A 'Responsible Clinician' - usually a psychiatrist - legally must be assigned to patients under compulsory mental health treatment orders. Photo: 123RF
- No psychiatrists to oversee care for some patients under Compulsory Treatment Orders
- Doctor and families warn tragedy may result
- Consumers say more holistic support needed for this vulnerable group
- Health NZ exploring "alternatives", including putting nurses in charge.
A psychiatrist fears there will be "tragic outcomes" for some mental patients - known to be a danger to themselves or others - who have no clinician directly overseeing their care.
It is a legal requirement that patients under compulsory treatment orders are assigned a so-called 'Responsible Clinician', usually a psychiatrist.
However, information released under the Official Information Act shows this is not happening in some regions.
The snapshot of data, from 8 October, showed that in MidCentral, 81 patients under compulsory treatment orders had no Responsible Clinician.
In Counties Manukau there were 15 patients in this position, along with nine in Waikato and four in Hawke's Bay, while the other 14 regions had "nil".
Te Whatu Ora said it was possible some patients were "briefly" without a Responsible Clinician during "transfers of care".
However, consultant psychiatrist Professor Marie Bismark - who went to the Ombudsman to force Health New Zealand to release the information - said that should never happen.
"If a patient is being transferred, they are supposed to stay under the care of one RC until another signs the form to say they are picking up care. That's to make sure no one falls through the gaps."
She was sceptical of Te Whatu Ora's "data quality".
"I suspect that MidCentral is being honest about their shortage of psychiatrists, and that in other regions, they're trying to make their numbers look better than they are by allocating Responsible Clinicians who don't actually work in the clinic that the patient attends."
Under the Mental Health Act, people can only be subjected to compulsory treatment if they are at risk of self-harm or violence, or unable to take care of themselves.
Responsible Clinicians have the critical job of ensuring they get the right diagnosis and treatment, and writing court reports.
Professor Marie Bismark. Photo: University of Melbourne / supplied
Bismark said without an experienced clinician in charge of their care (and complete Mental Health Act reviews and appear in court to request extensions of treatment orders) people were "falling out of the Act", lapsing back to voluntary mental patient status and stopping treatment.
"These patients are so unwell and so vulnerable and because most of them are being forced to have care they don't want, they have little incentive to complain in order to get better care," she said.
"And that's my real concern - that harm is going to occur. I'm so worried that patients under the Mental Health Act who don't have a Responsible Clinician are at increased risk of harming themselves or harming others."
Bismark said she had spoken to Mental Health Minister Matt Doocey about the situation on two occasions, and also sent him an email.
A spokesperson for Doocey told RNZ it was "an operational matter" and it was up to Health New Zealand to respond.
Mental Health Minister Matt Doocey. Photo: RNZ / Samuel Rillstone
Health NZ looking at 'additional strategies'
In a written response to RNZ, Health New Zealand said workforce shortages had affected the provision of Responsible Clinicians across the country, but it was "committed to the safety and wellbeing" of staff and patients.
National chief mental health and addiction Dr Leeanne Fisher said where there were gaps, local teams put "mitigations in place" to meet its statutory obligations, such as telepsychiatry.
"This includes shared care agreements, which allow local teams to make use of locums and psychiatrists from different services. In some cases, this may mean the RC is not based in the same location as the patient.
"In MidCentral's case, a roster is in place to ensure that all people who need to be reviewed are seen as required by the Act."
It was anticipated that all patients in MidCentral would have an allocated RC by January, when another senior doctor was due to start.
Nationally, Te Whatu Ora was looking at "additional strategies and approaches" to fix the problem long-term.
"This includes exploring the appointment of Registered Nurse RCs and developing non-SMO [senior medical officer] RC roles."
However, Bismark - who quit her job at the Kāpiti Mental Health Clinic earlier this year after doing the work of three doctors for months - said nurses could be understandably reluctant.
"It's a hell of a responsibility for a nurse to carry. If there's a suicide or a homicide, and you're the Responsible Clinician, it rests on your shoulders."
Safety key for families
Yellow Brick Road chief executive John Moore - whose organisation supports families of people with mental illness - said whānau wanted their loved ones to be "safe".
"They do not want to carry the burden of something tragic happening with their loved ones that involves someone else's safety.
"I cannot overstate that this is a small population of people we're talking about, and this should not be stigmatising for people experiencing mental distress - but this is a real fear that families have."
Consumer advocate Megan Elizabeth, from the organisation Changing Minds, said compulsory treatment orders were "hugely contentious" within the community of those with lived experience of mental illness.
"There are people who feel the Mental Health Act has been detrimental to them on their journey, simply through their experience of being placed under it.
"And then there are people who do feel it is a support there at that moment of absolute crisis."
However, everyone agreed compulsory treatment orders could not simply be a matter of "set and forget", she said.
"This is something that's really important to the community. When you are in a really vulnerable position, you want to know that the supports are in place."
Advocates hoped the revamped Mental Health Act would include more options for holistic care and peer support, to ensure people received care before they reached the point of requiring compulsory treatment, Elizabeth said.
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