‘Crisis’ on the horizon as police pull back from mental health callouts

Saturday, 3 May 2025

While police districts begin to pull back from responding to mental health callouts, medical professionals are warning of the dangers. Katie Ham reports.

When a community mental health nursing team arrived at a Central Otago orchard in the golden light of late summer, the situation was volatile.

Reports had come in that a man in deep psychological distress had allegedly sexually assaulted two fellow orchard workers.

It was the end of the cherry-picking season, and the three seasonal workers had been living together in shared accommodation. Over recent days, the man’s behaviour had reportedly grown erratic.

As the response team pulled up the gravel drive, the orchard owner met them with visible relief, a broad smile cutting through his worry. Help, at last, had arrived.

But it quickly became clear to the team that this wasn’t a situation they could manage alone. The man required immediate hospitalisation under the Mental Health Act.

They realised they needed police assistance to carry out the transfer safely. That help, however, is no longer guaranteed.

Since the shift away from police-led responses to mental health crises began late last year, frontline healthcare workers have found themselves navigating a new system.

Now, rather than calling emergency services directly, they must ring the non-urgent 105 police number and wait. The decision to dispatch police falls to a calltaker - neither a sworn officer nor a medical professional - who must weigh the risk from afar.

But after waiting to speak to a calltaker for more than half an hour, that response team in Central Otago faced an impossible choice: should they leave the man where he was, posing a potential risk to the rest of the orchard workers, or should they wear it themselves and transport him directly?

“You can imagine that in a situation like that the minutes feel like hours,” someone involved in the incident, who The Post agreed not to identify, said.

The team would take the man to hospital themselves.

But with the nearest hospital more than two hours away the two mental health responders and a student were going to have to control him along the way.

Previously, police would have transported the man themselves while the healthcare team followed along behind. Now, the risks once shared are increasingly healthcare workers to bear alone.

A ‘phased’ transition

Last year, then Police Commissioner Andrew Coster announced that police would be starting to only respond to mental health callouts where there is an “immediate risk to life and safety”.

Events which fall short of that threshold would be directed to “more appropriate” services, he said, and with mental health callouts making up 11% of all 111 calls in the year to May 2024 the rationale was clear: free up police resources to divert them back to their core functions.

“It has been clear to me for some time that this is simply not sustainable and prevents us from keeping other areas of the community safe,” Coster said at the time.

Mental Health Minister Matt Doocey added that being met by a uniformed police officer sometimes caused more harm for those in crisis.

“People in mental distress are not criminals. Those seeking assistance deserve a mental health response, rather than a criminal justice response,” he said.

Phase one of the new system kicked in on November 4, and saw mental health transport requests become “subject to a higher threshold before police agree to become involved” and a “streamlined” handover process for voluntary mental health patients among other things.

On April 14, a staggered transition into phase two began with each district being assessed for their readiness. Those districts currently in phase two are: Waitematā, Counties Manukau, Waikato, and Tasman (excluding Kaikōura).

At phase two, police who have taken someone detained under the Act to hospital will leave after an hour unless there is an immediate risk to life or safety, and restrictions have been placed on Act assessments in custody suites.

Phase three and phase four will move towards a 15-minute handover time in hospitals, a pull-back of police responding to missing mental health patients and a shift away from responding to welfare checks where there is no risk of criminality or to life or safety.

Accounts from the frontline

Since the changes began in early November, accounts from the healthcare frontline have already revealed flaws in a strained system.

Just two days after the rollback began, a young vulnerable patient at risk of deliberate self harm needed to be taken to an acute mental health unit, Stuff previously reported.

In emails also provided to The Post, the patient is described as having a background of significant trauma, and had been assessed as having a risk of deliberate self harm and impulsivity, including jumping out of vehicles.

But police, in line with new policy, refused to transport her.

Instead, four security staff physically restrained the patient. She suffered a bloody nose from hitting the floor and was given an intramuscular injection of medication against her will, Stuff reported.

According to emails seen by The Post, the patient is described by those on site as becoming “distressed, crying out for help and fighting the whole time”. The medication then kicked in, and she was transferred by ambulance.

Healthcare workers involved in the incident have questioned whether, if police had attended when called, the young patient could have been restrained properly in the first instance, and not been injured or needed medication.

The following month, two female mental health workers were called to the Wānaka police station to see a man who had been found on a stranger’s property, according to a community mental health nurse who The Post agreed not to name.

It was assessed that the man needed to be transported to Dunedin for inpatient care, but police refused twice. Instead, police suggested the mental health responders hire private security to assist them, according to the nurse.

Unprepared to take the risk, the health workers let the man go, they said.

“We want the police to recognise that when we call them for help, we’re not just phoning them up just because we want a police car. But we’re getting calltakers with no medical training overruling teams with 60+ years of experience in mental healthcare between them.”

However, when the man’s brother then called the police directly to ask for help, they did eventually respond. With no medical training, responding officers decided the man did not need hospitalisation and instead took him to a motel in Haast, according to the nurse.

In a state of agitation, the man left the motel and went into the bush, despite being ill-equipped for the conditions in just a T-shirt and jeans. A search and rescue operation was launched, and he was eventually found, the mental health nurse said.

Then came the incident in the Central Otago orchard.

“If things keep going like this, it’s inevitable that either a patient or a member of the public are going to get seriously injured, or worse.”

The Post put this incident to police, but they didn’t comment.

Another community mental health nurse said the advice they were being given by management was “if at risk, walk away”.

“But as a health professional, it’s almost impossible to do that. When you’re faced with a person in mental distress, their family looking to you to help them, the public looking to you to help them, how do you just walk away?”

The solution was a direct line of communication with police to be used in situations like these, and a trust in the determination of mental health professionals about whether a person needs urgent hospitalisation, they said.

Emergency clinicians warn of ‘postcode lottery’

While community mental health nursing teams are tasked with going out to patients in need to assess them, emergency department clinicians wait to receive any patients needing hospitalisation when an inpatient mental health bed isn’t available.

Here, in emergency departments, a fresh set of problems await those in mental distress and their loved ones.

From healthcare clinicians without any formal restraint training to no place to house those at risk of harming themselves or others while they wait for the appropriate care, doctors are left feeling stuck between a rock and a hard place.

“The two-second promotion on emergency medicine is that the emergency department is where you come when your mamma and the police don’t want you. That invariably means we’re the ambulance at the bottom of the cliff,” emergency doctor from Palmerston North, Thomas Carter, told The Post.

But, Carter warned, “there is no-one in my emergency department with hospital-provided training about how to properly restrain someone”.

Further, emergency departments couldn’t just build rooms to accommodate mental health patients dropped off by police or community nursing teams, he said.

The result is that they would be housed with other patients awaiting treatment, surrounded by things like glass and without video cameras to document any restraints.

Speaking in his personal capacity as a Northland emergency doctor, Gary Payinda echoed many of Carter’s concerns.

“We all understand that police, in an ideal world, wouldn’t be the first response for someone in a mental health crisis, but the reality is there’s no one else to call. The country doesn’t have enough acute mental health resources in terms of community mental health nurses but also grave shortages in public psychiatrists,' Payinda said.

Payinda said he saw patients on the worst days of their lives and had come to realise the essential role both the police and mental health workers provide.

“You just know what this will result in - severe crises out in the communities and in emergency departments. It’s inevitable,” he said.

But perhaps the biggest concern of all was what would happen to those in rural communities where police officers are based hours away from hospitals.

“What happens in the likes of Dargaville Hospital, where there’s no overnight doctor or security staff? Emergency departments in rural areas are woefully under-prepared to handle potentially violent or delirious patients.

“The whole thing sets up a postcode lottery concept. If you live in a well-resourced area, you won’t feel as much of the pain, but those in under-served areas will be the first to cop it.”

Psychiatrist at Tauranga Hospital, Mark Lawrence, added that the experience of a mental health patient will be - at least in part - determined by the relationship local police have with the healthcare professionals.

“We have a good relationship with our police in Tauranga and Whakatāne, but that’s not always the case. But if it becomes very hard lined, things are going to be very challenging and I certainly am fearful there’ll be a disaster of some kind,” Lawrence said.

Unions and advocacy groups united in calls to halt new system

The Mental Health Foundation has been unequivocal in its request for the rollback of the police response to stop immediately, until the Government can show a clear plan for an alternative response system.

Chief executive of the Mental Health Foundation, Shaun Robinson, told The Post that each further phase risked a dangerous breakdown in care for the 70,000 Kiwis who call 111 each year in mental distress.

“For each one of those people, they have friends and family. Hundreds of thousands of New Zealanders will be affected by these changes, so it’s really important we get this right. These are life or death callouts,” Robinson said.

The New Zealand Nurses Organisation joined the Foundation’s calls for the withdrawal to be stopped until critical resources were made available, with the Mental Health College chair Helen Garrick adding that this “is a matter of safety for everyone, including the people who need mental health support, their whānau and the mental health workforce.”

The Public Service Association also warned of “avoidable tragedy” if the transition was not reversed.

“The safety of mental health workers should be the top priority for the Government,” PSA national secretary Fleur Fitzsimons said.

Safety ‘police’s number one priority’

But, as things stand, it’s full steam ahead for the police withdrawal from mental health callouts.

According to manager of the police community prevention and partnership, Inspector Brett Callander, police and Health NZ remain committed to working together “for a smooth transition to occur safely and without unintended consequences”.

The process wouldn’t be rushed as police made sure everyone was confident in the changes, and each phase would have a start date that clearly be communicated with the relevant district, he said.

“Safety is always police’s number one priority. Police have always, and will always, respond when there is an immediate risk to life or safety. This will not change.

“Outside of an emergency, for work that has been implemented as part of the mental health change project, police have a threshold for what sits with police and what doesn’t.”

But a detective from the North Island told The Post he thought it was a “no-win situation”. “There’s no easy answer, as situations can be so changeable and if police aren’t there health staff may be hurt.”

According to Health NZ director of specialist mental health and addiction Karla Bergquist, the safety and well-being of staff and those requiring mental health support remains the priority.

“At the heart of these changes is ensuring people receive the right care at the right time. We have been working closely with police to ensure the changes are well implemented,” Bergquist said.

Health NZ was also focused on “continuous improvement”, she said, and for any issues that arose there were “clear low and national escalation pathways”.

Independently of the rollback, work on the implementation of a four-year programme of work to strengthen ED security is ongoing, she said.

All eyes turn to Budget 2025

As Budget 2025 looms, the question then becomes - could more money be on the way to bolster mental health services?

For those medical professionals spoken to by The Post, increased investment is the “clear and obvious solution” to the emerging problems, and the hope is that this will be reflected in the new Budget announced on May 22.

“It’s simple. We’ve got a Government who have cut 1500 healthcare staff and who have tasked Health NZ with finding $1.4 billion. Instead, the Government needs to reverse its cuts to the public service and invest in community mental health workers,” Payinda said.

Robinson from the Mental Health Foundation agreed, suggesting New Zealand follow in the footsteps of the UK who invested $1 billion into mental health services ahead of starting the incremental retreat of police responding to mental health callouts.

“We want to see a budget, we want to see a firm plan for replacement services, or else we’re going to have a disaster on our hands,” Robinson said.

But, as Opposition mental health spokesperson Ingrid Leary argued, examples of narrowly avoided crises are already emerging.

“Mental health workers are having to make choices of supporting patients by travelling them to hospital emergency departments knowing things can escalate very quickly putting their own lives in danger,” she said.

It’s only a matter of time, Leary said, before something even more sinister happened.