When patients kill

There are serious problems with Wellington’s mental health services. In the space of 15 months in 2015 and 2016, four people died as a result of five attacks by Wellington mental health patients. This dreadful series of tragedies has now resulted in a disturbing report that outlines individual failures and more widespread systemic problems.

It is astounding to read, in a guarded and awkwardly-written report, that in one case a patient seems not to have been seen by a psychiatrist at all. ‘‘There is no evidence of psychiatric assessment, no detailed mental status report, no diagnosis and no discernible comprehensive recovery plan,’’ says the review team headed by Auckland psychiatry professor Graham Mellsop.

In another case, psychiatric intervention was said to be ‘‘minimal’’. How on earth could this happen? Here the report is frankly disappointing: the review team couldn’t ‘‘definitively establish’’ whether this was because of poor record-keeping, ‘‘clinical file structures’’, or staff workloads.

This is a remarkably weak conclusion from a panel of powerful experts. The chief executive of the Mental Health Foundation, Shaun Robinson, however, says a lack of funding and staff is eroding services.

There is some evidence in the report to back him up. In one case, for instance, a half-way house which had supported one of the patients had recently closed down. We can’t know whether this service would have prevented the tragedy. Certainly Capital and Coast DHB has been anxious to downplay the dangers posed by a spate of such closures in recent times.

However, it’s striking that the review report also says the DHBs should argue for more residential accommodation for high-need mental patients. That is a telling recommendation, especially given the evidence that some of the patients carried out their attacks while no longer taking their medication. Some family members told the review team that they were made to feel responsible for ensuring the patient took their medicine. This is really too much to ask from families trying to cope with seriously troubled people.

The report also suggests that the principle of ‘‘least restrictive care’’ of patients has been carried too far. Sometimes more ‘‘maternalistic’’ action is needed, it notes, and recommends better training of staff.

Like most other such reviews, this one found serious communication failures, including the neglect of an urgent fax message from a patient’s GP. It recommends a single record system and a unified ‘‘user recovery plan’’ for every patient. It seems amazing this is not done routinely already.

The public needs to be fair about the terrible difficulty of predicting why one patient will kill or maim someone when most others with similar issues won’t. The difficulty of the task, however, does not mean the system can escape accountability.

In this case the system failed terribly, and the review team’s report needs action. Already, however, the DHBs are resisting its recommendation that new patients should be assessed by a psychiatrist within two weeks. Why? Is it because they know the psychiatrists are already overloaded?

Wellington’s mental health services need urgent reform.