Police say mental health callouts are cutting into their crime-fighting duties. Photo: 123RF
Senior nurses with special authorisation for assessing and detaining mental health patients have quit over safety fears.
They are worried at a police pullback on mental health callouts, and changes to hospital procedures, that kick in from Monday.
Health New Zealand clinical chief for mental health and addiction Murray Patton said the safety of staff and patients is the most important consideration.
Police will call ahead to ensure that staff are able to receive someone in mental distress, Patton said.
"Police have assured us that they will not be leaving the emergency department, they won't be leaving the person there, before they do a final check... that things are safe and that it's ok for them to leave," he said.
"We're not expecting staff to put themselves in harm's way. We were not wanting staff to enter situations where they feel there may be some element of risk," Patton said.
Police would still be expected to assist in situations in which staff feel unsafe, he said.
At the same time, 90 percent of mental health workers in two new union surveys said the changes would make them and their patients less safe.
Public hospitals and clinics from Monday were changing their procedures to cope with officers who intend to spend less time in EDs, on transport and callouts.
Police have been saying for months they must cut the time officers spent on non-urgent mental health callouts, as crime-fighting duties were being squeezed out.
About a half a dozen of the nurses had given up their additional roles as duly authorised officers (DAOs) in response.
"This decision was made on an individual basis and was a personal decision for each DAO based on their concerns regarding health and safety issues that may arise from 1 November," they said.
"This wasn't an impulsive or reactive decision, it was made after consideration of the information available, insight into the current risks involved in practising in the mental health field as a DAO, and likely risks in the future."
It was not clear which hospitals the nurses that continued with their regular jobs were based at.
They said they discussed the situation with their families and close contacts first, then met in mid-September to discuss it between themselves.
DAOs have special responsibilities under the Mental Health Act, such as to give advice about mental health services and how the law works, and help assess people.
In a new survey by the Nurses Organisation, and in a separate survey* of mental health workers by the PSA union, 90 percent of mental health nurses said the police pullback would make them or their patients less safe.
To the assertion, "The upcoming changes could increase escalation risks", 60 percent of the nurses strongly agreed and another 30 percent agreed, in the NZNO survey.
Earlier, Health NZ told RNZ the three new operating procedures brought in today involved "low risk" interactions with voluntary patients; from March, other changes would widen that to apply to sometimes more agitated or violent compulsorily-detained people.
The nurses who have quit their DAO roles said: "We work in a field where, in part, we educate our clients on health and safety, risk management and making informed decisions.
"We believe that this is what is occurring in this situation - as DAOs we have made an informed decision after considering what is important to us i.e. our ongoing health and safety within our work."
In a new survey by the Nurses Organisation 90 percent of mental health nurses said the police pullback would make them or their patients less safe. Photo: 123RF
Greg Davies, a DAO at Wairau Hospital in Marlborough, who has not quit, said he had yet to hear about those who had, but was not surprised.
"I would think they will [quit], yep, tip of the iceberg."
At Wairau, their mental health unit previously dropped to as low as seven general mental health nurses, but was back up to a dozen, he said.
"I do think we'll lose staff because of this, they've got too much pressure."
Staff who had already done full shifts would have to cover after-hour callouts, and have less police cover when transporting patients from Blenheim - across "two mountain ranges" - for admission to Nelson Hospital, Davies said.
He and colleagues only got to see the new operating procedures a few days ago.
Davies told Checkpoint the changes were based on 'assumptions'.
"There's been a lack of consultation with the workforce ... it seems to have been rushed through.
"We have a great working relationship with the police at the moment, and generally we only call upon them when we need to.
"This process is going to slow us down in doing our job," he said.
"We have two people on call overnight. If we are slowed down going through a process and it takes us eight hours instead of six hours to admit someone to Nelson in the night, we're not going to be available to do anything else."
As late as Friday, Health NZ was advising staff of late "urgent" changes being made to the three new operating procedures.
The PSA said it asked Health NZ to hold off but was rejected.
Only 13 percent of respondents in its survey expressed confidence in their workplace's ability to manage the risks under the changes.
"Mental health workers are saying loud and clear the implementation of the change is profoundly unsafe and that the risks of serious harm to them, the people in their care and the public are very high," said PSA health lead Ashok Chankar.
The new standard operating procedures stressed that staff must still call in police if there was violence, or an immediate risk to life or safety, or an offence had occurred.
"We will be closely monitoring how the first phase of change proceeds to ensure our planning for the subsequent phases are appropriate," Health NZ told RNZ in a statement on Wednesday.
Health NZ says staff safety a priority
Health NZ said it had only heard anecdotally about a small number of DAOs quitting, so was not able to provide data.
"It is also unclear whether any of these possible resignations are from the statutory role (Duly Authorised Officer) only or from their substantive role," it said.
It did not know the total number of DAOs it had.
It said staff safety and wellbeing were a high priority amid the new changes.
"We want to acknowledge that changes like these can be hard, and we recognise there will be a period of adjustment" Health NZ director of specialist mental health and addiction Karla Bergquist said in a statement on Friday.
The new standard operating procedures gave staff a chance to feed back on what was and was not working.
Police and Health NZ plan to review this in late November.
Police said in a statement that ensuring people "receive the care they deserve from the right professionals when they need it" was at the heart of the changes.
"We are committed to working together to deliver the best service for those in mental health distress, which will require some pivoting and re-evaluation of processes as we go, to get the best outcomes for everyone involved."
* The PSA survey ran 8-22 October and was sent to 6151 members, with 438 responses. The margin of error was 5 percent.
