Hon Dr David Clark Ministry of Health
Hon Michael Woodhouse Spokesperson for Health Parliament Buildings
Dear Dr David Clark and Mr Michael Woodhouse,
Re: Industrial Action by DHB Psychologists
We are writing to express our grave concern about the lack of action being taken by the government to address the Psychology workforce crisis in our DHBs. As you are hopefully aware, there are significant problems with recruiting, training, and retaining psychologists to work in DHBs. High levels of turnover and vacancies are negatively impacting patient well-being and recovery and leading to burnout for psychologists and other staff members, with many clinicians leaving the DHB. This leaves the DHB vastly under-resourced to meet the needs of the growing population.
Given the alarmingly high rates of suicide and self-harm in NZ and the governments’ agenda of prioritising mental health, it seems reasonable to think that the role of Psychology would be also be prioritised given our specialist skills in providing evidence-based treatments that address this. As indicated in the most recent data, we have had an increase of 2.5% in deaths by suicide in 2018. There were also 3081 hospitalisations of young people under the age of 20 for self-harm in 2018, 30% of whom are rangatahi Maori. Overall, this is an increase by more than 200 from 2017. This data, of course, does not include those not seen in hospital, of which there are many. Reversing these trends is going to be challenging and will need expert input across the spectrum of mental health settings.
A key finding of the Mental Health and Addictions Inquiry was the need for patients to have access to high quality treatment, as would be expected in any other health sector. We need to be able to offer treatment that has a strong evidence base of working, which Psychologists are uniquely trained to deliver. Psychologists are highly trained specialists who have distinct abilities that add to health services and provide support to other professions. This includes the following roles:
1. Deliver treatment that has been robustly evaluated and demonstrated to improve mental health and reduce long-term cost on health and social sectors. This occurs in the following areas: Neuropsychology, corrections, CAM HS & CMHC’s, and both acute and chronic physical illness.
2. Psychologists are often the staff who provide therapeutic services at the highest level of stepped care -for those with the highest levels of risk and complexity- and are often integral to decision-making about which interventions are likely to best meet clients’ needs.
3. The scientist-practitioner model and extensive involvement in research is an integral component of psychologists’ core training. Psychologists are well-placed to lead evaluation activities of service delivery, including evaluating service functioning and developing/refining treatment delivery.
The international benchmark is 20 Psychologist FTE per 100,000 population. Currently New Zealand has 11.8 Psychologist FTE on average with a 34% vacancy rate for Psychologists. This contributes to incredibly long waitlists at DHBs and within specialist teams, meaning that people can’t access care when they most need it. These are people who require specialist psychological treatment at the secondary or tertiary level- they will not be served by the planned investment in primary health care. The prime minister’s chief science advisor and his colleagues outlined what they referred to as a “three-fold approach” including primary prevention as well as suggesting “revitalising and upgrading therapeutic service” to match the needs of people experiencing mild and more severe mental health disorders. While primary prevention is likely to play a role in reversing current trends, it is unlikely to succeed without significant upgrades to secondary services. We need to be able to offer evidence-based treatment for people with complex presentation and active suicidal thoughts and behaviours. To be able to maintain and expand these services we need to keep experienced Psychologists in our DHBs and staff these services so they can offer care in a timely manner.
The government has attempted to put band-aid solutions on these problems. While having lofty ambitions, charity projects are often under-researched and unable to meet the demand. Clinicians in GP offices are part of the stepped care model but do not address those who meet criteria for DHB care. There has also been nothing done to address pay or training disparity between DHBs, corrections, and private practice. As such, the DHB is beginning to operate with under-trained and under-resourced clinicians which is severely impacting on patient care for those who are most vulnerable. It is also resulting in staff burnout and high levels of turnover, thus perpetuating the problem. Expecting staff without appropriate training and/ or experiences to provide treatment for some of the most unwell and at-risk members of our society is a recipe for disaster. This is not unique to Psychologists, however Psychologists have an extremely important role within DHBs in providing training and supervision to other staff, which is protective for both patients and staff. Additionally, DHBs are meant to provide training for new clinicians, but cannot do this without experienced clinicians available. As such, the on-going undermining of the role of Psychology within the DHB is leaving mental health services, clinicians, and service users at very high levels of risk.
While we applaud the significant investment into Mental Health suggested by the latest wellbeing budget, we are very concerned that the lack of investment into our existing workforce will impede progress. Asking for pay parity with other government departments, adequate training allowance to maintain competency, and in increase of Psychology FTE to be able to treat those presenting to DHBs is far from demanding. The lack of willingness to negotiate thus far both communicates a devaluation of mental health in New Zealand and a severe lack of understanding of the breadth and scope of the problems facing our community.
We urge you to invest in solving these problems more adequately for New Zealand.
Dr Tessa Brudevold-Iversen, Clinical Psychologist
Dr Maria Sampson, Clinical Psychologist
Dr Julia Somervell, Clinical Psychologist