Professor Marie Bismark. Photo: University of Melbourne / supplied
A psychiatrist, who has resigned after months of doing the work of three specialists, says the final straw was being denied a panic button in her office.
In an interview with Nine to Noon, Professor Marie Bismark said she was caring for more than 300 patients at the Kāpiti Mental Health Clinic, some of whom were "seriously unwell " with a history of violence, including rape.
Psychiatrist warns of unsafe working conditions
Over a 20-month period, she made several requests to Health New Zealand management for a personal alarm to be installed in her office.
However, just before Christmas, she was advised the "business case" had been turned down.
"And I'm sure you can imagine how that feels," she said.
"I don't know what a duress alarm costs to install but I'm sure it's less than the cost of a locum psychiatrist for one day.
"And to essentially be told by an organisation that your safety and the value of the work you're providing to the community you care for is worth less than the cost of a duress alarm, that was pretty devastating."
It was just one example of the way in which the health system was not taking adequate care when it came to staff health and safety, she said.
"We see those kind of false economies all the time where people are trying to cut costs and it ends up costing the health system more."
The World Health Organisation recommends one psychiatrist for every 14,000 people, whereas Bismark had sole responsibility for a region of 60,000.
After a site visit to the Kāpiti Mental Health Clinic, WorkSafe inspectors issued three improvement notices to Te Whatu Ora Capital and Coast.
"At one point I said to a senior manager that I was barely holding on by a very thin thread. And he said, 'I can meet with you in four weeks'."
Bismark, who was just been appointed to the Medical Council, said the entire psychiatry profession was under pressure, with 20 percent of positions currently vacant.
"The median age is now 55, so many of them are going to be retiring within the next ten years and we don't have the new pipeline coming through."
While the government had previously committed to funding an additional 13 training places for psychiatrists, there was nothing for that in the recent Budget, she noted.
Meanwhile, clinicians of all kinds were becoming inured to overwork, and health managers were taking advantage of their commitment to their patients and ignoring basic safety measures.
In her new role with the Medical Council, Bismark said she was particularly keen to support doctors who had their own mental health struggles to return to "sustainable" practice.
RNZ has contacted Health NZ for comment.
Mental health targets are achievable: Minister
Minister for Mental Health Matt Doocey said it felt like the sector was in a workforce crisis.
"Our workforce is burning out because they are covering vacant roles. I went to a mental health adolescent service in Wellington recently, 50 percent workforce vacancy rate," he told Nine to Noon.
"We had an inpatient facility here in Christchurch, about two years ago it closed down because they couldn't find enough staff. So what we need to do is retain the current staff.
"We need to look at skilled migration, no silver bullet, but we need to attract those who are interested in coming to New Zealand, but ultimately we need to train more of our local workforce and that's what the mental health and addiction workforce plan will focus on."
Doocey praised the work being led by the Green Party co-leader Chlöe Swarbrick around ADHD, and said a similar approach could be applied to other specialists.
He was interested in looking at the scope of psychiatrists and similar roles to see if some of their tasks could be performed by other medical and mental health professionals.
Newly announced funding would also help to spread the load outside the public sector, he said.
"What we're trying to do is activate the NGO and community sector, who have a workforce capacity outside the publicly-funded mental health service, that we can power up, that can actually take some of the demand off a constrained publicly-funded mental health service."
Doocey blamed previous governments for not acting sooner to address chronic workforce shortages.
He said he wanted to do things differently, including setting up an assistant psychology role.
"We have about 500 people who graduate in undergraduate psychology degrees, hoping to get one of the 50 clinical internship placements for psychology.
"Now, we need to grow that number of internships and I hope to double that, but at the same time that 500, if they don't get one of those places, they disappear. So I'm looking to introduce a new registration where they can be picked up and taken into the mental health workforce.
"We need to open up the existing training pipelines but actually look at new registrations as well."
In a statement, Mental Health, Addiction and Intellectual Disability Service's Paul Oxnam said duress in the system was reviewed after concerns were raised.
"An additional duress button was installed in April," he said.
"Staff safety is a priority at all times, and staff are supported to respond appropriately to threatening physical or verbal behaviour.
"All staff are trained in in de-escalation techniques, and there are protocols to follow if they cannot calm someone who is acting in a concerning way. Protocols used depend on the person's level of agitation and range from using verbal de-escalation techniques to calling the police."