The Mental Health and Addictions Inquiry report says a “significant investment” is critically needed now to build the workforce but offers no quick fix to the current workforce crisis.

The long-awaited 200-page Inquiry report released yesterday  – which acknowledges the current mental health and addiction system is “under severe pressure and unsustainable” – has been generally welcomed by the sector.  But, in a week where there has been several reports of mental health nurses being injured by patients, workforce bodies are wanting prompt and decisive action on the report’s recommendations – including boosting funding – with the Government due to formally respond to the report in March in the lead-up to the 2019 Budget being announced in May.

Substantial new and extra investment will be needed to implement the Inquiry recommendations which calls for a major expansion in the number of people reached by mental health and addiction services – from the current 3.7% per cent to more like 20% within five years – and that more service options be made available, particularly evidence-based talk therapies.

But at the same time the report acknowledges that recruiting and retaining mental health and addiction workers is a “major problem”. “Workforce shortages, working conditions, increasing assaults on staff in inpatient units, negative perceptions about mental health, and a risk-averse culture are all contributing to a workforce crisis.”  (See bullet point Inquiry workforce concerns and findings below)

Andy Colwell, the convenor of the Public Service Association’s Mental Health and Addiction Committee, said the clock was now ticking because, as the report noted, mental health workers and others had been waiting long enough for change.

“It is important to note that this report puts a spotlight on escalating demand for specialist services, limited support for people in the community and difficulties recruiting and retaining staff,” said Colwell. “As the panel has concluded, this is a system that is under pressure – and I would add a system where staff safety is being put at risk every day.”  He said implementing the report’s recommendations would depend on putting the workforce – along with service consumers and the community – at the heart of the implementation.

Professor Max Abbott, a psychologist and former national director of the Mental Health Foundation commended the report and its recommendations but said one of the few shortcomings was the report omitting the changes needed in the health and education sectors to train and build the needed workforce.

“Without a significant increase in graduate numbers reflecting the demographics of the population they serve, a changing skill mix and ongoing professional development, the required developments cannot occur,” said Abbott who is now Dean of AUT’s Faculty of Health and Environmental Sciences.

Ian Powell, executive director of the Association of Salaried Medical Specialists, welcomed the report’s calls for the skilled mental health workforce to be strengthened.  He said in its submission to the inquiry it had called for an increase in the psychiatrist workforce to be a priority. “There is a crisis in the psychiatrist workforce in district health boards with 56% suffering work-related burnout.”

Dr John Bonning, the Waikato Hospital emergency doctor who is president-elect of the Australasian College for Emergency Medicine, said he agreed with the report that the time for talk was over and it was time for commitment and action. He said the College was looking forward to to working with all stakeholders “to put people at the centre of changes to ensure it’s easier and faster for people in need to access care and support when someone is facing mental health or addiction challenges”.

The inquiry report calls for the Ministry of Health to “urgently develop a proposal for Budget 2019” to make talk-based therapies and other workforce-based services much more widely available.  Also for workforce professional bodies to join service providers, service consumers, advocates, whanau and key government agencies in a major national co-design process that needs to get underway ‘rapidly’. “We expect that, in line with international experience, it is likely to take three to four years to implement 80% of the desired change, even without the challenge of workforce shortages and the need for a co-design process at the outset,” says the report.

PSA national secretary Kerry Davies said it would be looking for areas where its members – which include mental health nurses, alcohol and drug clinicians and counsellors, mental health workers, peer support workers, occupational therapists, social workers and psychologists – could make a contribution to ensuring a real transformation and tangible co-design process took place.

WORKFORCE CONCERNS REPORTED TO INQUIRY

  • Overwork, burnout and the increasing risk of assaults.
  • Lack of career planning, limited training and limited professional development.
  • Short-term focus on immediate staffing needs, the lack of a clear ‘pipeline’ of new skilled staff and inadequate facilities.
  • peer-support workers described being undervalued, poorly paid and provided with limited training and career options.
  • Concerns expressed about lack of cultural competence among workers
  • The Māori mental health workforce has greatly expanded but there are still concerns that isolated Māori staff may be expected to manage all Māori referrals or to use the same approach as their Pākehā colleagues
  • Recruiting staff to all mental health and addiction roles and retaining existing staff are major problems
  • Workforce shortages, working conditions, increasing assaults on staff in inpatient units, negative perceptions about mental health, and a risk-averse culture are all contributing to a workforce crisis.
  • These problems are putting pressure on existing staff and the system is not preparing adequately for the workforce needed now and into the future.

WORKFORCE INQUIRY FINDINGS

  • Additional investment in services for people with less severe mental health and addiction needs is required – as can’t stretch existing resources allocated to people with severe needs.
  • “Significant investment” will be required to build a workforce able to deliver services to people across the spectrum of mental health and addiction needs.
  • This investment needs to start as soon as possible, as it will take time to train the workforce.
  • More skilled and trained peer-support workers, community-based workers and Māori and Pacific support services  are all needed
  • A major Inquiry priority is providing more access to evidence-based talk therapies and most talk therapies require a skilled workforce.
  • The Inquiry says “suitably trained” a wide range of practitioners can deliver psychological therapy including the non-registered workforce, GPs and practice nurses, mental health professionals, peers and cultural practitioners.
  • Higher intensity talk therapies can be delivered by health disciplines with specialist training including psychology, psychiatry, psychotherapy and counselling.
  • “Psychologists and skilled nurse specialists may need to directly provide therapies for people with more severe and complex needs and will play an important role as members of multi-skilled and multicultural intervention teams.”
  • The long-lead in time means that an immediate priority is to start building the psychologist workforce as current projections are that numbers are not keeping up with population growth.
  • Increasing a skilled and trained peer workforce, a strong and varied cultural workforce, and further developing the skills of generalist nurses, GPs, support workers and allied health practitioners will be necessary.
  • The Inquiry recommends that the Ministry of Health is directed to “urgently develop a proposal for Budget 2019” to make talk therapies, alcohol and other drug services and culturally aligned therapies much more widely available, informed by workforce modelling, the New Zealand context and approaches in other countries.
  • Workforce professional organisations be part of the recommended National Co-Design process which should “explicitly” consider worker wellbeing issues

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:

• DEPRESSION HELPLINE: 0800 111 757
• KIDSLINE: 0800 543 754 (available 24/7)
• LIFELINE: 0800 543 354 or 09 5222 999 within Auckland (24/7)
• NEED TO TALK? Free call or text 1737 (24/7)
• SAMARITANS – 0800 726 666
• SUICIDE CRISIS HELPLINE: 0508 828 865 (24/7)
• WHATSUP: 0800 942 8787 (1pm to 11pm)
• YOUTHLINE: 0800 376 633, free text 234 or email talk@youthline.co.nz

There are lots of places to get support. For others, click here.

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