Health Insight > The changing face of New Zealand
Privatisation of Mental Health Care
Back in the 1950s, times were changing and people's awareness of the world around them was expanding. The insane asylums had been around for many years but they were becoming something of a social embarrassment to governments who had little idea what to do those who could not function in the fast changing world.
The mental asylums as well as accommodating dysfunctional were also experimental facilities for electric shock treatment and new drug trials. They also became alternative places to prison for people that governments didn't like and yet they had sufficient credibility that people who were feeling out of sorts with the world could admit themselves.
In hindsight we can see that a lot of stupid stuff went on and the majority of inmates were adequately cared for, but it is really only thanks to the more humane staff that anyone had an enjoyable or reasonable standard of life in these places.
As far as I have been able to determine, the closing down of psychiatric health institutions in New Zealand began under the national government in the 1960s. There was talk that these places had outlived their usefulness and that the inmates at such places would be better off in the community.
But at that time the only discussion was about moving people into the community and no discussion about how they would be cared for and how the money and administration would work.
So the privatisation of long-term care services for the mentally ill went almost completely unnoticed by society. While some people (former patients) ended up living in boarding houses and a few were taken back by their families, a great many ended up in state owned houses to be cared for by untrained people managed by emerging private companies.
In most New Zealand cities today, state owned houses accommodate groups of people in flatting type situations. In a few of these houses, the people are reasonably competent and require little more than a helper to be present 24/7 to ensure that they are looking after themselves, but most other houses require more staff.
In a hospital, people are generally referred to as patients, but in these privately run houses they are referred to as clients and some of these clients require 24 hour person care. The range of problems that these clients suffer is very broad it could be spina bifida, early onset dementia, brain damage and everything in between.
Many of these clients require assistance dressing and what most of us would consider daily activities. Everyone is treated as an individual and life care plans are made up in consultation with the families, family doctors and medical specialists as required.
On the face of it, this seems like a win-win situation for everyone. The clients are cared for, untrained and unqualified people in the community get work as carers and most companies invest in training their staff to a reasonable level of competency in terms of personal client care and administering medications.
Under the old system of the psychiatric institution, most of these people would have been accommodated in something closer to a hospital setting and the majority of the staff would have been trained nurses. There is nothing wrong with the present accommodation though there are times when staff may be inadequately trained to deal with some of the situations they may face.
When there are a large number of people housed in one facility, it requires less staff per patient or client than under the present model. But when a nurses salary may be $60,000 per year, and untrained caregivers salary may be less than $30,000. If one was to carefully do the maths, there main fact be a slight cost saving on wage's. But when we look at the cost of maintaining one building as opposed to hundreds of houses, there is more likely to be a huge cost saving in the care of one facility than many.
But because the ownership and maintenance of the properties falls under a different government portfolio, it is not counted in the actual healthcare costs even though it is paid for out of people's taxes.
In the current model, the corporations pay nominal rent for state owned houses in which they house their clients. The clients have a lifestyle plan which ensures that they get a reasonable level of care and quality of life. So for the most part, the clients are well cared for although we do hear of occasional cases of abuse.
How the corporation works
The various corporations providing care services are contracted by the government to do the job that the government was tasked to do and paid for the people's taxes.
In practice there are a multitude of expectations and protocols that staff must adhere to even though some of the protocols are beyond the comprehension of many staff. Because the corporations only pay minimum wages or slightly above, many of the staff are incapable of doing the job. So as long as nothing goes wrong all is well. But if they make a mistake their fault.
Therefore if a client happens to die on their shift, the staff must undergo a police enquiry as well is an internal enquiry by the corporation. In short, the frontline staff, the people who care for the clients tend to be overworked and mistakes are common. But if it is deemed that a staff member has made a mistake, they can be made to be responsible, lose jobs and even face prosecution. In short the protocols although they are designed to ensure good client care are also designed to protect management.
Because the staff are ordinary people and not well-trained, the atmosphere in the homes is often very casual which is nice for the clients, but administratively this is a challenge because there is not always clear communication at staff change over about what has happened during the previous shift, paperwork is often incomplete because staff simply don't have the time and even with blister packs, there are often errors with medications.
I don't have access facts and figures, but I would expect that if the government had maintained proper institutional facilities, the level of care for all these mentally and physically impaired people would be improved and the overall costs of caring for them reduced.
But under the model of privatisation, the extra that the government is paying the companies and corporations that are overseeing the services could be spent elsewhere.