people talking

SocietySeptember 2, 2019

Mass exodus warning as DHB psychologists escalate their strike

people talking

More than 600 psychologists in New Zealand have voted to continue the strike they began last month. They say poor pay, long hours, and an institutional lack of respect are causing a mass exodus.

A month ago, on the 31st July, 600 APEX psychologists in 16 District Health Boards (DHBs) stopped working overtime. APEX has since voted to continue the strike into next month. From Tuesday, DHB psychologists and clinical psychologists will stop taking on new clients, and cease group therapies.

DHB psychologists state they are underpaid, undervalued, and overworked. Annmaree Kingi, a consultant clinical psychologist in forensic services at the Canterbury DHB, says psychologists have reached crisis point. “The people we’re taking on over time are getting more complex, our workloads are going up, the environments in which we work are stressful, and we’re burning out,” she explains. “I’m a psychologist with coming up 15 years’ experience, and I could increase my salary by a third if I walked – just to a government department. If I went into private practice, I could double my salary for less work.”

As part of the Wellbeing Inquiry, a task force looked at recruitment and retention at the DHB level. “To keep up with current demand, there was a need for around 268 psychologists,” says Kingi. “Since then we’ve lost around 70.” Recruitment is proving just as difficult as retention. “New people coming through are seeing burned out colleagues,” says Kingi. “Why would they come and work in that system when they could go to the Department of Corrections?”

Kingi says DHB psychologists are leaving in droves for ACC, the Department of Corrections, and private practice. They’re working overtime, have no leadership positions within the medical field, and aren’t getting the professional development they need. Clinical psychologists are among the most highly qualified workers in the country, with an average of seven years’ university training. They work with both medical practitioners and the clients who need them.

“That places us in a very good position to help the transformation of mental health services, but we – as a profession – can’t get into leadership roles,” Kingi explains. “The medical model is the dominant model in mental health practice. We have to fight to be at the table to help our clients more broadly, which we really want to do.”

The medical model may affect how DHB psychology leadership is organised, but it’s not affecting the industry where it really needs to: professional development. “If you wanted surgery, you would expect the surgeon to be right up to date with the current techniques,” says Kingi. “You wouldn’t want them using techniques from ten years ago, especially if you had a complex problem. We’re feeling really burned out by that. We’re doing a lot of work outside our normal hours to feel like we’re being good scientists and practitioners.”

Already DHBs have been affected by the lack of overtime work; psychologists don’t just work in stereotypical mental health settings. “We work in health settings, brain injury settings, elderly settings, with child and family health, eating disorders, we’re everywhere,” says Kingi.

“There are psychologists working in physical health services too: in cancer wards, in diabetes centres, in chronic pain. You can’t assess brain injury and ongoing issues without psychologists because we do all the testing. We assess dementia, we work with people who’ve had major spinal injuries. It’s huge.”

The clients DHB workers are seeing now are more complex than in the past. A clinical psychologist in Auckland, who preferred to go unnamed, explains that because there is increased demand for psychological services and there are fewer psychologists, clients are suffering. “You need more diagnoses and more difficulties now to see one of us. More people are being referred, but they end up on waitlists. The outcome is that people are waiting longer to see a psychologist and to have therapy.” She says she’s seen a report detailing two-year waits, and waits of nine months to a year have been recorded elsewhere.

Dr John Alchin, a pain specialist at a Christchurch hospital, says psychologists are essential to his team. “The patients we see with chronic pain have complex problems for which there is no quick fix, and usually no effective biomedical treatment. That is beyond the scope of mere doctors and medical specialists to adequately address. We rely on our non-medical colleagues to assess and address the psychosocial aspects,” he says.

The non-medical colleagues in his team are physiotherapists, occupational therapists, nurses, social workers, and clinical psychologists. “They usually have more effect on patient outcomes than we do.”

Alchin says there is a high demand for psychologists, but the pay scale doesn’t reflect it. “[Clinical psychologists have] a particular skill set, which is of great benefit in a range of difficult health conditions; and their rarity – each University has a very limited number of training places. Many apply, but few are chosen. They are a rare breed. They need to be paid adequately to encourage them to work in the public system.”

The psychologists Alchin works with enjoy their job, but the remuneration just isn’t enough to cover the overtime, the student loans of around $80,000, and the emotional trauma working as a DHB psychologist can entail.

“When emergencies happen, we drop everything,” says Kingi. “The mosque shooting, the Canterbury quakes, Pike River – we drop everything and we walk into those jobs at the front end and work really hard and make a difference, and yet we’re not seen in terms of shaping mental health services over the longer term.”

“If we walk away, people at the severe end will lose psychologists, and meds will not treat them alone. They need us.”

At the moment, Kingi is using her psychological skillset on herself to maintain her passion. She and the other APEX psychologists have hesitated to strike for a long time. “We don’t do this stuff lightly, but this is where we’ve got to.”

DHB psychologists have never taken industrial action like this before. “It’s just something we wouldn’t do,” says Kingi. “It’s been a really difficult process for all members on that basis. We are impacting the very people we care about and it does not feel good. The second the ministry of health and the government say we’re essential, and offer us something, we’re coming back.”

The Auckland clinical psychologist echoes this sentiment. “Now’s the time we need to stand up and say something for the future: for DHBs, to keep them sustainable; and for clients, who are asking to see us and are waiting on lists for months.”

“It is with heavy hearts that we strike. It was not an easy decision for us to make, and to tell our clients, but it’s so they can have better access to therapy. It’s heartbreaking to hear how long they have to wait.”

Kingi has a final warning for the government from an industry she says is burned out: “there will be an exodus of us, across the country, into private practice. It would be disastrous, but that’s where we’re all at.”

Keep going!