Sunday, 17 August 2014

The State of Mental Health Wards in this Country

I am writing this following recent comments on my previous blog on Ward 21 Palmerston North Hospital  and the recently released article on Stuff (Manawatu Standard) on the sad loss of another young life in that same ward.

Now I (and many at the blog) have had plenty to say about Ward 21, but a past comment on Wellington Services and the latest comment from Tauranga suggest Mental Health services in this country are in a dire state.

Before I move on with this subject here is something I used to ask our clients in the health sector when presenting for Like Minds Like Mine.  Is Mental Health an Industry or a Service?  Industry is an automaton by and large and uncaring in it's approach.  A service actually identifies, formulates, and proceeds with an action plan to garner better results.  I'd like to think Mental health is a service, but too many robots from the days of The Bins still permeate as staff and the level of care (or lack thereof) is plainly evident.

And don't get me wrong, yes I do know and understand that working in Mental Health is a challenging and demanding occupation, but money needs to be thrown at the industry to better align it to a caring recuperative service.  And that is plainly evident if deaths are occurring at an alarming rate (one is too many).

So what to do?  Recently, (apparently) a review was undertaken at Ward 21.  I don't have the results of that review or the reason the review was formulated, but I feel now there should be a Royal Commission of Inquiry into Mental Health Services in this country (nothing less if patients are dying in the service).  It's fair to say many wards or units are in disarray, under funded, poorly staffed and generally have such a bad reputation that clients that need to seek their services are too scared to present for referral.  The anecdotal evidence in the community fosters that assertion. And this surely has a detrimental cost on not only that individual but also family and the community at large in the event things do go wrong.

The Inquiry should be directed at three key areas:

1.  Are Ward staff suitably qualified and do they meet the Standard for Caring (yet to be written I suspect)  for their clients?

2.  Are clinical psychologists and psychiatrists qualified to look after patients and do they also meet a Standard of Care for their clients (both on the ward and in the community)

3.  Do the mental health wards physically meet the requirements of the clients?

It's time we stood up and demanded better services for those who are unfortunate enough to require such service.  A cancer patient is treated like royalty. Heart patients get the King treatment.  People on general wards are very well treated by and large.  Mental Health is sadly the distant (and oft forgotten) bastard baby.

One area that has been raised is the way Mid Central Health "manage" their Ward services.  For some time a Psychiatrist has been the Ward Manager.  Now psychiatrists are very much psychiatrists first and not necessarily good managers, so there could be justification in saying wards are mismanaged and in disarray due to lack of skills and knowledge to do such a job.  So why not institute a Ward Manager (someone trained to manage and get results) with Ward Psychiatrists and staff working alongside in recuperative care?  A start, works in business.

Anyway, your thoughts please (post them as a reply here).  We need to prevent deaths and turn around lives.

Below is a running commentary by links found in the comments section below to allow easier access for those wishing to read them.

1. Review slams DHB's mental health service (from Manawatu Standard)

2. Rise in district's suicides horrific (from Manawatu Standard)

3. Ambulance staff boost to accelerate response (from Manawatu Standard - fixing the bottom of the cliff whilst holding back on a fence at the top.)

4. External Review of Mental Health Services at Mid Central DHB

5. Mid Central DHB Tactical Response

6. Report on service losing beds (From Manawatu Standard)

7.  Radio New Zealand Radio article on Mental Health services and funding.

8.  Mid Central DHB hold public Meeting to apologise, families of victims not invited. (From Manawatu Standard.

9.  Parents lose Faith in DHB (from Manawatu Standard)

10.  An obituary piece to Erica Hume from Sunlive.co.nz

11. News regarding Hulme actions to change Ward 21 and all MH wards/services.

12. Suicide Strategies Needed by DHB's and MoH Dated 2 August 2016.

13. Another suicide in MH care - Wellington  Dated 3 August 2016

14.  From the Herald - Multiple Murders Waikato DHB  Dated 11 October 2016


23 comments:

  1. And then this today on the Manawatu Standard webpage. http://www.stuff.co.nz/manawatu-standard/10390919/Review-slams-DHBs-mental-health-service

    ReplyDelete
  2. Thanks for posting a new topic Gunner. It is not the nursing staff at fault but the failings from dhb staff that lead to all of this mess. I am sitting here asking myself why wernt some of my actions on the ward not investigated. I was there myself during the 2 suicides...and then locked away, drugged up and now what has become very clear...locked away to be shut up. I am now in the community and fighting alongside 2 grieving familes, not only for their own justice but for improvements for the ward. A place people should be able to heal, become well and then be released. Not drugged up and put in a corner. I am appaulled with mid central dhb but will fight for a dear friend and 2 families. In the next couple of weeks we will be enlightened to a whole lot more with internal reviewers report being released.

    ReplyDelete
  3. Ok, news folks. According to a good source, MidCentral Health are about to launch into a restructuring of Mental Health services at Ward 21 and will lower the number of beds available for inpatient care.

    And I have had contact with a local health reporter and I asked her to research three things:

    1. The number of people with mental health issues on the books in the region given there were around 1000 (number of beds) placed in the community when Lake Alice and Manawaroa closed, and still accessing services, be it on the ward or in the community, and how Mental Health numbers are increasing globally as well as nationally, population is growing, and services are diminishing.

    2. Research the survey of mental health services throughout the country a few years ago and Mid Central Health's placing on that survey (last or near last) and how they have improved if at all (common opinion amongst mental health clients it's gone backwards).

    3. Research the number of clients in the community that have taken their own life whilst under Mid Central Health's watch? Be it on the Ward or elsewhere. And find out if any of those in the community were turned down care on the ward (I know of one who was turned down twice after suicide attempts. He later lay down in front of a train.

    Seriously, Mental Health is a ticking timebomb and the fuse is near to exploding in everyone's face. I'm not sure how damning this latest review will be.

    I have solutions. I will blog them shortly.

    ReplyDelete
  4. I also asked the journo to ask MCDHB if they have ever done a Consumer Satisfaction Survey of all their clients to see where they need to make improvements.

    ReplyDelete
  5. Ward 21 fails because:

    1. The colour scheme is cold and impersonal
    2. The Layout is clinical
    3. There is no 24/7 recreational facilities
    4. Staff to client ratio is poor.
    5. There are other things too but none come to mind

    How to fix things:

    1. Change the paint scheme to one that is warm and inviting. Clients should have good visual stimuli to help them in their recovery.

    2. Nothing can be done about the layout now unless MCDHB decide to build a new facility that caters for 50 beds (40 open ward, 10 HNU) A new facility is needed as the next statement should open their eyes.

    3. There is no active stimuli for clients on the open ward. At Taharoto in it's day there was an art room, a small gym (the boxing bag was well used), a piano and guitar, a libary and jigsaw Puzzle area. All these areas were 24/7 and as mental health clients don't sleep when unwell it stands to reason something to do during both day and night would assist recovery. Ward 21 has a smoking area, two TV rooms and an art room only accessible for a few hours a day under supervision. Idle minds, idle hands, and as a consequence the opportunity to overthink, a sad reality with those experiencing mental distress.

    4. In the job I do (intellectually and physically disabled adults) the staff patient ration for 16 hours a day is 2 to 5. From memory HNU was 2 to 5, the Open Ward is about 3/4 to 25. Doesn't sound much but to be honest 25 open ward clients are prety much in a distressed state and heavily medicated and if you raise the staffing levels and made staff monitor the wards consistently two things happen. Clients see staff and can open up to them instead of being ignored at Starship Enterprises Bridge. Staff can also see the dynamics of the ward and can deal with issues as they happen, not as used to happen, in a retrospective manner. I remember from my times on the ward, staff were seen on three occasions. 1. The coffee walk. 2. Smoking in the yard (since gone I believe), and 3 at the Bridge usually talking amongst themselves or doing paperwork.

    Hopefully I am wrong in my assertions, but suspect not judging by two reviews into the ward since my time there.

    I'm sorry if I sound like I am being overly critical of MCDHB Mental health services but rest assured I'm not doing this out of any personal vendetta. My focus is on my friends and others who have to deal with this at stages during their lives. Is it fair on them (and me) knowing that it is not safe there? I want services (not industry), I want sustainable options for improvement. I want a world class and world leading service. MCDHB need to throw bath money and staff to turn things around and a rocket up their jacksie needs to happen for change to occur. Forget bang for buck, think less coffins being built by undertakers.

    ReplyDelete
  6. And it doesn't stop. Further news story in today's Manawatu Standard. We are in crisis in our region as most knew anyway. http://www.stuff.co.nz/manawatu-standard/news/10407142/Rise-in-districts-suicides-horrific

    ReplyDelete
  7. From that article, Quote " Nicholas Glubb said more than half of the people who committed or attempted suicide were not known to specialist services." Unquote His assertion is that around half "are known" to the service then. Are they doing enough to stem this epidemic? And of the half that weren't known, how many knew about the poor service the community and the ward offers? More questions than answers I fear.

    ReplyDelete
  8. Bottom of the cliff set to gain funding and staff. http://www.stuff.co.nz/manawatu-standard/news/10411448/Ambulance-staff-boost-to-accelerate-response Meanwhile top of the cliff set to lose beds and who knows what staff will go? Seriously, I am in fear of the consequences.

    ReplyDelete
  9. The real problem is that people don't matter in this country. The emphasis is put upon youth suicide as they have their whole taxpaying life ahead of them. There comes a point when those people who didn't suicide as teens come to realise life really isn't worth it, people don't matter to the government, it's all about money, token gestures worth of their tax went to mental health services, and they should have suicided when they were teens when someone thought they mattered, in monetary terms at least.

    ReplyDelete
  10. The external review of MCDHB Mental Health services is out and pretty damning. Good to see many of my assertions have been identified and addressed. But of concern was the mention (and only a mention) of the 11 suicides under Mental Health in the region in the past year.

    The review:

    http://www.midcentraldhb.govt.nz/HealthServices/MentalHealth/Documents/September%202014%20HAC%20MH%20External%20Review%20FINAL(25Aug14).pdf

    Also accompanying the release of the review is MCDHB's tactical response to points raised by the review team. Be very interested to see how this pans out, more especially the recruitment of qualified New Zealand trained clinical staff.

    http://www.midcentraldhb.govt.nz/HealthServices/MentalHealth/Documents/September%202014%20HAC%20MH%20Work%20Programme%20FINAL%20(26Aug14).pdf

    Of real concern still is the lack of consultation by both the review team and the MCDHB big wigs with the end users of the service, the consumers. Too often we get phone calls from market research companies and Polling organisations to get data on how to best manage a business or run the country. Take the political polls. We'd find it laughable if the polls were only directed at the MP's and Public Service staff that work under them wouldn't we? A truer review of a service therefore is targetting those that have a bigger say in an organisation, the user (or voter). Socialist thinking maybe but in the end if poeple are left out of the equation, they're more inclined to opt out of the equation, which in itself requires more resourcing to fi=x the issue or redress it.

    ReplyDelete
  11. Unfortunately the links can't be clicked on in this blog and therefore you have to copy and paste. Not able to do same from my phone. Can you put as web links please?

    ReplyDelete
  12. Regrettably this site doesn't allow text editing in comments so can't do as you ask (I'd like to). I might just edit the main blog here and see if I can place the links there at the bottom.

    ReplyDelete
  13. Its sad....not only are their two families grieving, but these people are trying to get change for the ward. My only intention is to make the ward a better place for both consumers and staff. I have been involved throughout many months of torment to say the least. But within my heart i know theres something more i can do, this summer i wish to trampt through the tararua crossings as a tribute to both people lost at ward 21, and also to raise hope for those who question suicide as an option. If anyone else is interested to join me let me know :)

    ReplyDelete
    Replies
    1. Yes it's a very sad state of affairs all round. We can only do what we have to do and your plan is noble and well meaning. Don't give up hope.

      Delete
  14. Latest article from the Manawatu Standard goes someway in reporting the issues, see in main body of text in original blog for update (6). Still a lot of questions have to be asked and a more thorough diagnose and synopsis of the service here in Palmerston North before the situation is sorted to everyone's benefit.

    ReplyDelete
  15. Latest on funding (lackthereof) of Mental Health services on Radio New Zealand yesterday (2/9/14) in the main Blog above ( number 7). Scrutiny is growing.

    ReplyDelete
  16. And it just goes from bad to worse. The MC DHB holds a public meeting to apologise for the deaths on the ward and DON'T INVITE THE FAMILIES CONCERNED!! In fact in the Manawatu Standard article (8 in the main blog) they have never met face to face to discuss or apologise. Bureacracy gone wrong or a damning indictment of management in a service in crisis. Royal Commission of Inquiry please!! And in an article in the local Tribune newspaper CASPER (Community Action on Suicide Prevention Education & Research) state there are 11 suicides in this country per week!! Yes, PER WEEK!! Times ago we had a horrific Road Death's figure and money was thrown at prevention and it worked. Time money was thrown at preventing suicides. See my blog http://rednaz1958.blogspot.co.nz/2013/03/teaching-social-sciences-instead-of.html for some positive corrective actions.

    ReplyDelete
  17. MCDHB are liars, like to play games....denial and delay they seem quite good at. They don't realise you cant win a chess game with yourself. It is utterly horrible what they have done and are continuing to do to families and others involved.

    ReplyDelete
  18. And as for funding...what price can you put on a life???

    ReplyDelete
  19. Please read and share

    http://www.sunlive.co.nz/news/82510-worst-decision-of-ericas-life.html

    ReplyDelete
  20. This comment has been removed by the author.

    ReplyDelete
  21. And another life on a ward (Waikato). I had the great pleasure to be admitted to Ward 21 and on face value huge improvements have been implemented. The big two for me go hand in hand - ward rounds by staff every 20 - 30 minutes and with that comes one of my initiatives I was asking for, staff/client interaction on the ward and removing staff locked in the nursing station and not having a sight of clients queuing up for attention, often ignored (no longer).' Also there appears to be an injection of younger keen students being a a part of the staffing roster. But still it's plainly obvious changes nationally need addressing. We hear about the suicides on the wards. How many suicides occur to clients out in the community and fly under the radar?

    ReplyDelete
  22. This comment has been removed by the author.

    ReplyDelete