One of the country’s most experienced psychiatrists said care for our most vulnerable is at crisis point and he had “no option” but to resign when it became clear he couldn’t affect change within the system.
Dr Erik Monasterio is a consultant forensic psychiatrist with almost 30 years of clinical experience.
He is regularly called on by the courts to give evidence in cases when an offender's mental health needs to be assessed.
He has experience in hundreds of homicides, including specific insanity and infanticide cases. Earlier this year, Monasterio gave key evidence in the murder trial of Lauren Dickason.
Monasterio spoke to TVNZ’s Sunday programme about the avoidable consequences of untreated psychotic disorders.
“Services have become so disorganised, chaotic [and] under-resourced, my concern is that if the chaos continues, we will see more and more adverse incidents occurring,” he said.
Sunday spoke to three families who feel mental health services failed after their loved one was killed by someone suffering from an untreated psychotic disorder. Between five and seven New Zealanders are killed each year in this way.
Additionally, sufferers of psychotic disorders like schizophrenia are four and a half times more likely to die by suicide than the general population.
Since the story aired, numerous people have come forward with their own stories of inadequate care of loved ones which have led to incarceration or death.
Monasterio was the clinical director of Mental Health Services for the Canterbury Regional Forensic Service between 2015 and 2021.
He said the 2019 mental health inquiry highlighted the lack of resources and funding in the sector but rather than help, he believed it had made things worse.
“Increasingly in New Zealand, we’ve been unable to provide services to treat the 3% of the population who are affected by serious mental illness but the [inquiry] pointed out that we should be providing care to up to 20% of the population.”
The government diluted resources and focus away from severe sufferers, he said.
Tipping point
The situation reached a tipping point for Monasterio in 2021.
“I took my responsibilities of leadership very seriously. I go well out of my way to try to bring attention to the difficulties that people with serious mental illness face. But my ability to lead an effective service was compromised,” he said.
He said his frustration was at what he claims was interference in his ability to his job as clinical director, disabling bureaucracy, and a failure to act on warnings about the dire state of services.
“Nobody wants to leave a service in a worse situation than you found it [but] when I felt I could have no impact in that, I felt that my only option was to resign.
“I was far more likely to be able to achieve better outcomes by stepping outside of the system.”
Monasterio said since he left, he had become aware of even more staff who’ve stepped down from public health sector roles.
“The staffing crisis in mental health services was foreseen many years before Covid and proposed initiatives to address this were repeatedly ignored by the DHB,” he claimed.
'Significant improvement'
Te Whatu Ora Canterbury’s Lisa Blackler said the organisation acknowledges the contribution Monasterio made in his time with the forensic service.
“We also acknowledge the pressures our specialist mental health and addiction services are experiencing right now, including our consultant psychiatrists. Workforce shortages are a large part of this," she said.
However, she said staffing has seen a significant improvement recently with many nursing roles recruited.
“We do have several senior forensic psychiatrist vacancies which we are actively recruiting for. We are sourcing locum doctor support to ensure we have effective cover while we recruit.”
In 2019, the Government invested $77 million over four years in mental health and addiction workforce development. This was topped up with a further $10 million from the Budget 2022 specialist services package.
“Te Whatu Ora is committed to improving and transforming the system to ensure that anyone who needs support gets it, regardless of age or location, with timely access to care. Our staff go above and beyond to provide care to our community, and I thank them for all of their hard work,” Blackler said.
Monasterio said while he and other colleagues have “a very high level of concern”, he said he’s hopeful and committed to looking for solutions alongside the new government.
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