‘Exhausted’ workers in Palmerston North mental health ward facing risk of assault every day

By Jimmy Ellingham of RNZ

Content warning: This story mentions suicide

Fourteen staff members at Palmerston North Hospital’s new mental health ward, Ngā Wai Ngāro, have been forced off work after being assaulted by patients.

Now, the brother of a former patient of the service, who died by suicide while under its care, says inadequate staffing levels are putting people at risk.

This week, Coroner Matthew Bates also criticised staffing levels at the service, when he released his damning findings into the preventable death of ward patient Erica Hume.

Ricky Gray, whose brother, Shaun, died by suicide in 2014, has used the Official Information Act to uncover raw data about assaults across Palmerston North Hospital’s mental health facilities.

He found there were 24 assaults on staff at the hospital’s new ward and the geriatric mental health unit in February, and another 47 in March.

During the three months before patients moved into the new $67 million unit in February, numbers were in the teens, where they returned in April.

“The numbers there are showing that every day a staff member is going home after being assaulted,” Gray said.

“Their family are there to support them, obviously, but they have to pick themselves up the next day and go to work.

“We don’t think any worker should have to go through that each day. It’s got to be affecting them.”

Among the criticisms Coroner Bates levelled at the service when considering the 2014 deaths by suicide of Shaun Gray and Erica Hume was staffing levels.

Coroner Matthew Bates. Photo / Jeremy Wilkinson

The coroner found understaffing was putting too much pressure on those on duty at the old ward.

Ricky Gray said that although the physical environment had changed since the opening of the new unit, the staffing situation had not.

“The most concerning thing for us really is it’s not just short-staffing alone. As demonstrated in the external reviews and the coronial findings from Shaun’s death, the issue becomes bigger than just numbers on the roster.

“I think with the sustained pressures that they’re all under, the culture in the workplace is now like a cancer. People are becoming exhausted, desensitised.”

The new ward has a different layout and nurses’ desks are scattered throughout.

Ricky Gray said because of such changes, the move into the unit should have happened gradually to ease stress.

Erica Hume’s mother, Carey, agreed, likening the transition to moving house.

“If you put that into a mental health-ward context, you’ve got staff unfamiliar even though they’ve had training in there, new patients coming in who don’t know what’s going on or how things work,” Carey Hume said.

“They’re stressed because of that. They’re stressed and in there because they aren’t well and they need some help to get back to being in full health.”

Raw figures didn’t always include the context behind incidents, she said.

“We find the staff are encouraged to report every minor [incident], but they don’t report the circumstances that led to an event.

“That’s quite often quite telling because that’s the patient’s perspective of it as well.”

Carey Hume was concerned about short staffing.

“Our feedback that we gave them was that we stressed the hospital design, the ward layout and operating model, was heavily reliant on staff presence.

“Therefore, it was vital all shifts were fully staffed.”

Health NZ interim group director of operations MidCentral Katherine Fraser-Chapple said there had been a slight increase in instances of aggression towards staff for a range of reasons, including highly unwell patients and adjustments to the new environment.

“While the recent spike has understandably heightened concern, overall incident patterns remain within the range we typically see across a 12-month period.

“We have strongly encouraged staff to report all incidents, including lower-level behaviours such as verbal abuse, to ensure we have a complete picture of risk.”

Since February, 14 staff had suffered injuries requiring time off work. Of those, 10 had returned.

“The incidents recorded since February vary widely, from verbal threats and verbal abuse through to physical contact, pushing, and more serious assaults such as punching.”

Health NZ had a violence and aggression steering group overseeing “system-wide improvements”, while the new ward had a violence minimisation working group, led by the charge nurse.

Health NZ said its figures about assaults referred to the new ward only, and didn’t include the geriatric ward.

Recruitment remained a focus, Fraser-Chapple said, but Health NZ didn’t say how many vacancies there were.

On Friday, New Zealand Nurses Organisation publication Kaitiaki reported the new ward had vacancies for 20 fulltime equivalent workers.

Nurses Organisation delegate and Wellington-based mental health nurse Grant Brookes said the rise in assaults could relate to staffing levels.

“The new unit is more than twice the floor space of the old unit and staffing numbers haven’t been increased.

“This is one possible factor for the spike in assaults with the opening of the new unit.”

It had a flow-on effect.

“If a whaiora [patient] becomes distressed in one part of the building, it takes a lot longer for staff to respond to that.

“It also means they won’t necessarily have multiple staff responding when it’s needed. Distress can quickly escalate in this new, bigger space in a way that it didn’t in the smaller one.”

Assaults on healthcare workers were increasing across the country, particularly in mental health wards and emergency departments, Brookes said.

SUICIDE AND DEPRESSION
Where to get help:
• Lifeline: Call 0800 543 354 or text 4357 (HELP) (available 24/7)
• Suicide Crisis Helpline: Call 0508 828 865 (0508 TAUTOKO) (available 24/7)
• Youth services: (06) 3555 906
• Youthline: Call 0800 376 633 or text 234
• What's Up: Call 0800 942 8787 (11am to 11pm) or webchat (11am to 10.30pm)
• Depression helpline: Call 0800 111 757 or text 4202 (available 24/7)
• Helpline: Need to talk? Call or text 1737
• Aoake te Rā (Bereaved by Suicide Service): Call 0800 000053 or referrals@aoake-te-ra.org.nz
If it is an emergency and you feel like you or someone else is at risk, call 111.

- RNZ