Latest news with #JohnCrawshaw
NZ Herald
6 days ago
- NZ Herald
Auckland Mayor Wayne Brown renews calls for Auckland bed tax
Today on The Front Page, University of Otago senior politics professor Dr Leon Goldsmith is with us to unpack the complexities of this never-ending conflict. Tauranga's Flynn Chisholm breaks the New Zealand record for a Døds dive, leaping from a 40m cliff in Majorca. Video / Instagram @fizzysends Discover Japan, don't just visit it Commuters wait on a full train as infrastructure issues suspend train operations. Speaker Gerry Brownlee told her to leave the House for the rest of the week due to her remarks. Video / Parliament Video Ministry of Health Director of Mental Health Dr John Crawshaw and Health NZ National Director, Mental Health and Addictions Service Enhancement Phil Grady address the media. Nearly 300 children from around Rotorua got the chance to train with NBA star Steven Adams today. Video / Kelly Makiha NZ Herald Afternoon News Update | NZ's economic outlook and Aotea Square bomb scare Aotea Square was evacuated after an unidentified bag was found, sparking fears of a potential bomb threat. Video / Alyse Wright Prime Minister Christopher Luxon and Labour leader Chris Hipkins in the aftermath of the latest polls. Video / Mark Mitchell Ministry of Health Director of Mental Health Dr John Crawshaw and Health NZ National Director, Mental Health and Addictions Service Enhancement Phil Grady address the media. Senior reporter Melissa Nightingale talks to Herald NOW about the young man's sentence. Trip Notes Podcast host Lorna Riley discusses the world's most important hotel and Amsterdam's strategies to tackle the challenges of overtourism. Video / Herald NOW Brent Carey, CEO of Netsafe, explains the risks and safety concerns related to Instagram's recently introduced location feature. Video / Herald NOW Spark has announced it has sold 75% of its data business to Pacific Equity Partners.
RNZ News
6 days ago
- Health
- RNZ News
Canterbury's Mental Health Services inquiry findings 'really concerning', psychiatrist says
From left - Nemani Tunidau, Eparama Tunidau and Laisa Waka Tunidau. Laisa was murdered as she walked home from work by Hillmorton mental health patient Zakariye Mohamed Hussein in 2022. Photo: Supplied A forensic psychiatrist with nearly 30 years experience says unless an inquiry into Canterbury's Mental Health Services prompts real change there will be "more adverse incidents". The inquiry, by Director of Mental Health Dr John Crawshaw, found "significant" problems in the service's governance, care model and resourcing. Dr Crawshaw began his inquiry under section 99 of the Mental Health Act in June 2022, after Hillmorton forensic mental health patient Zakariye Mohamed Hussein murdered Laisa Waka Tunidau as she walked home from work. Hussein was on community leave at the time of the killing. The findings, released on Tuesday, included "critical staff shortages", staffing vacancies affecting admissions and discharge processes, a "siloed culture and care model", concerns about the service's governance and delayed resourcing decisions at the regional governance level. The final report, released three years after it began, has 18 recommendations aimed at addressing the key issues. Dr Erik Monasterio, a forensic psychiatrist with nearly 30 years experience, worked at the then-Canterbury District Health Board (CDHB) for 25 years. He was the Clinical Director and Director of Area Mental Health Services for the Canterbury Forensic Service between 2015 and 2021. Speaking to RNZ, Dr Monasterio said his first impression of the report was how the recommendations were going to be "implemented and opreationalised" in a way that would lead to "improvement in functioning and a reassurance around patient safety and reasonable standards being met". Dr Monasterio said the inquiry's findings were "really concerning". Issues around governance identified in the report were "at the core" of difficulties that had arisen, he said. He said he wrote a letter in late 2016 which was co-signed by other clinical directors of the DHB's mental health services addressing "likely implications" of the change in leadership and governance structure that had been identified in the report. "I forewarned that this change in leadership structure was going to undermine the viability of the services and likely lead to adverse outcomes. "So it's very, very frustrating that those concerns were largely ignored. And some of the issues that have arisen, a significant component of the issues that have arisen, are as a consequence of that change in leadership and governance structure." Dr Erik Monasterio. Photo: Pool / NZME - Mike Scott Asked how unsafe Canterbury's Mental Health Services were in 2022, Dr Monasterio said a lot of very experienced staff had left. "The knowledge at every level of the institution was significantly watered down. "The processes had become watered down. So in the absence of good processes and good leadership, you just don't know what you don't know. But you know you're sitting in a situation which is potentially very risky." Dr Monasterio said he left his role over concerns he had about the "viability of the service". "To the extent that I felt I couldn't remain in the leadership position because I felt that there were acute risks, both to staff and patients and the community, and I could not enact a positive change from within the institution and as a Forensic Service at the highest level of seniority that I could achieve." He said Dr Crawshaw's report "paints a grim picture". "The issues that are identified therein, unless people can convincingly show that they have an initiative and a plan to change that, then I think it'll just continue to get worse," he said. "Unless you get this right there's going to be more adverse incidents. I don't think there's any doubt about that." Consultant forensic psychiatrist Associate Professor James Foulds, who worked at Hillmorton for seven years until 2023, told RNZ he felt the report was a "fair summary" of the problems in the mental health system. "I feel sad for the people who have been affected by the poor state of mental health services in Christchurch - not just the families of the two people who were murdered but also the many people with serious mental illness who haven't been able to get an acceptable level of care, and the health staff who have suffered from working in this environment." He said there needed to be "accountability" from senior mental health service management in Canterbury. "Some of the senior managers who were present at the time have already moved on, but there needs to be a change in the culture of the organisation and that starts at the top." Dr Monasterio agreed. "Unless you change that culture, nothing's going to change." Dr Crawshaw said the "most significant and prevailing issue" concerned staffing in the clinical areas, especially the adult inpatient, community and forensic services. "In the inpatient areas, there were daily issues in ensuring minimum safe staffing levels." The divisional leadership team had "significant concerns" about the number of staff vacancies and the "relatively junior nature" of the clinical staff in some areas. There were "critical shortages" of staff in many areas of the service, particularly inpatient units. "Clinicians frequently used the phrase 'on numbers', referring to being deployed to an inpatient unit to bring up the numbers of staff on a roster to a perceived safe capacity. "The inspection team heard concerns that people were working overtime and double shifts, to meet the 'on numbers' expectation. While the magnitude of the issue was unclear, it was raised repeatedly by staff in interviews. Some staff stated that they no longer wished to do overtime and double shifts due to the level of personal stress and strain it caused them." Director of Mental Health Dr John Crawshaw. Photo: Nathan Mckinnon / RNZ In relation to nursing staff, Canterbury, like other services across the country, had a challenge with a "missing middle" - nurses who were "competent and experienced but still have a long career in front of them". When the inspection was carried out there was a group of staff nearing retirement. They appeared "fatigued and were possibly experiencing burnout". Some of the new graduates had been placed in "unsafe situations". "For example, a newly graduated registered nurse spoke of arriving for a shift at the forensic mental health inpatient unit and being told that they would be the shift leader, a task they felt wholly unprepared for." Some nursing staff were "afraid to come to work" with an "unacceptably high rate" of assaults on nursing staff by patients. "Staff reports of experiencing the clinical environment as unsafe were particularly prevalent in forensic services. There, staff described how a number of senior staff had recently left, particularly from the acute medium secure unit. "This had left both a gap in staff numbers and a gap in expertise. Some staff appeared to be distressed by and angry at the situation; particularly those working in the acute medium secure forensic ward." Health New Zealand (HNZ) national director of mental health and addictions Phil Grady acknowledged the "significant failings" identified in the report. HNZ was "committed" to implementing the recommendations to "prevent the tragic events of 2022 and 2024 from happening again". "We recognise the loss and grief these families have and continue to experience and express our sincere condolences to them. We are deeply sorry for the failings in our systems. "We have reached out to these families to apologise and discuss Dr Crawshaw's report, and will remain in contact, if that is their choice, to update them on progress to implement actions from the report." HNZ accepted all of Dr Crawshaw's findings and had an action plan in place to implement the recommendations, which focused on the underlying issues related to governance, the care model, and resourcing. "We are focused on continuing to provide senior leadership oversight of planning for the service, building a framework, and ensuring there is sufficient staff with the right level of training and experience to safely and effectively deliver services." Grady said there had been "demonstrable progress" on key recommendations including establishing a clinical governance framework and increasing clinical staffing by 11 percent since 2022. Clinical decision making on patient leave was "consistent with policies" and there were weekly audits of compliance in place. "There are clear pathways both within the service and nationally within Health New Zealand to escalate and manage risk." Mental Health Minister Matt Doocey said in a statement Waka Tunidau's death was a "tragedy no family in New Zealand should ever have to experience". "The release of this report today is an important moment. It shines a light on the long-standing failings in Canterbury's mental health services, failings I've been assured, there is a robust plan in place to address. "I have been upfront that we must do better to improve the mental health system and improve outcomes, this has been my top priority from day one." He said the government inherited a "long-standing fragmented and underperforming mental health system". "And this report underscores the scale of the challenges we have been left with and continue to face." Doocey said public and patient safety "must always come first". "I have made it clear to Health New Zealand that the issues identified in this report must be addressed urgently, and that progress must be visible and ongoing. "We are taking action. I have prioritised committing additional funding for forensic services, strengthening regional accountability, and growing the mental health workforce. Because every New Zealander should be able to get the support they need, when and where they need it, and those around them should have faith that they will be properly looked after while in care." Sign up for Ngā Pitopito Kōrero , a daily newsletter curated by our editors and delivered straight to your inbox every weekday.
Scoop
7 days ago
- Health
- Scoop
Canterbury Mental Health Review Released
A formal regulatory inspection of Canterbury-based mental health services has set out a series of recommended changes for Health New Zealand and is continuing checks over the next 12 months. Ministry of Health Director of Mental Health Dr John Crawshaw, who undertook the inspection under Section 99 of the Mental Health Act, acknowledges the tragic circumstances prompting this work. He expressed his deep sympathy for the family mourning the loss of Laisa Waka Tunidau who was murdered by a patient on community leave from Christchurch's Hillmorton hospital in June 2022. The Ministry's inspection began the following month in July 2022. Sadly, there was a second tragic incident in 2024 involving a patient under the care of mental health services at Hillmorton – underscoring the urgency of addressing underlying issues facing the Canterbury service. Dr Crawshaw says the circumstances of both incidents were separately investigated by Health NZ and are not directly covered by the Ministry's report, which looked more deeply into the underlying issues related to governance, the care model, and resourcing. He says the report recognised the difficulties for mental health services brought by COVID-19 during the pandemic on top of a legacy of events in the region that have stretched mental health services and exacerbated existing systemic issues, and the findings of the review should be seen in that light. Dr Crawshaw says the goal of mental health services is to support, care for, and treat individuals affected by serious mental illness to keep both them and the community safe. Where there are serious service failures, such as in this instance, the legislation provides significant investigative powers to find causes, make recommendations and then monitor progress. The report makes 18 recommendations covering governance, the care model, and resourcing. The overall theme of the report is the need for better cooperation between service leadership and service delivery to prioritise service, enable staff to do their best, improve the models of care, and planning. 'There have already been significant improvements made by Health New Zealand in many areas.' Dr Crawshaw notes that the use of leave plans and leave protocols have been assessed and updated following an independent review. Safeguards now include a detailed leave procedure, an updated safety and risk assessment framework for leave, an amended missing person policy, and a review of the electronic clinical record system. As of next week, for patients under the Mental Health Act who are cared for in Hillmorton's forensic services (but are not special patients), all leave requests, which follow a very robust, carefully considered process, will also require final review by the Director of Mental Health. This arrangement will be in place while the report's recommendations are being implemented. Dr Crawshaw says Health New Zealand's work in quality improvement and progressing the report's recommendations will be carefully monitored over the next 12 months. He says this will help provide the public with a stronger degree of assurance that underlying issues are being addressed and progress continues to be made.
1News
7 days ago
- Health
- 1News
Inquiry finds 'significant' problems in Canterbury's Mental Health Services
An inquiry into Canterbury's Mental Health Services found "significant" problems in the service's governance, care model and resourcing. The findings included "critical staff shortages", staffing vacancies affecting admissions and discharge processes, a "siloed culture and care model", concerns about the service's governance and delayed resourcing decisions at the regional governance level. The final report, released three years after it began, has 18 recommendations aimed at addressing the key issues. Health New Zealand (HNZ) has acknowledged the "significant failings" and is committed to implementing the recommendations. The daughter of a woman murdered by a mental health patient last year says the report "confirms a very broken mental health system". ADVERTISEMENT "I think it's a tragedy this report has taken so long so long to be finalised and released. I can see numerous aspects in it that, if they had been remedied earlier, could have prevented the death of my mother." Director of Mental Health Dr John Crawshaw began his inquiry under section 99 of the Mental Health Act in June 2022 after Hillmorton forensic mental health patient Zakariye Mohamed Hussein murdered Laisa Waka Tunidau as she walked home from work. Hussein was on community leave at the time of the killing. It is only the second time such an inquiry has taken place. Dr Crawshaw released his review on Tuesday. He said drafting of the report took longer than anticipated due to several factors including the extreme weather events in 2023 and delays in receiving key information. Dr Crawshaw said in his report the inspection arose from concerns he held "as to whether there were systemic issues in these services". "The Director needed assurance that the services were complying with legislation and related guidelines, and were able to deliver appropriate care and treatment for tāngata whaiora [patients or consumers] under their care." ADVERTISEMENT Daughter of a woman murdered by a mental health patient last year says the report "confirms a very broken mental health system". (Source: 1News) 'Critical' staff shortages Dr Crawshaw said at the time of the inspection the then-Canterbury District Health Board (DHB) had a population of nearly 600,000 people and was one of the largest DHBs. The district had been exposed to several significant events including the earthquakes of 2010/2011, several serious floods, the Kaikōura earthquakes, Port Hills Fire, the Christchurch terror attack and Covid-19. The events contributed to "increased strain" on specialist mental health services and said the mental health services were "not well placed" to meet the additional strain. His report said the "most significant and prevailing issue" concerned staffing in the clinical areas, especially the adult inpatient, community and forensic services. "In the inpatient areas, there were daily issues in ensuring minimum safe staffing levels." The divisional leadership team had "significant concerns" about the number of staff vacancies and the "relatively junior nature" of the clinical staff in some areas. ADVERTISEMENT When the inspection took place the impact of Covid-19 was a "significant exacerbating factor". Nemani Tunidau, Eparama Tunidau and Laisa Waka Tunidau. (Source: "While the effects were different across the various disciplines, it was evident that all disciplines … were affected. In addition, it was clear that not all disciplines felt heard and involved in clinical decisions. "There were reports of impacts on clinical care. Forensic mental health services were particularly challenged. Not only were there issues in maintaining minimum safe staffing levels, there were issues associated with the experience and seniority of staff." There were "critical shortages" of staff in many areas of the service, particularly inpatient units. "Clinicians frequently used the phrase 'on numbers', referring to being deployed to an inpatient unit to bring up the numbers of staff on a roster to a perceived safe capacity. "The inspection team heard concerns that people were working overtime and double shifts, to meet the 'on numbers' expectation. While the magnitude of the issue was unclear, it was raised repeatedly by staff in interviews. Some staff stated that they no longer wished to do overtime and double shifts due to the level of personal stress and strain it caused them." ADVERTISEMENT Dr Crawshaw said in some interviews a "palpable level of distress was evident". The staffing shortages appeared to particularly impact forensic mental health services, he said. "The clinicians seemed tired. There was a sense that many of them were no longer putting in discretionary effort, due to fatigue and burnout. Many clinicians spoke of the 'moral injury' they experienced by being obliged to provide suboptimal care to tāngata whaiora." Staff 'afraid to come to work' In relation to nursing staff, Canterbury, like other services across the country, had a challenge with a "missing middle" – nurses who were "competent and experienced but still have a long career in front of them". When the inspection was carried out there was a group of staff nearing retirement. They appeared "fatigued and were possibly experiencing burnout". Some of the new graduates had been placed in "unsafe situations". ADVERTISEMENT "For example, a newly graduated registered nurse spoke of arriving for a shift at the forensic mental health inpatient unit and being told that they would be the shift leader, a task they felt wholly unprepared for." Some nursing staff were "afraid to come to work" with an "unacceptably high rate" of assaults on nursing staff by patients. "Staff reports of experiencing the clinical environment as unsafe were particularly prevalent in forensic services. There, staff described how a number of senior staff had recently left, particularly from the acute medium secure unit. "This had left both a gap in staff numbers and a gap in expertise. Some staff appeared to be distressed by and angry at the situation; particularly those working in the acute medium secure forensic ward." The service capped inpatient beds to ensure minimum staffing levels, with 193 beds. At the time of the inspection there were 178 in use or available. Dr Crawshaw said the response, while "understandable" from the desire to maintain minimum safe staffing levels, had "brought challenges". Some staff said there were occasions when patients needed to be managed overnight in a unit or ward different to the one they were admitted to, and others felt there was "general pressure" for early discharge or delayed admission. ADVERTISEMENT "Community staff raised concerns regarding the perceived risks they were holding and managing as a result. Some expressed concern that this was resulting in suboptimal care for tāngata whaiora." The bed number caps also meant that sometimes people with serious mental illness who had not entered treatment through the justice system "fell out of care or were unable to be admitted". Frontline forensic mental health staff expressed "significant concern" about their safety and ability to provide a service. "The inspection team heard there was a particular difficulty in the acute medium-secure unit. Apparently, a significant number of senior staff had retired or left that unit, affecting both staff numbers and experience levels." Of the staff in the unit 50% had less than three years' experience working in health services. 'Culture of blame' Dr Crawshaw said that on numerous occasions, the forensic mental health clinical governance team raised concerns to senior management about shortages of staff in the service. ADVERTISEMENT The inspection team also heard there was a tendency to blame individuals. "Interviewees used the term 'a culture of blame' and described situations where bullying had occurred and staff had been prevented from escalating issues due to a fear of repercussions." He said overall the staff appeared "dedicated to providing the best care they were able to". However, they felt care was compromised in several ways including staff limitations, and the increased pressure for early discharge. "In some cases, people required readmission following discharge, or, where they were not readmitted, their mental state and care deteriorated in the community. "Sometimes, staffing and bed capacity issues meant admission was delayed for people who required care." Dr Crawshaw said the observations were similar to what he had heard from other services around the country. ADVERTISEMENT "However, staff in Canterbury - Waitaha were particularly stressed." The morning's headlines in 90 seconds, including poll numbers paint grim picture for leaders, Trump sending the National Guard into Washington, and where have all the coaches gone? (Source: 1News) There were also concerns about how the service was incorporating te ao Māori into their model of care. "This was of particular concern to the inspection team given the cultural needs of the people accessing the forensic mental health services at the time of the inspection." The inspection team had "significant concerns" about the functioning of operational and clinical governance within the service. He was also told that clinical governance at a district level was not working effectively and that an emergency framework had been put in place. Dr Crawshaw did not receive a draft clinical governance structure at a level above the service until March 2024. ADVERTISEMENT "Staff reported difficulties in the escalation and consultation processes and gave examples of issues that had not been effectively resolved." He said there was an "overall reactive mode of governance". "Senior leadership was aware of the impact of staffing issues and had been putting reactive plans in place under urgency to address this (often daily). However, this very short-term focus compounded governance and communication issues." He said nationally all mental health, addiction and intellectual disability services are "under pressure". Several common challenges included mental health services struggling to improve access for Māori, the need for mental health services being greater than available sources and a "shortage" of suitably qualified mental health clinicians, as well as a need for investment in facilities. "When things go wrong during the delivery of mental health services, service providers are subject to intense scrutiny and criticism. As a result, many mental health clinicians practice in a risk-averse manner. This also affects staff recruitment and retention." Dr Crawshaw's 18 recommendations looked at three of the main concerns raised: governance, care model and resourcing. "The uniting thread across these recommendations is the need for better cooperation between leadership and service delivery to prioritise these services, enable staff to do their best, improve the models of care and plan for the future." ADVERTISEMENT His recommendations included prioritising and focusing on mental health service performance, implementing clear pathways of decision-making and governance, and reviewing the care model. He also recommended the organisation focus "maximum effort" on staff recruitment, retention, supervision, training and mentoring. There also needed to be strategies developed long-term management, budget, staffing and facilities as well as establishing and investing in a Māori mental health service. Hillmorton Hospital, in Christchurch. (Source: 1News) 'Significant failings' HNZ national director of mental health and addiction Phil Grady acknowledged the "significant failings" identified in the report. HNZ was "committed" to implementing the recommendations to "prevent the tragic events of 2022 and 2024 from happening again". "We recognise the loss and grief these families have and continue to experience and express our sincere condolences to them. We are deeply sorry for the failings in our systems. "We have reached out to these families to apologise and discuss Dr Crawshaw's report, and will remain in contact, if that is their choice, to update them on progress to implement actions from the report." ADVERTISEMENT HNZ accepted all of Dr Crawshaw's findings and had an action plan in place to implement the recommendations, which focused on the underlying issues related to governance, the care model, and resourcing. "We are focused on continuing to provide senior leadership oversight of planning for the service, building a framework, and ensuring there is sufficient staff with the right level of training and experience to safely and effectively deliver services." Grady said there had been "demonstrable progress" on key recommendations including establishing a clinical governance framework and increasing clinical staffing by 11 per cent since 2022. Clinical decision making on patient leave was "consistent with policies" and there were weekly audits of compliance in place. "There are clear pathways both within the service and nationally within Health New Zealand to escalate and manage risk. " In addition to recommendations identified in the report, HNZ had already made improvements to embed regional planning, decision making and information flow, increase staff recruitment, upskilling and training across the service, develop a cultural narrative to include a te ao Māori perspective, and upgrade a range of facilities. "To ensure progress of the recommendations continue, we welcome Dr Crawshaw's increased oversight of the service over the next 12 months. "We are committed to improving the service and our actions will be closely measured against this report, and two other event reviews conducted by Health New Zealand." ADVERTISEMENT Elliot Cameron appears in the High Court in Christchurch this morning for sentencing for murder. (Source: Pool/ NZME / George Heard). (Source: 'A very broken mental health system' In June another Hillmorton mental health patient, Elliot Cameron was sentenced in the High Court at Christchurch to life imprisonment with a minimum term of 10 years for murdering 83-year-old Frances Anne Phelps, known as Faye in October last year. Phelps' daughter, Karen Phelps, told RNZ that while the report did not specifically address her mother's case there were "many serious issues" identified that had "negatively impacted the ability to deliver services". "Most of these issues are no surprise as they were blatantly apparent in my mother's case namely staff shortages, communication and governance issues, pressure for early discharge and not enough funding to provide adequate services and care. "It's no surprise that Elliot Cameron was encouraged to move out of Hillmorton, that he was not being supervised or under treatment and his aggravated symptoms were not addressed. This report confirms a very broken mental health system. "So now the question remains will this be remedied, which will require significant funding, and that doesn't seem to be a priority for this government, or will another member of the public be killed? I think it's a tragedy this report has taken so long to be finalised and released as I can see numerous aspects in it that, if they had been remedied earlier, could have prevented the death of my mother. It's a timely reminder that every day counts when serious mental health service issues are identified and every day they are not remedied puts the public at risk." ADVERTISEMENT Following his sentencing a suppression order was lifted allowing RNZ to report Cameron killed his brother Jeffrey Cameron in 1975. A jury found him not guilty of murder by reason of insanity and he was detained as a special patient. Cameron was made a voluntary patient at Hillmorton Hospital in 2016, and then in October last year murdered Phelps, striking her with an axe. RNZ exclusively obtained emails from Cameron to his cousin Alan Cameron sent over more than a decade, detailing his concerns that he might kill again. In response to the revelations, Chief Victims Adviser Ruth Money said it was hard to see Phelps' death as "anything other than preventable". RNZ earlier revealed another case involving a man who was made a special patient under the Mental Health Act after his first killing was recently found not guilty of murder by reason of insanity for a second time, after killing someone he believed was possessed. After that article, Money called for a Royal Commission of Inquiry into forensic mental health facilities. After Cameron's first killing was revealed, Money said she stood by her recommendation. "The public deserves an inquiry that can give actionable expert recommendations, as opposed to multiple Coroners' inquests and recommendations that do not have the same binding influence. The patients themselves, and the public will be best served by an independent inquiry, not another internal review that changes nothing."
RNZ News
12-08-2025
- Health
- RNZ News
Critical shortages in Canterbury's mental health services
Critical staff shortages, an unsafe work environment and failures of leadership are among the findings of a review into Canterbury's mental health service. Director of Mental Health, Doctor John Crawshaw carried out the investigation and spoke to Lisa Owen. Tags: To embed this content on your own webpage, cut and paste the following: See terms of use.
