Memo Musa, the chief executive of NZNO, said the organisation welcomed the inquiry’s terms of reference and was pleased that the inquiry was due to report back by the end of October.
Prime Minister Jacinda Ardern announced the inquiry yesterday, to be chaired by former Mental Health Commissioner Ron Patterson, saying nothing was off the table for the review, which has a particular focus on ensuring equity of access to mental health and addiction services and improving outcomes. (See inquiry details and team members below.)
Musa said that currently the mental health workforce was not well co-ordinated and he hoped the inquiry would widen early to take in workforce issues, as NZNO believed it was important that the workforce was resourced well so it had the diverse skills and capacity to respond to mental health needs.
The inquiry’s terms of reference call on the inquiry team’s report to help inform the Government’s future decisions for the mental health and addiction system, including workforce planning and training and the funding of mental and addiction services.
“The initiative to have more nurses in schools and extending free doctor’s visits for youth will help stop the flow of childhood mental health stress moving onward to become major mental health issues,” said Musa.
“Nurses have a role to play in mental health as they are working with people, whānau and communities every day. The focus on the elderly, children and youth is most welcome in the scope of the inquiry.”
He added that there was “no health without mental health”. “Mental health is too important to be left to health professionals alone and needs to be joined up with community and government services.”
Alcohol addiction needs to be on table
Alcohol Healthwatch and Māori public health organisation Hāpai Te Hauora have also welcomed the inquiry and called on it to address the growing problem of the link between alcohol and poor mental health.
“The Government was right to include addictions in the inquiry into mental health,” said Anthony Hawke of Hāpai Te Hauora. “In 2012 we had the chance to raise the price of alcohol and save lives. We didn’t. Our communities paid the price. Now is the time for this to be remedied.”
Executive Director of Alcohol Healthwatch Dr Nicki Jackson agreed. “Alcohol has become considerably more affordable since our new laws were put in place. Drinking has become worse. The Government has stated that all solutions to improve our mental health are on the table – research shows that one solution to our shameful suicide rates is to raise the price of alcohol. This approach is particularly effective in reducing suicide among young males.”
Inquiry into Mental Health and Addiction
The basics
Purposes of the inquiry
Hear the voices of the community (including consumers, families and providers of services) on New Zealand’s current approach to mental health and addiction and what needs to change.
Report on how New Zealand is preventing mental health and addiction problems and responding to people’s needs.
Identify unmet needs (across full spectrum from mental distress to enduring psychiatric illness) and which groups of people present the ‘greatest opportunity’ to make a difference to.
Consider previous investigations, reviews, reports and consultation processes relating to mental health and addiction, including the Peoples’ Mental Health Report (2017) and Blueprint II: Improving mental health and wellbeing for all New Zealanders (2012).
Recommend specific changes to New Zealand’s approach to mental health – with a particular focus on equity of access, community confidence in system and better outcomes for Māori and other groups with disproportionally poorer outcomes.
Inform the Government’s decisions on future arrangements for mental health and addiction system including:
Scope of the inquiry:
Inquiry members:
Professor Ron Paterson (Chair) was the Health and Disability Commissioner 2000-2010 and is currently a professor of law at the University of Auckland and Chair of the New Zealand Centre for Human Rights Law, Policy & Practice Advisory Board. He is recognised internationally for his expertise in patients’ rights, regulation of health practitioners and healthcare quality improvement, and has chaired several major health system reviews in Australia.
Dr Barbara Disley is a former director of the Mental Health Foundation (1991-1996) and a former executive chairwoman of the Mental Health Commission (1996-2002). She is currently chief executive of Emerge Aotearoa, which provides a wide range of community-based mental health, addiction, disability support and social housing services nationwide.
Sir Mason Durie is a psychiatrist and professor of Māori Studies at Massey University. An expert in Māori health and culture, he has served on a range of health-related committees, councils and advisory groups, including the Mental Health Foundation (1976-1980) and the National Health Committee (1998-2000), and was a Families Commissioner (2003-2007).
Dean Rangihuna is a Māori consumer adviser for the Canterbury DHB with a particular focus on mental health services. He has consumer/lived experience and knowledge of Māori mental health models.
Dr Jemaima Tiatia-Seath has research expertise and experience in Pacific mental health and suicide prevention. She is currently acting co-head of the School of Pacific Studies at the University of Auckland and is a senior lecturer for Pacific health at the School of Population Health.
Josiah Tualamali’i is chair of the Pacific Youth Leadership and Transformation Charitable Trust. In 2016 he received the Prime Minister’s Pacific Youth Award for Leadership and Inspiration and he is a semi-finalist for Kiwibank Young New Zealander of the Year (2018).
Source: Inquiry Cabinet Paper and Terms of Reference
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WHERE TO GET HELP:
If you are worried about your or someone else’s mental health, the best place to get help is your GP or local mental health provider. However, if you or someone else is in danger or endangering others, call police immediately on 111.
OR IF YOU NEED TO TALK TO SOMEONE ELSE:
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Mental Health Commissioner Kevin Allan, in a report released yesterday, listed a series of failings with the DHB’s care of the man leading up to his death and concluded the Counties Manukau District Health Board breached the Code of Patients’ Rights.
He also expressed concern that the level of nursing care for the man “was unacceptable” as the nurses had not carried out adequate risk assessments or responded appropriately to changes in the man’s mood and behaviour or his friend’s concerns.
The man was admitted to the DHB’s acute mental health unit on a Friday afternoon in 2014 under a compulsory treatment order (and put under 15-minute observations) after being found wandering outside Auckland airport appearing dazed and confused after an international flight. On the Monday morning he was found unconscious in his room and was unable to be resuscitated.
The commissioner’s expert nurse advisor Dr Tony Farrow said the nursing staff’s risk assessments of the man were inadequate; they did not appropriately respond to the man’s deterioration in mood and they should have requested an urgent risk assessment from a registrar or consultant after the man’s visiting friends shared their concerns that the man was talking about making a will.
Among his recommendations, the Commissioner also suggests the DHB consider having psychiatrists on duty at its acute mental health unit during weekends and public holidays.
The DHB said changes that have been made following the incident in 2014 include having a Medical Officer of Specialist Scale on duty every weekend; an on-call psychiatrist does a clinical review of all new inpatient admissions within 24 hours; a new clinical handover procedure has been adopted; and a serious incident review has led to 10 recommendations looking at after-hours practice and ensuring staff are able to provide appropriate assessment and treatment of clients experiencing drug or alcohol withdrawal issues and can liaise with ED about mental health patients with complex medical co-morbidities.
Police found a man wandering outside an airport following an international flight.
The man appeared dazed and confused. He was taken to a police station, where he was seen by a consultant psychiatrist and a duly authorised officer/social worker.
The psychiatrist recorded her impression as: “Psychosis NOS [not otherwise specified] — possibly associated with mood disorder, possibly drug-induced. History of polysubstance abuse.”
The man was admitted directly to a psychiatric inpatient unit and placed on observations every 15 minutes. A second psychiatrist recorded that he believed that the man was mentally disordered and a temporary compulsory assessment and treatment order notice was issued.
At 2pm that day, a Friday, the man was reviewed by a consultant psychiatrist, who decided on a plan that included further assessment and monitoring for signs of withdrawal. She recorded a request that the man be reviewed by a registrar the following day (Saturday) and on Sunday if necessary. However, the man was not reviewed again by a psychiatrist during his admission.
At 5pm, a house officer conducted the man’s admission physical examination. The house officer recorded a history of substance abuse, chronic pain, and anxiety. There is no record of a risk assessment.
On Saturday the man’s mood appeared low; he was subdued and kept to himself, but approached staff to have his needs met. He is recorded as showing no signs or symptoms of withdrawal. The house officer reviewed him again, but did not request a review by the on-call psychiatrist or undertake a risk assessment.
On Sunday afternoon the man was visited by two friends. After they expressed concerns about the man to the ward clerk, the man’s allocated nurse was called and spoke to them.
The friends told the man’s nurse that they thought the man was “low and distressed as he was expressing thoughts of wanting to make a will as he believed that he would not be able to make [it] out of the hospital”. The nurse said she asked if the friends knew whether the man had any suicidal intention or plans. They were unable to identify any, but said that he was dissatisfied with his recent trip.
The friends also told the nurse that the man had had a psychiatric admission two years ago, had been using LSD for the previous two weeks, and had begun to identify himself as the “Messiah”. The nurse mentioned the conversation to another nurse and recorded it in the progress notes, but did not seek a medical review.
At around 5.30am the next day, a psychiatric assistant saw the man standing by his open door acting unusually. He was told to stay in his room until 6am when breakfast was due and the man responded by slamming the door and sitting on his bed – and then started to pace back and forth. Just before 6am he asked for extra blankets and at around 7.15am was seen lying on his bed by the night nurse during handover, apparently sleeping
Handover finished around 7.40 am and the morning shift nurse asked whether the man had been seen eating breakfast and was told he hadn’t. At around 8am two nursing students offered to check the man’s blood sugar levels as he had type 2 diabetes, and found the man unconscious in his room. Sadly, the man could not be resuscitated.
The DHB did not provide services to the man with reasonable care and skill, and breached Right 4(1) because staff failed to:
It was recommended that the District Health Board:
The full report can be read on the Health & Disability Commissioner’s website.
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