients in their cells any longer. At the time of the review of Auckland’s mental health services ordered by the Minister late last year we were told constantly that one result of the review would be that police cells would no longer be used as an adjunct to overflowing acute units. Now 6 months after the review team reported back we have the police themselves in desperation advising that they have had enough of looking after up to six patients a month in the Henderson cells for periods of up to 4 days at a time. Thankfully police lawyers are finally looking into the legality of the practice and I will be interested to see what their advisers tell them. At the same time a New Zealand Public Service Association delegate is expressing deep concern over what will happen if the Henderson police do finally refuse to allow their station to function as a psychiatric outpatients unit. The delegate mental health nurse Richard Schulman advises that mental health services in the Waitemata District Health Board area are becoming worse and that putting an end to holding patients in cells will “create more and more pressure on acute beds because we do not have enough as it is.” 
In another of the strange vagaries of mental health funding the same article reveals that while space has been built for three new intensive care beds at the Taharoto unit the beds have not been funded. Once again as with the Wellington situation everyone knows the problem and everyone appears to know the solution but somehow there is a massive disjunction between knowing where resources need to be applied and actually getting them there. In another of the oddities of mental health resources in Auckland and west Auckland when last I heard the Manawanui Maori health unit at Carrington had plenty of that “built space” plenty of beds and plenty of staff but only one or two or no patients. I do not know whether anything has changed but even if there are difficult underlying treaty issues involved at the unit surely while those are being resolved that resource of staff and amenities could be put to better use in a district that is constantly in crisis through a lack of staff and amenities. 
As for the wider situation with the Waitemata District Health Board it appears to be in absolute chaos and the Auckland review does not seem to have helped. That is not surprising when one considers that part of the district health board response to the review was to provide “an extra 20 intensive packages of care” which sounds really good until one discovers that those extra packages are not beds in acute units as one might have suspected but instead funding to allow patients to move into the community. This is extremely odd given that the pressure on acute inpatientbeds including the practice of holding people in cells was identified in the review as a key problem. I do not know whether the fact that Dave Davies who is the head of mental health at Waitemata came over from the Health Funding Authority where he was one of the leading lights in denying Auckland inpatient beds but I would not be surprised if the background of that gentleman might contribute to aspects of the current confusion over priorities in that district. 
However it is not just a lack of inpatient beds that is contributing to the crisis. There is also the fact that funding for community services is often insufficient and in fact penalises providers for succeeding. For example if a non-governmental organisation offers level 4 accommodation to seriously ill patients when those people start to recover the funding is cut. So there is no motivation to the provider to do its best to help people get better. There is a very perverse incentive at work here. At the same time community providers are at times reluctant to cater for people who they think will cause too much trouble. All in all it is no wonder there is a shortage of step-down beds in the community even and especially where they are needed the most. 
The structures for funding in the sector are simply not set up to succeed. This comes on top of the fact that Northland Waitemata Auckland and Manukau are still funded at only 60 percent of mental health blueprint targets. Some questions continue to need to be asked. For example what has changed as a result of the Auckland review? There was a lot of talk about integrated care and the need for people to talk to each other across silos but if that is supposed to be happening why are frontline mental health nurses still not allowed any significant input into what is going on? Why is the only information staff are getting about police plans to end the use of cells for patients coming to staff through the media? Why are staff not involved in discussions on how best to manage the string of crises that will almost inevitably result from the police decision? Waitemata’s mental health services are in serious trouble at the Te Atarau the Taharoto unit and elsewhere. There is a huge dissonance between workers and management. 
Today I spoke with a nurse in one of the acute units who said that when she hears management talking on the radio or other media she does not recognise anything that they are saying as relevant or pertinent to the life of either her patients or to the staff like her who are doing their best to care for them. This is not strength-based recovery; nor is it integrated care or any of the other nice buzzwords that abound in the mental health world. We continue to have an ongoing crisis at least in the north that I believe demands action way beyond that which the Minister has already seen fit to take. We do not need more inquiries or more money wasted on yet more layers of bureaucracy. What we do need is clear leadership focused on bringing common sense to the application of what resources there are both inside the hospital system and outside in the community sector. 
Members of the mental health workforce must be involved in a genuine way in planning and decision making. The needs of tangata whaiora and their families and friends must be respected to the maximum extent possible. Those needs are not just about countering stigma or about consumer representation great as those initiatives have been; they are also about very sick people having the right to be cared for properly in a hospital bed and not in a police cell. Children and young people with mental illness should have all the funding allocated to them spent on them. The Ringfence project has revealed once again that children and youth miss out with services not even delivered to the contracted levels that are way below blueprint targets anyway. 
I am sick of hearing lack of workforce as being the reason for all those failures. After 3½ years of a Labour-led Government committed to workforce development that excuse is becoming somewhat tired. We would have more staff and more quality staff if we paid them better. We could do that if there was less wastage in how money was spent. We could provide more inpatient and community beds if the will was there to manage systems more effectively. I hope that the coming year will see some real leadership taken from the highest levels of Government before more lives are lost and more staff blamed for tragedies that in the end are not caused by worker inadequacy but rather by massive ongoing systemic failure.