Homeless mental health patients still being kept in hospital for too long

Social workers helping the homeless in Auckland are concerned some mental health patients are still being kept longer than needed in hospital because housing is hard to find.

Health New Zealand said people treated in mental health units without a place to go were not discharged to the street but it could take days or weeks to arrange accommodation for them, however it has no available data on this.

A man who was recently discharged from a mental health unit in Auckland, and homeless, said he had to call around to find somewhere to stay in order to be released.

Ritchie* said living on the street is tough.

"The most difficult part is trusting people not to hurt you when you're not looking and finding somewhere warm to sleep," he said.

"You don't really take into account the time when you're homeless, you're just free but just alone that's all."

Ritchie said while in the mental health unit, he called a charity which manages temporary housing and they had a spare room.

He said he had very little support from health workers after leaving hospital.

"I think they should at least have someone knock on the door to where they are discharged to ... just to check up once a week at least for the first three months to see if they can handle the enviornment because they just got out of another different enviornment," Ritchie said.

"Just to see if they're comfortable and safe."

It's a familiar story at Maranga Fanau, which manages housing with wrap-around support at a property in Manurewa where there are 75 rooms each with their own bathroom and shared kitchen.

One of the directors Phyllis Latu said people were referred to them from multiple agencies and Middlemore Hopsital.

"They've definitely outlived their first, second and third chances. The people who come into this housing are probably up to their 10th chance so it's been hard and there's challenges that they face whether it could be addictions, suffering from mental wellbeing, it could be financial."

Latu said people should not have to stay longer in mental health units because they were homeless but being discharged to boarding houses with no available support was not the answer.

She regularly did a roll call of homeless on the streets of Manurewa and said most have needed mental health care at some stage.

"Most of our homeless have been in Te Ao Mai at Middlemore, they've been discharged, they've gone nowhere, they're doing nothing and they're still on the streets."

Health New Zealand northern region mental health and addictions lead Pauline McKay said it's not uncommon for someone to remain in inpatient care for longer than was clinically necessary - days or weeks - while suitable accommodation was arranged.

But there is no data on exactly how long - RNZ was refused an official information request because it would require manual collation of information held on patient files.

McKay said people were not discharged to homelessness in the Auckland region but may be sent to transitional housing, boarding houses, or motels.

"If it is not possible for a person to return to their previous accommodation, we work closely with housing and social service partners to ensure appropriate accommodation is identified before they leave inpatient care," she said.

"For people with no fixed address, our clinical teams, which include social workers, liaise with agencies such as MSD, Kāinga Ora, community housing providers, and NGOs to identify suitable accommodation and provide support as part of discharge planning."

The Mental Health and Wellbeing Commission released a report in June last year which monitored the mental health and addiction system.

It found there had been no change over five years in the proportion of people accessing mental health and addiction services who were homeless - in the 2023/2024 year six percent of specialist mental health and addiction service users were homeless.

It is a long-running issue.

A 2020 report released by the Chief Ombudsman raised concerns about two Auckland mental health units in which people were staying longer than clinically needed because they had nowhere to live, one for up to 17 months.

McKay said a programme underway with the Ministry of Housing and Urban Development in Auckland, Rapua Te Āhuru Mōwai, supported people who were homeless to transition from inpatient mental health care into stable housing with wrap-around support.

"While we cannot comment on individual cases, there may be situations where it appears a person has been discharged into homelessness when this is not the case," she said.

"For example, a person may be discharged to a boarding house and then leaves, or a person may leave the unit before the discharge process has been complete and we are unable to locate them."

Aaron Hendry runs Kickback, an organisation responding to youth homelessness that also has a drop in crisis centre The Front Door.

He said when people, including teenagers as young as 16, were discharged to temporary housing it became a vicious cycle.

He would like to see young people in crisis provided with appropriate housing that included wraparound support.

"The fact that they are experiencing homelessness, that they're in emergency housing, hostels and lodges, that is exacerbating their unwellness and they're going into ED ... then discharged back into the same situation," Hendry said.

"That's just a continual rotating door in and out of the health system."

He said emergency departments were no place for young people in crisis.

"We are concerned that a young person will die as a result of what is clear gaps in the system as it is right now."

Kickback is advocating for duty to assist laws, which would place responsibility on government agenices to support people experiencing homelessness.

As for Ritchie, he felt like his mental health had improved and he could plan for his future.

"To be able to call a place home is very difficult to say it and mean it," he said.

"I want to be living here, I like it. I've got a lot of plans ... everything's looking good."

*Not his real name