Professor Marie Bismark. Photo: University of Melbourne / supplied
One of the country's fastest growing regions - the Kāpiti Coast, north of Wellington - is losing its only remaining psychiatrist.
Professor Marie Bismark is gutted to be leaving her patients, but is burned out from doing the work of three doctors.
Soon after she started as a consultant psychiatrist at the Kāpiti Mental Health Clinic, the other specialist on staff quit.
"I had hoped I would be there for 10 to 15 years, but after 12 months I have resigned."
She was not the only one leaving the public health service, she said.
"There are many psychiatrists who want to be working in the public system and who want to be serving their local communities. But at the moment, the system is not safe or sustainable."
Following a site visit in April, WorkSafe inspectors issued three improvement notices to Health New Zealand, giving management until November to fix health and safety risks to staff.
Health New Zealand Capital and Coast has also received two provisional improvement notices - issued by health and safety reps - for two other mental health services in the region.
"Not safe or sustainable": Kapiti's only psychiatrist quits
The Kāpiti clinic has since employed another doctor with experience in mental health, but he was not a psychiatrist - and the registrar position was still vacant.
Bismark said when there was no doctor available at Kāpiti, patients in crisis sometimes had to travel to Wellington and sit in the emergency department for hours.
"And it's not just the psychiatrists who are affected. Some of our mental health nurses and social workers are carrying huge caseloads."
Earlier this year, one in three psychiatry positions in the greater Wellington region were vacant - the equivalent of 22 full-time specialists.
Paul Oxnam, clinical director of the Mental Health, Addiction and Intellectual Disability Service, said like other providers, Capital and Coast was continually looking at services to "understand what works well and what could be improved".
An overhaul of mental health services was "in its early stages", including the formation of the Local Adult Specialist Mental Health and Addiction Service.
"This service is designed to provide care that is closer to people's homes, and more joined-up with the supports they can access in the community."
Implementation would continue into next year.
As a result of the provisional improvement notices, Capital and Coast was making improvements to its adult mental health service's access and bed management processes, escalation planning, and recruitment and retention.
Work had also started on reviewing the facilities at the youth forensic intellectual disability service.
Regarding the Paraparaumu service where Bismark worked, planning was underway "to look at how best to address the matters identified".
Budget lacks promised funding
The National Party's election manifesto included a commitment to increasing the number of psychiatric registrar places to 50 a year, up from 37 - but there was nothing in the Budget.
Mental Health Minister Matt Doocey. Photo: RNZ / Samuel Rillstone
Dr Hiran Thabrew, New Zealand chairperson of the Royal Australian and New Zealand College of Psychiatrists, said members were questioning "when and how" those additional training places would be funded.
"The system doesn't respond to people in serious distress and it fails to keep them from reaching crisis levels.
"And this impacts not just the community but also the workforce. People who work in mental health really want to help people, and when they feel they can't do their best by their patients because of the lack of resources and workforce shortages, that really affects them too."
According to recent research from the University of Otago, 94 percent of psychiatrists surveyed believed current resourcing was insufficient, and 98 percent reported people needing specialist treatment were often (85 percent) or sometimes (13 percent) unable to access the right care due to resourcing constraints.
Mental Health Minister Matt Doocey told RNZ work by Health New Zealand was underway on developing a mental health and addiction workforce plan.
Bismark finishes at the Kāpiti clinic in a couple of weeks and will take up an appointment with the Medical Council, as well as continuing her work at the University of Melbourne, where she researches patient safety and clinician wellbeing.
It took two months of her three-month notice period for Te Whatu Ora to approve the vacancy being advertised, she noted.
"I think the system is in crisis and it doesn't feel as if there is acknowledgement that we are in crisis."