This week we reported, not for the first time, concerns about inadequate record-keeping by board mental health staff, on this occasion involving the sad case of an apparent suicide of a patient on hospital grounds in 2017.
Corinda Taylor, of suicide prevention charity Life Matters, who has been campaigning for improved record keeping, prompted by the poor standard of the notes for her son who died in 2013, was understandably perturbed at the lack of progress.
The report of the 2017 case in which the mental health commissioner, Keith Allan, found the board practices wanting came hard on the heels of the SDHB announcement of the terms of reference (TOR) for the independent review of the Southern mental health and addiction system.
The board is seeking proposals from consultants to lead the review, a process which was delayed by the Covid-19 crisis.
Ironically, given concerns about the board’s paperwork, the TOR document has not been updated to recognise that the Health and Disability System Review report, from the panel led by Heather Simpson, is no longer in its interim state with the final version released in mid-June.
Whoever gets the job of undertaking the review will be required to explore what the TOR describe as "issues and road blocks that are symptomatic of a system under pressure", and there is no shortage of them.
The TOR acknowledge the connectivity of information systems is a challenge across the system along with integration within and between clinical multidisciplinary teams, non-government organisations (NGOs) and primary health.
Nor do the TOR shy away from pointing out the office of the health and disability commissioner has expressed concern around the increasing number of complaints the commissioner receives about the board’s mental health addiction and intellectual disability services (MHAID).
The list of concerns is not uplifting reading – discharge planning, complex case management, risk management, whanau engagement and communication with consumers and whanau. Particular mention is made of the provision of inpatient care in the Wakari inpatient units, cover in Lakes district and the interface between the MHAID and the emergency department.
Also looming large in the challenges facing the services is the condition of Wakari Hospital, listed, in a recent Ministry of Health assessment of hospital buildings, as one of the worst-designed mental health facilities in the country. It has been in desperate need of attention for years and it is expected that its refurbishment could cost more than $40 million.
Poor facilities have wide-ranging effects — longer recovery rates, longer stays in hospital, more incidents involving staff and patient injuries, increased seclusion rates, more staff sick leave and increased likelihood patients will need to be readmitted.
Finding suitable crisis accommodation and long-term homes for people with complex needs is also an issue with the TOR pointing out the trend in Dunedin is for people with complex and challenging behaviour to return to hospital when arrangements break down, putting extra pressure on inpatient services.
Ensuring people across the Southern region have equitable access to services is another headache for any system revamp, along with recruiting and retaining staff, particularly in rural areas.
Building on work already begun, those carrying out the review will be required to come up with recommendations for a transformation of the service and a plan to implement them.
No date for the completion of the review is given in the TOR. We hope this will be addressed in the reviewer selection process and does not reflect a lack of urgency in commitment to addressing these longstanding issues.
