Managing Mental Health Services

Here in little old Ao tea roa we have a pretty good mental health system.  It's been progressive and community based since the mid 1990's and generally a majority of clients are now living without wholesale care.  However, if new clients and recovering clients need to access Mental Health services, primarily acute, sub acute, or respite on a ward, they are first seen by either a GP, a Police Psychiatrist, or the CATT Team.


If someone sees a GP about their mental health they will probably be given a referral to Mental Health services if that is the proper course of action.  Although most GP's aren't well versed in Mental Health matters, they do know enough to seek further treatment.

If someone is seeing a Police psychiatrist, chances are they are in a state of mental health disarray, having been picked up for the safety of the community and or themselves.  Generally these folk are forwarded onto the Mental Health Ward locally as a sectioned inpatient.  All good so far.

Now alongside Mental Health Services set up in any region (or DHB) is a team called the CATT team.  The CATT team works off an 0800 number and is primarily set up to answer calls for help within the community, either by the client themselves, or a family member, or flatmates.  The system allows for a psychiatric trained nurse (or nurses) to visit a clients location and make an assessment on his or her mental state.  They will make an assessment and that client will be managed accordingly.  From experience, clients new to the service will be voluntarily admitted to the ward for observation and medication started (after being further assessed by a ward psychiatrist).  A large number of existing clients will be dealt with on the spot and most will not be admitted, though respite care maybe sourced.for them.  The rare occasion an existing client is sent onto the ward is if medication issues exist, the client is in obvious distress, or if the community needs protecting from any behaviour that could be deemed dangerous or unsettling.

Now as we know, most systems are not perfect.  It's widely acknowledged that the New Zealand Wards are all over stretched, some poorly staffed, and most in need of some TLC.  So where does CATT sit in this picture?  Obviously there is a large body of clients that need to be catered for and in some areas cries for help "seem" to go unheeded.  Why is this?  Well of course the first priority for any CATT Team is how many beds are available on the wards!  If there are none, then CATT have to work around that to the satisfaction of the parent Health Board and to the client themselves.  If a client presents in a dangerous state, they will be admitted no doubt.  But if it's seen that maybe the GP could handle the case then that recommendation will be made.  If other respite care facilities have spare beds, then maybe that will be an option.  CATT knows this and will act accordingly.

As I said, no system is perfect.  There have been many stories of people being assessed as Ok to live in the community still with community based care, and some have gone on to do life threatening acts.  Many have become frustrated with their seemingly lack of care and have acted in a manner that then deems them a danger unto themselves or the community.  So who is to blame?  CATT?  Lack of Services for a Growing Population? The Individual Clients Making Wrong Choices?

All the above and some.  I was told some time ago when I myself was on the ward that drug induced psychosis was filling ward beds faster than services could cope.  Mostly teens or young adults, and these very people due to their addictions and psychosis were a greater threat to society than run of the mill psychiatric clients who needed care every now and then.

So what are we as a society being asked to do?  Do we build bigger wards to acknowledge the shortage and the problem that besets society, or do we spend more on policing so drugs are stamped out of all society, i.e. nip it in the bud?  I know Police and CATT are overworked, as are all mental health staff, but surely if we as a society make it "uncool" to do drugs, let the kids at school know that drug abuse leads to life long mental illnesses and sometimes death or life long injury from attempts on their own life, maybe that's enough to allow CATT to then admit my mate Brendan for much deserved respite care.