NZ Mental Health – the hows, whats, and whys

The NZ public mental health system is a confusing beast, so before I write on what’s wrong with it, I’ll give a quick overview of how it works.

Mental health emergency lines are the absolute front line of mental health treatment. People in crisis call these lines, and the poor soul on the other end get to prise adequate information out of the caller and work out what services they need, all the while trying to keep the caller safe. This sometimes involves sending out the police or an ambulance if they believe there is real danger to the caller. In less urgent circumstances, this usually involves referral to the mental health emergency team.

The emergency mental health team is many people’s first true contact with ‘the system’. It goes by many names, usually incorporating the words ‘crisis’ or ’emergency’. It’s the equivalent of the emergency department for physical medicine.

A mental health emergency team usually has a handful of mental health nurses (at least two on duty at any given time), a couple of psychiatrists (one on call at all times, plus one or two holding a few office hours during the week), and an administrator. The nurses are the core of the team’s operations, making home visits to people in crisis, assessing those who have presented at the emergency department, and co-ordinating with the psychiatrists on the team to get people seen, and with the inpatient unit for severe crises. Treatment with the emergency team will usually last for about a month – long enough to get someone stabilised, or to get them their first appointment at Community Mental Health.

Community Mental Health is the workhorse of the mental health system. It’s made up of psychiatrists, psychologists, mental health nurses, social workers, occupational therapists, counselors  and probably a few things I’ve forgotten. They’re responsible for everyday non-urgent mental health care. When a person is referred to community mental health, they’re assigned a case manager to co-ordinate their care.

The final element in the system is the inpatient unit. Inpatient units are far less common than they were thirty years ago, but they still exist. They’re usually divided into two parts – inpatient and intensive care. Both sections are designed strictly for short stays – a few months at most. The services offered are varied – sometimes there is therapy and activities, but sometimes there is just medication and a weekly review by a psychiatrist

So there’s the outline of the system. Tomorrow I’ll start on what’s wrong with it.


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