2 December 2019
Honorable Iain Lees-Galloway
Member of Parliament for Palmerston North
NZ Labour Party
PO Box 1430
Palmerston North 4440

Dear Mr Lees-Galloway

RE: DISTRICT HEALTH BOARD PSYCHOLOGISTS’ WORKFORCE CRISIS

I am a resident in your Palmerston North constituency and Consultant Clinical Psychologist at the hospital. I am writing to urge you to take immediate action to stop the flood of psychologists leaving our DHBs. You will be aware we are currently at an impasse negotiating our MECA (18 DHBs/APEX). The DHB negotiators told us the DHB CEOs agreed on making an offer that seemed a genuine attempt to address our workforce crisis, but that the funding required was rejected by Cabinet. Psychologists are disappointed with the unwillingness of your government to provide essential psychological servicesi for the people of New Zealand. MidCentral DHB has approximately 13.5 full-time equivalent (FTE) psychologists. At less than one psychologist for every 13 000 people in our region, it’s one of the worst ratios in New Zealand. We should have at least 1: 5 000, or 36 FTE. Your government’s talk about improving mental health services and investing in children’s wellbeing is sounding hollow. We have experienced enormous turnover and, revealingly, many of those who have left are still practicing in Palmerston North. They have quietly sent a message you must hear: being a psychologist at a DHB has become untenable.

We want to keep psychologists in our public health system

Sadly, the more psychologists that DHBs lose, the more psychologists they will lose. Every resignation increases the pressure on those who remain and makes it more likely we’ll leave too. Vacancies in teams with no psychologists left are extremely unattractive to those DHBs hope to recruit. At MidCentral DHB there are no psychologists in Ward 21 (inpatient adult mental health), rural mental health teams (e.g. Tararua), early intervention in psychosis team, older adult mental health, or Oranga Hinengaro (Māori mental health), and our rehabilitation/dementia service is down to only 0.6FTE.

In addition, it’s a struggle to recruit Intern Psychologists (in their final – usually 7th or 8th – year of training) or retain them when they qualify. We simply lack capacity to supervise them, which constrains the number of placements the university training programme can offer. Without a steady supply of new graduates, our workforce crisis will worsen.

We want people to have more access to psychologists when needed

We are deeply concerned about the effect this lack of psychologists is having for people in Palmerston North and across New Zealand. DHBs have allowed psychologists to drain away from the public health system to unacceptably low levels. The demand is only increasing. Much like Palmerston North’s inevitable summer water restrictions, access to psychologists is now severely limited right when we are needed most. You urgently need to fill the reservoirs, so the restrictions can be lifted, and people can get the specialist psychological services they need. For example, DHB mental health services are funded for only the most distressed 3% of the population and it is estimated that only 0.7% of those get to see a psychologist. And DHB child development services have waiting lists up to two years long for assessment and diagnosis of suspected Intellectual Disability or Autism Spectrum Disorder.

We want to reduce health inequities

Economists tell us there are only two reactions to a scarce resource: you wait for it, or you pay for it. And as you know, when it comes to people’s health, waiting can be dangerous. We are well on the way to a two-tiered psychological health system in Palmerston North. One where the rich access high-quality care quickly in private practice, and the poor are stuck for months or years on public waiting lists.

We want to solve this crisis urgently

The New Zealand public has loudly demanded your government address the rising number of suicides, poor availability of psychological assessments and treatments, and the over-reliance on a medicalised system. Stopping the outflow and refilling our DHBs with psychologists is essential. The Mental Health Inquiry, He Ara Oranga, recommended your government urgently prioritise access to psychologists. Instead, in the year since then, the number of DHB psychologists is still going down and wait times are still going up.

Palmerston North psychologists would like you, our local MP, to represent our concerns and encourage your Cabinet colleagues to immediately reconsider the mandate that was given to DHBs to settle our MECA. We need to come to an agreement that will keep the psychologists we still have in DHBs and attract many more if we are to meet the need for our services. Does your government truly care about “wellbeing” and mental health? Do you truly care about improving the quality of children’s lives? Do you truly care about reducing health inequities for Māori, rural communities, and disadvantaged groups? We do. A lot.

A psychologist’s client recently said: “You listen to us; I hope the government listens to you”.

We hope so too.

Sincerely,
Dr Amber Barry
Clinical Psychologist
APEX Psychology Delegate

On behalf of the remaining APEX Clinical Psychologists at MidCentral DHB

We are highly-trained specialist health practitioners. Clinical Psychologists require a minimum of two post-graduate qualifications to qualify and practice. In Palmerston North, most new graduates have either an Honours or Masters degree and Doctoral degree. We provide a range of skilled services in the health system:

We assess, conceptualise, and diagnose a wide range of complex patient/client presentations. We provide effective evidenced-based treatments for a range of mental health disorders, including Cognitive-Behavioural Therapies, Acceptance & Commitment Therapy, Dialectical Behaviour Therapy, and numerous disorder-specific treatments (e.g. exposure and response prevention for Obsessive-Compulsive Disorder). This also includes individualizing interventions when there are co-morbid mental health, addictions, disability, and/or medical conditions.
Psychological assessment and treatment can have a significant medical cost offset. We are the experts in the science of behaviour and behaviour change, so can design, implement, and supervise effective interventions to improve a range of physical health outcomes, particularly for complex cases. For example, adherence to medical treatments (e.g. in diabetes), making significant lifestyle changes (e.g. with cardiac conditions or obesity), preparation for gender affirming medical interventions, addressing motivation, emotional, or cognitive barriers to rehabilitation (e.g. with neurological events), treating functional neurological symptoms/disorders, or preventing/removing nasogastric feeding tubes in infants/children (with significant cost and quality of life benefits).
We undertake neuropsychological assessments to diagnose conditions such as: Intellectual Disability, Specific Learning Disorders (e.g. dyslexia), Autism Spectrum Disorder, Foetal Alcohol Spectrum Disorder, or Neurocognitive Disorders (e.g. dementia or brain trauma). We recommend effective strategies based on the results of neuropsychological assessment for issues such as: brain tumors or post-neurosurgery, effects of chemotherapy on children’s developing brains, impairments and recovery after a stroke or aneurysm, or in progressive neurological conditions (e.g. Neurofibromatosis, Multiple Sclerosis, dementia). We also assess and advise on people’s decision-making capacity, for example, their need for an enduring power of attorney, or under the SACAT or MHCAT legislation.
We supervise and train non-psychologists who provide emotional or behavioural support for patients/clients. We provide consultation on psychological aspects of care to Multidisciplinary Teams or regarding individual colleague’s cases.
As post-graduate trained researchers and scientists, we evaluate programmes and interventions and design quality improvement initiatives. Our advanced skills in analysis, conceptualization, ethics, and research methods mean we are well-placed to contribute to or provide leadership in strategic planning and organizational/national health policy.