The Right Honourable Jacinda Ardern
Private Bag 18 888
Dear Jacinda Ardern,
We are a group of clinical psychologists who work at a Maternal Mental Health service for a District Health Board (DHB). Our service is fortunate in that we have three remaining clinical psychologists (who each only work part time hours), and two of these staff are senior clinical psychologists. One of our group resides in your local electorate. We provide assessment and treatment of mothers who are pregnant and/or have a baby under 12 months old and who have a moderate to severe mental illness. We work alongside an Infant Mental Health service in an attempt to provide a comprehensive service to parents and their infants over these crucial early years.
We are passionate about providing care and supporting women in their motherhood journey firstly in regards to their own well-being, and further to promote the development of secure attachment relationships with their infants, thus assisting in safeguarding future mental well-being of the next generation. There is clear evidence that untreated Maternal Mental Health conditions have significant negative impacts on emotional and social development across the lifespan, i.e., infants of parents with severe depression have higher rates of adolescent mood disorders and suicidal behaviours. The societal costs of inadequate treatment of Maternal Mental Health difficulties therefore have significant costs in regards to the long term health and educational needs of their infants.
We have eagerly watched your own incredible journey into motherhood whilst simultaneously running the nation. We appreciate that you understand the inherent difficulties and challenges of this time of early motherhood, even with adequate supports and resources in place. There are significant socio-economic challenges in our local population, with half of all children living in socioeconomically deprived areas, and a significant proportion of adults receiving care for a mental health condition. The mothers that we support tend to experience financial hardship, significant histories of trauma and sometimes live in abusive or otherwise unsafe situations.
We were so thrilled when you were elected Prime Minister and excited for the future of mental health service delivery. We were especially enthusiastic about what your focus on mental health might mean for our service. Unfortunately, we are not yet seeing this focus translating into our direct clinical practice.
We’ve seen more investment in psychologists and mental health in the primary care setting, which is commendable. We share your hope that in the long term this will filter down into reducing the demand for secondary level mental health services. However, currently, demand is very high for secondary level mental health services and these patients require more intensive treatment than primary level services are able to offer, even when well funded. These patients require the input of multi-disciplinary teams who are highly trained to assess and treat the severity and complexity that they present with. Psychologists perform a key role in such teams, being highly trained to both formulate, diagnose and treat mental illness.
The numbers of psychologists leaving our DHB tell a story, with 67% of psychologists having left our DHB in the last two years. Vacancy rates remain high, with some adult community mental health centres (CMHCs) whom we work alongside now having no psychologists at all. Thus, many clients will receive sub optimal treatment. For example, for clients with emotion dysregulation difficulties, we in the Maternal service typically work alongside CMHC psychologists to provide very long term and intensive therapies (sometimes years and/or requiring inpatient treatment). The treatment of choice for clients with emotion dysregulation difficulties is dialectical behaviour therapy (DBT) which has a strong evidence base, but which the CMHC is now typically unable to provide.
No medical treatment has a comparable evidence base to DBT. However, in the absence of any CMHC psychologists our clients are often unable to receive anything other than psychotropic medication and case management. For the mothers attending our service, this will in turn affect the ability of their baby to learn to regulate their own emotions, with potentially lifelong adverse consequences. We are extremely concerned about this situation.
With such attrition of psychologists in CMHCs, we in Maternal services are being overburdened with managing extremely complex, chronic and risky presentations including active suicidality and psychosis, that we are unable to manage adequately alone given our time limited service admission criteria.
We are very concerned that currently the care that psychologists are able to provide is sub-optimal. Our caseloads are high. There are simply not enough psychologists for clients to be seen in a timely manner, and to receive the number of sessions and intensity of therapeutic work that would be indicated by the complexity and severity of their difficulties. With the lack of availability of talking therapy, there is an over-reliance on prescription of psychotropic medication, with anecdotal reports from psychiatrists and GPs that they prescribe more than they would if medium to longer term psychological therapy were more readily available. With clients being underserviced by talking therapies, we find that acute crisis presentations increase and so our mental health staff, including psychologists, end up providing more crisis management rather than managing their difficulties therapeutically in planned way which serves to mitigate risk.
Many of the psychologists who have left our DHB in recent years have been senior staff. Currently there are not enough senior clinical psychologists to supervise all of the more junior psychologists in the service. The difficulty obtaining good quality supervision by an experienced supervisor is noted by psychologists as a factor in their decision to leave mental health services. Interns and new graduates are coming into a system without the required senior psychologists to supervise, mentor and train them. This results in a staff retention problem with many newly qualified psychologists leaving the DHBs within the first few years of graduating. This makes little economic sense given the costs involved in the many years of clinical training psychologists receive.
We feel that the current work conditions and pay scale in DHBs are out of step with the government’s stated suicide prevention and mental health initiatives. We would like you to consider the requests made by psychologists throughout the recent period of strike action, in order to retain these highly skilled professionals within DHBs.