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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The Deputy Health and Disability Commissioner Rose Wall this week released a report finding Bay of Plenty District Health Board and two registered nurses in breach of the Code of Health and Disability Services Consumers’ Rights (the Code) for failings in the care provided in 2015 to the baby in its hospital.
The baby, just seven days old when admitted for jaundice, had to be transferred to the neonatal intensive care unit of another DHB where a plastic surgeon was consulted following blisters, swelling and an extravasation injury resulting from IV fluid and antibiotic treatment while in BoPDHB’s care.
Wall says in her report that amongst the failings (see full case study, findings and recommendations below) was that a junior paediatric registrar had prescribed IV fluids at a much higher rate than recommended by the DHB’s own policy and other national guidelines. Multiple staff reviewed the baby but did not pick up that her IV fluids were too high and also multiple staff failed to fill in the baby’s fluid balance chart in accordance with the policy requirements.
She found the afternoon shift nurse (RN B) in breach of the Code for not carrying out the hourly IV site monitoring and documentation required, not documenting an issue with the IV pump alarm or alerting the night shift nurse about the problem. Wall found the night shift nurse in breach for failing to review the baby’s IV site for two hours at the start of her shift and failing to document the phlebitis and infilitration scores.
Amongst the HDC recommendations (see below) was that the DHB use the incident as an anonymous case study for the induction of nursing and medical staff to the children’s ward and neonatal unit.
The DHB reported to the HDC that after its own investigation in 2015 it had carried out a number of actions, including asking all nurses to read and sign the DHB’s paediatric fluid balance protocol, education updates on IV luers, documentation and fluid balance charts for nurses, and the Children’s Ward now undertakes monthly audits of IV access.
RN B told the inquiry that on the shift in question her husband had rung and asked whether she could come home to look after a sick family member, but the ward was extremely busy so she decided to stay.
She acknowledged her documentation that shift was poor but said she had been checking the baby frequently as she knew “full well the higher rate of extravasation injury in neonates” and if there had been any obvious tissuing she would not have hesitated to remove the line. RN B formally apologised to the family for her part in the incident and said she and her colleagues had “learnt a valuable lesson about neonatal infiltration risks and the need for clear and concise documentation”.
RN C also apologised and said she had spent many hours reflecting on what happened. She said she had made changes to her practise in response, including redoing her IV certification, being prepared to delegate tasks if a shift is busy (as it was on the night in question) and being much more vigilant in checking the dosage of IV fluids and antibiotics, even if infusion has begun before she takes over a shift.
A seven-day-old baby was taken to the emergency department by her parents in the evening (Day 1) after paediatric advice was sought by their midwife because the baby was showing signs of jaundice.
The baby was triaged at 10pm and then reviewed at midnight when it was recorded she had had 11% weight loss since birth, jaundice, and reduced feeding. At around 2.40am the baby was admitted to the children’s ward (the special care baby unit was at full capacity) and was treated with phototherapy.
At nearly midday (now Day 2), the baby’s temperature spiked. The consultant paediatrician ordered investigations to try to determine the cause, and after the baby had several episodes of apnoea it was decided to commence intravenous (IV) fluids and antibiotics. A junior paediatric registrar (Dr D) prescribed the antibiotics and IV fluids. The registrar prescribed IV fluids at a rate of 180ml/kg/day, which was higher than the amount recommended by the DHB’s policy and other national guidelines.
On the morning of Day 3, the baby was reviewed and it was recorded that the septic screen was negative, but IV antibiotics and fluids would be continued, and that a fluid balance chart would be maintained.
RN B cared for the baby on the evening shift of Day 3. During the shift, the nurse administered the baby’s antibiotics then recommenced the IV fluids. At about 8.30pm the IV monitor began to flash, saying that there was a “downward occlusion”. RN B and a senior nurse investigated the line and the IV site but did not find any obvious issues. RN B did not clearly document the issues she had with the IV line during the shift, nor did she hand these over to the following shift.
Another registered nurse (RN C) took over the baby’s care at 11.15pm for the night shift but did not review the baby for nearly two hours. At around 2.30am, the baby was due for her next antibiotics. The nurse said that there were no signs of phlebitis or tissue infiltration when she commenced the first IV antibiotic. During the administration of the antibiotic, the baby’s mother noted a blister forming on the baby’s upper arm, and yelled for the nurse as the arm started swelling immediately. RN C stopped the antibiotic infusion and called for assistance. The baby was reviewed by a senior house officer and treated for an extravasation injury (caused by the IV antibiotic going into the tissue).
In the morning, the baby was reviewed by the consultant paediatrician, who noted blistering and a blackened area on the baby’s wrist. The baby was transferred to the neonatal intensive care unit at another DHB for plastic surgery review. She fortunately recovered without her injury needing plastic surgical intervention.
It was subsequently found that paediatric fluid balance charts from throughout the baby’s Bay of Plenty DHB hospital admission were not filled in regularly by staff in accordance with the DHB’s ‘Fluid balance chart recording standards (Paediatric)’ policy.
Bay of Plenty DHB:
RN B:
RN C:
The full HDC decision can be viewed here
]]>Hana Reedy and Api Nasedra presented a photo of their 15-year-old daughter Ariana, who they lost to suicide two months ago, framed by the names of the thousands of New Zealanders calling for an inquiry into mental health. An earlier video of Mrs Reedy’s story inspired an outpouring of support online for the petition and inquiry.
PSA national secretary Erin Polaczuk says a poll has shown 77% of New Zealanders support an independent inquiry into mental health and support services and – prior to the election – all parties except National and Act had committed to holding an inquiry.
“Families like Hana’s are being forced to face their darkest hours alone,” says Polaczuk. “Hana’s call for a mental health inquiry is supported by tens of thousands of people not because her story is unique, but because it reflects a shared experience of a system that is failing the people who need it most.”
Polaczuk says the unions’ members were stretched with many crisis teams on the brink of collapse.
Hawke’s Bay Today reported that Reedy didn’t want other families to go through what she had after the health system failed her.
“She [Ariana] attempted suicide twice before and I had tried everything to get her help. I begged as hard as I could but she was turned away. Our mental health system is failing our young people.”
After the first attempt, Mrs Reedy took Ariana to get help from the hospital but after two nights she was back at home. The same thing happened soon after and, after begging for help, she was told Ariana would have a spot in a mental health ward in Wellington but when they packed to leave, they were then told her bed had been taken.
Instead, she went into the general children’s ward and because “she wasn’t considered serious even though she tried to take her own life” was released again.
“All I was given was a pamphlet and some phone numbers.” One month after Ariana was released, she took her life.
“I truly believe if she could have got the help she needed, she would still be here today. I cannot begin to tell you the pain I am going through.
“I tried so hard. I still remember how much I begged. I still don’t understand how we were let down.
“The mental health system is in crisis and parents like me are being forced to pick up the pieces but we aren’t trained to that.”
YesWeCare.nz, which ran The Shoe Project suicide prevention campaign, supported the family. Coalition members include the Public Service Association (PSA) which represents many mental health workers.
Mrs Reedy’s petition will remain open and can be signed at http://change.org/mydaughter.
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, phone:
LIFELINE: 0800 543 354 (available 24/7)
SUICIDE CRISIS HELPLINE: 0508 828 865 (0508 TAUTOKO) (available 24/7)
YOUTHLINE: 0800 376 633
KIDSLINE: 0800 543 754 (available 24/7)
WHATSUP: 0800 942 8787 (1pm to 11pm)
DEPRESSION HELPLINE: 0800 111 757 (available 24/7)
SAMARITANS: 0800 726 666
OUTLINE: 0800 688 5463 (confidential service for the LGBTQI+ community, their friends and families)
RURAL SUPPORT TRUST: 0800 787 254.
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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