Story by Anna Whyte, from the Post. Click here for original story (paywalled)….
The proposed closure of an intensive mental health service is “insulting nonsense”, according to one advocate, and news to the minister in charge, who found out on the day The Post put in a request for comment.
Te Whatu Ora – Health NZ proposed earlier this month to close Segar House ‒ its Auckland-based tertiary level specialist psychotherapy service ‒ and redistribute the services and funding.
Mental Health Minister Matt Doocey had not been told of the proposal until Thursday.
In the change document, which was leaked to psychotherapist, broadcaster and former Segar employee Kyle MacDonald, it proposes to disestablish the programme, re-invest the resources into community mental health teams and redeploy staff.
“It’s insulting nonsense,“ MacDonald said. ”Frankly, I think it’s going to put people’s lives at risk.“
The document states there were “very few such services available in Australasia” and “the day programme is the only one in New Zealand“.
It said that “since 2019 admissions to the programme have steadily declined”.
“Whilst there have been impacts from the pandemic, the ongoing low volumes of people admitted onto the programme do not make this a sustainable model of care.”
It said that there were currently 11 people doing the day programme and one admission in 2024, and three others in process.
“Based on the service description, there is unused capacity within this highly skilled workforce.”
MacDonald said that based on conversations and his understanding of how the programme works, he disputed that.
“There’s actually quite a long pathway in, there’s the programme, and then there’s a pathway out.
“It’s a long-term treatment. It’s generally done in six-month blocks. Most people will do around 12 months. Some do 18 months.”
MacDonald said the proposal “doesn’t address anywhere … that it’s a specialist intensive programme that’s actually generally for people who aren’t able to be contained and treated effectively in community mental health centres”.
“Some of the clients they see were chronically suicidal patients,” he said.
“This particular group of clients, which attract a diagnosis of borderline personality disorder, tend to have a chronic suicidal presentation ‒ so they’re chronically suicidal, and they’re often chronically bouncing around from things like self harm to addictive behaviour, to being sexually reckless, driving, gambling.
“There’s a lot of self destructive behaviours, and it’s a pattern over time.“
In response, Health NZ’s Auckland group director of operations Michael Shepherd said the proposal would not see any reduction to frontline mental health staff “and in fact would result in mental health expertise being available to more people”.
Within the document, it says the full time equivalent staffing roles were 2.7 psychologists, 0.4 psychiatrist, 1.8 psychotherapists and 0.5 for an administrator. There was also 2.64 under ‘vacancy and funds’.
MacDonald said from his understanding, they had struggled to hire for vacancies, which was a common problem across the mental health workforce, “and now they’ve got standing vacancies which they can’t advertise, so it does sort of seem a bit rich on the back of all of that, for Te Whatu Ora to turn around and say actually you’re not seeing enough clients”.
Shepherd said Segar House had very low numbers of people accessing the programme and the proposal “comes from a need to utilise the clinical expertise of staff to meet the needs of more people”.
“In all other districts tangata whaiora (person seeking health) with similar presentations are treated with individual therapy or group-based programmes, which is what we are proposing.
“The consultation process is still under way and no decision as to the proposal has been made. While the consultation process is occurring tangata whaiora will continue to receive the same service and support that they are currently receiving.”
Doocey said he “had not been made aware of the proposed changes to Segar House until [Thursday], I have informed Health NZ I expect to be updated on the proposal at our next officials meeting on Monday”.
“I have been assured by Health New Zealand, and it is my expectation that the people who use this service will continue to be seen and supported. My understanding is that no final decisions have been made.”
Doocey said he had been very clear with Health NZ his priority was to increase timely access to mental health and addiction support, and he had set a “very clear expectation with Health NZ that no frontline mental health and addiction jobs will be lost throughout any change process”.
