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As plans for Dunedin’s new hospital start to firm up, University of Otago researchers have called on the Government to consider not just what mental health services are needed, but where they are best located.
New research by Associate Prof Ruth Cunningham, of Wellington, shows acute mental health care units remain in the shadows, neither fully integrated into general hospitals nor part of the community.
Researchers analysed the locations of all 22 acute mental health units in the country, of which 20 were on hospital sites.
The team analysed geographic data and mapped mental health units’ locations in relation to other hospital facilities and public amenities.
Prof Cunningham said most acute mental health units were set up after large psychiatric institutions were closed, with the shift to community mental health care towards the end of the 20th century.
These acute units were built on the less desirable parts of existing hospital sites that had remained undeveloped.
"We found that mental health units are usually located on the outskirts of hospitals.
"Compared with medical wards, they are much further away from the main entrances, the cafes, and other services, such as the radiology and emergency departments.
"They are also a long way from community services, such as shops, parks and public transport."
She said the location of mental health units on the periphery was understandable for hospitals built prior to 1990, because they could not readily incorporate new units within their existing architecture.
"However, there is no reason that this should become the norm, which appears to be what has happened, with recent builds either maintaining this peripheral position, or not including mental health units at all, as is the case with both the new Christchurch and Dunedin Hospitals."
Research co-author Prof Susanna Every-Palmer, of Wellington, said while people in acute mental health units required access to medical resources such as laboratory and radiology facilities and the emergency department, they also needed easy access to community resources such as cafes, libraries, green spaces and public transport.
"Making the units easy to access for visiting family members and reducing stigma are also essential for recovery."
She said it was important to develop a clear idea of where best to locate facilities as the Government prepared to transform mental health and addiction services and overhaul many of the existing acute mental health inpatient facilities.
"We need to explore whether hospital sites are appropriate or whether inpatient mental health units could be replaced by smaller, community-focused and embedded facilities.
"This will involve working with service users and their whānau, and thinking more holistically than just bricks and mortar, to work out how spaces and locations where care is provided fit with a model of recovery and connect people to their community," she said.
"We need to consider not just what services are needed, but where they are best located."