Report on Waikato District Health Board Mental Health and Addiction Services released

Media release

15 April 2016

A formal inspection of Waikato mental health services by the Director of Mental Health has found an appropriate model of care in place, but also makes recommendations for a number of changes.

Dr John Crawshaw says overall, the Waikato services were found to be well managed and led but facing considerable pressure.

He says many of the recommendations in his report, conducted under S99 of the Mental Health Act, support changes already planned by the DHB through its existing ‘Time for Change’ report and subsequent strategic plan for mental health services, but not yet fully in place.

The investigation was prompted by public concern following a series of serious events affecting the Waikato service in 2015: the suicide of one patient, the unplanned departures of three mental health patients in two incidents and the employment of an overseas doctor as a psychiatrist who now faces court charges related to identity fraud.

Apart from the employment of the overseas doctor, the S99 inspection does not look specifically at those events, which are being investigated or followed up separately, but instead examines how the services are functioning and whether there are any systemic issues.

The subsequent investigation or follow up of those incidents by other agencies may result in further recommendations for the Waikato mental health services. This inspection was to check that the overall model was sound so that the findings of any separate investigations could be incorporated within it.

Dr Crawshaw says one strength of the S99 investigation is its breadth and depth. It incorporates interviews with more than 200 front-line staff and 105 service users, family and whānau.

‘There are families, and their loved ones with mental illness, who have been distressed by these incidents and by subsequent publicity. One incident resulted in a tragic death, and the Ministry extends its sympathy to those affected,’ says Dr Crawshaw.

There has been a significant increase in demand for mental health services (21% over 5 years nationally) which has impacted on service delivery.

Key recommendations from the investigation are:

  • Immediately: address staff shortages – particularly in critical areas; have a clear strategy to balance risks with good clinical management and patient rights; build support for mental health services internally and externally; build governance within mental health services and provide regular progress reports to the board and public.
  • Longer term: make changes in light of agreed mental health service plans including integrated care pathways (patient focused and evidence based) and strengthened cultural practices; these changes should be made over a realistic timeframe and done in a way to build community support.

A key focus of the recommendations is to build on existing change to increase public confidence in the services provided. 

The investigation states: ‘a more consistent commitment across the services to engage with whānau members as equals to the individuals accessing services. This is likely to assist ensuring wider community support for the services.’

Dr Crawshaw notes that DHB has already made changes to its mental health services in some of these areas including appointing an Executive Director of Mental Health Services in February; getting a better balance of risk and rights through its training and management model; strengthening clinical governance and beginning a process of greater community engagement on mental health services.

Further changes will be regularly reported to the DHB Board and Director of Mental Health.

The DHB’s plans to improve communications with local stakeholders will help restore the balance between public expectation of mental health services and what the local Waikato mental health services can provide.

‘I have recommended to the DHB that it uses these change reports to its Board and to me as a key part of its increased community engagement around its provision of mental health services,’ says Dr Crawshaw. 

The report is available at: Section 99 Inspection of Waikato District Health Board Mental Health and Addiction Services


Background information

What is a S99 Inspection?

This inspection was carried out under Section 99 of the Mental Health (Compulsory Assessment and Treatment) Act 1992.

Section 99 Powers of Inspection of Director

In relation to any hospital, or any ward, unit, or other part of a hospital, in which psychiatric treatment is given, the Director shall have all the powers of the Director-General of Health under section 148 of the Hospitals Act 1957, and the provisions of that section shall extend and apply accordingly

What prompted this Inspection?

The investigation was prompted by public concern following a series of serious events affecting the service in 2015: the suicide of one patient, the unplanned departures of three mental health patients in two incidents over two months; and the employment of an overseas doctor as a psychiatrist who now faces court charges related to identity fraud. 

Apart from the employment of the overseas doctor, this Inspection does not report specifically on those incidents which are being investigated separately. However it does consider the overall organisation, governance and delivery of mental health services in the Waikato DHB area and it was empowered to examine whether there were any systemic issues impacting on the service.

Who was on the Inspection Team?

The Inspection Team comprised: 

  • Dr John Crawshaw, Director of Mental Health, Chief Advisor, Ministry of Health
  • Dr Jane O’Malley, Chief Nurse, Ministry of Health
  • Wi Keelan, Chief Advisor, Māori Health, Ministry of Health
  • Mike Elliott, Principal Advisor, People and Capability, Ministry of Health
  • Chloe Fergusson-Tibble, Consumer Leader, Te Kupenga Net Trust, Tairawhiti

What is the role of the Director of Mental Health?

The Director of Mental Health is a specially designated statutory role which functions within the Ministry of Health. The Director is the Government’s principal advisor on Mental Health and holds comprehensive responsibility for the overall functioning of the mental health system. The Director is able to initiate a variety of inquiries to make sure the system remains accountable to service users and their families, those who work in the sector, and advocacy groups. 

Who did the Team talk to?

The Team were able to call for information from a wide range of sources. During the course of the investigation, the Team spoke with more than 200 frontline staff and 105 service users, family and whānau.

What does the Report find?

The Inspection Team acknowledges that there are families, and their loved ones, with mental illness who have been distressed by these incidents and subsequent publicity. The Inspection report finds that while the organisation, governance and delivery is generally sound, it does make a number of recommendations for Waikato mental health services. 

What are the key recommendations?

A key focus of the recommendations is to build on existing change to increase public confidence in the services provided.

Immediately: 

  • There is a need to address staff shortages – particularly in critical areas
  • There is an ongoing requirement in the mental health area to balance risk with rights
  • There is a need to build governance within mental health services and provide regular progress reports to the board and public.

Longer term: 

  • There is a need to make changes in light of agreed mental health service plans including integrated care pathways (patient focused and evidence based) and strengthened cultural practices
  • These changes should be made over a realistic timeframe and done in a way to build community support
  • The report notes an ongoing need to assess the buildings and infrastructure which support Mental Health services in the Waikato.

The report acknowledges that the DHB has already made change to its mental health services in some areas. These changes include:

  • appointing an Executive Director of Mental Health Services in February
  • getting a better balance of risk and rights through its training and management model
  • strengthening clinical governance
  • beginning a process of greater community engagement on mental health services.

The DHB also plans to improve communications with local stakeholders to help restore the balance between public expectation and what the local mental health services can provide.

What happens next? 

Further changes will be regularly reported to the DHB Board and the Director of Mental Health.

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