File shows red flags over DHB

The Ministry of Health has parachuted its own experts in to monitor mental health services in Wellington following concerns issues had not been adequately addressed after a string of highprofile suicides, murders and assaults.

It moved to inject its own expertise to help Capital and Coast District Health Board staff implement the recommendations of two separate reviews, and guide DHB members in asking the right questions of its management ’’to ensure it is fully informed’’.

In briefing documents to Minister of Health Jonathan Coleman late last year, ministry officials also mentioned concern had been raised through the director of mental health over the DHB’S ’’intention to reduce funding to primary care’’ in mental health, ‘‘without an overall strategic plan’’.

But the DHB said significant progress had been made since then, and funding issues were because of a funding reduction from the ministry.

The documents, obtained by the Green Party, show a ‘‘pretty clear’’ breakdown in the relationship between the ministry and the DHB, the party’s health spokeswoman Julie Anne Genter said.

In the 18 months to July 2016, five alleged homicides, the suspected suicides of two inpatients and a serious assault had been carried out by users of the DHB’S mental health services.

The documents also detail two separate reviews initiated by the DHB; one in response to five homicides, and one in relation to 11 suspected suicides by outpatients.

One referred to in the first report was Richard Hawkins, a paranoid schizophrenic who in 2015 stabbed a stranger at Waikanae railway station, shortly after reportedly making efforts to get help from mental health services. In 2002, Hawkins killed his brother Jason.

That report revealed the DHB’S community services were receiving 400 to 500 referrals a month, with only 19 fulltime staff and two psychiatrists. It also detailed an incident in which a GP’S fax to a crisis team about an acutely unwell patient, was never picked up. That same day, the patient killed a 67-year-old man.

The ministry suggested to Coleman a range of legislative and nonlegislative inquiries, if the DHB’S response was deemed inadequate.

‘‘We were aware that the DHB had commissioned two specific reviews regarding the serious incidents however, it also became apparent that the DHB was undertaking service and funding changes without an overall strategic plan,’’ officials said.

‘‘To date, the information provided by the DHB does not give the ministry sufficient assurance that there is an overall strategy and it is not clear from the DHB’S documentation and our discussions with them how much focus mental health has at board level.’’

It’s an assessment the DHB appears to have taken issue with, questioning what the ministry meant by ‘‘strategic plan’’ and pointing to a funding cut in 2015/16..

DHB general manager mental health, addictions and intellectual disability services Nigel Fairley said the contents of the report were out of date, and not reflective of the current situation.

‘‘We are confident with our direction, and the progress being made to implement the recommendations identified in the two reviews,’’ he said.

’’The key recommendations were around having a single clinical record, and improving how people access and move through our services. Work is under way to integrate and simplify clients’ records across the service. The three boards have approved additional funding to make the ICT improvements.’’

Fairley said primary mental health funding used to be allocated to DHBS based on initiatives. Changes had left them short by nearly half a million dollars.

‘‘In 2015/16 the Ministry of Health changed this to populationbased funding, and our funding reduced by $451,000 per year.

‘‘In 2016/17, we were unable to continue topping up this funding to previous levels. We still provide a $100,000 top-up, and our funding is higher than that provided through population-based funding.’’

Genter said it was a ‘‘dysfunctional approach’’ from the ministry; ‘‘asking DHBS to cope with health underfunding, and then blaming them for not having adequate mental health services’’.

The string of serious incidents was, at least partially, a manifestation of underfunding, she said.