Families in limbo as waiting list for child mental health services in Christchurch grows longer

Saturday, 2 September 2023

Canterbury families are waiting up to two years for specialist mental health support, with nearly 500 children on the waiting list.

Worried two years was far too long for her son, who is struggling at school with dyslexia and other learning and cognitive difficulties, Chelsea, who did not want her last name used, paid for her son to see a private psychologist.

While families like hers wait in limbo, the waiting list for the Child, Adolescent and Family (CAF) mental health services in Canterbury grows ever longer, and many private psychologists are at capacity.

Almost 500 children are on the waiting list for CAF in Canterbury, with an average of 400 more young people being referred each month for specialist mental health support.

An expert expected most of the lengthy waits would be for ADHD, anxiety and depression, as psychosis and suicidal children would be prioritised.

In the past 12 months, more than 4600 children and young people were referred to the service, with about 1500 currently receiving treatment. Five children or young people await a hospital admission.

The service receives an average of 72 emergency presentations each month, an increase of 36% in the last three years, with the typical age of a referred child being 12 and the youngest being 2, Māia Health Foundation chief executive Michael Flatman said.

Te Whatu Ora Waitaha’s CAF service manager, Deborah Selwood, said service demand had generally increased in the last four years. The compounding factor in the last year had been the rise in the severity of patients’ illnesses.

'We know that many more patients are presenting needing to be seen urgently and who are more acutely unwell,” Selwood said.

While demand for the outpatient service had increased by 121% in the last decade, full time equivalent (FTE) psychologist positions were “far below” what was required for population demand, said Annmaree Kingi, APEX interim president for psychologists division and clinical psychologist at Te Whatu Ora Waitaha Canterbury.

“The FTE is not growing in response to public demand, it’s been fairly static for years. Te Whatu Ora are not responding to those waiting lists with investment in psychology so people can access therapy.

“People are left to their own devices and families are left to cope,” Kingi said.

Meanwhile, many private psychologists have waiting lists of several months or are not taking on new clients at all.

Corina Grennell, a private clinical psychologist at The Bealey Centre, said there had been a rise in requests for specialist assessments, such as for ADHD, autistic spectrum condition, and for gender dysphoria/reassignment reports.

“Most places that offer these are at capacity,” Grennell said.

The other issue was affordability, with the standard psychologist fee $200 a session.

“While some families are covered by health insurance or their employee assistance programme, this is not the majority. So even if there were not waiting lists, they still could not afford it.”

After a two-month wait, Chelsea managed to get her son in with a private psychologist who diagnosed him with ADHD, but now he is on another waiting list to see a private psychiatrist by the end of the year.

A clinical psychologist can assess and diagnose ADHD, but they cannot prescribe medication - a psychiatrist does that.

“We’re in limbo land - without the confirmed diagnosis we can’t access things like teacher aids or medication,” Chelsea said.

“The time we wait to see a psychiatrist is the time that he’s not having the ability to get anywhere near where he should be learning-wise, let alone catch up. Social skills, friendship building - all of those things are affected with a child that has high level ADHD.”

Chelsea ‘s eldest son also has ADHD and was diagnosed about three years ago through CAF. The process took two years.

Another mum who previously had her daughter as an outpatient at CAF but decided to go private for her ADHD diagnosis said she felt the CAF service was so stretched it was “pushing people into private clinics”.

Yet one mother said while it took a while to get her daughter into the CAF service, her experience there had been “phenomenal”.

Te Whatu Ora would not confirm the length of the average waiting time for a child or young person to see a psychologist at CAF.

Selwood said of the 4638 children and young people referred to the CAF service, about 78% received their “first contact” within three days.

Over the past three months, the average time from referral to first face-to-face appointment was 16 days across all CAF services.

All referrals were triaged the same day, and contact was based on urgency or type of care required, she said.

“Many people don’t need to specifically see a psychologist, although they do consult on cases at times. Usually once someone has had a face-to-face appointment, treatment starts soon after unless they are triaged differently following assessment. In which case, the more acute cases will be seen first.”

Meanwhile, work continues on the new outpatients mental health facility for children and adolescents, Kahurangi.

Kahurangi will replace existing CAF outpatient facilities, which are currently split across two sites at Princess Margaret Hospital and the Hillmorton campus, and is due to be completed in August 2024.

While the new facilities will have state-of-the-art spaces for assessments, play, and family therapies, there are no plans by Te Whatu Ora to expand staff numbers.

“There has been significant investment into mental health and addiction services across the country in recent years, including increased provision of other services for children and young people across primary care and community providers in Canterbury,” Selwood said

This includes new community services for Māori and Pacific people of all ages.

But while the new services have their place in the community, Kingi said people would still need to see a clinical psychologist for more complex issues.

“When the complexity outstrips what they’ve got available, they need somewhere to go.”