The Auckland City Mission is adding a full-time mental health nurse to its healthcare services, in an effort to cope with the growing need for specialised care of the city's most vulnerable.
Since the Mission's medical centre opened a decade ago, the number of patients it sees each year has more than doubled.
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One of its long-time patients is Maia*.
The only constants in her life have been the Auckland City Mission and heroin. Her addiction began when she was 13 and working as a sex worker.
"I had to have sex with an old man, and I was crying and I didn't want to do it because he was a smelly old man. The guy I was with said, 'Here: smoke this, puff this'.
"Maybe three puffs later it was the needle."
She was hooked on heroin for more than 30 years, and says it was her way of coping with the work she did. From age 14 to 19, she was a sex worker on Japanese fishing boats.
"It's you lying there, but it's not happening to you," she says.
Last year Maia suffered a perforated bowel after months of eating badly; she knew she should be eating better, but she just didn't care. She started bleeding in her living room, and grew so weak she couldn't get help.
Eventually her neighbour discovered her, wrapped her in a blanket and carried her to the Mission, where she collapsed.
"By the time I did think about getting help I couldn't move. There was blood everywhere."
She received surgery and narrowly avoided death. Maia isn't homeless but she is on a benefit, and is reliant on the Mission.
"I'd just hate to think where I'd be if it wasn't for them," she says.
The Mission's Calder Centre provides healthcare for people like Maia who are in desperate need. Auckland City Mission chief executive Chris Farrelly says the patients have complex needs.
Some have experienced trauma which has led to an addiction, or have mental illnesses.
"The majority of people we are dealing with have been traumatised and are often very ill."
Mr Farrelly says the Mission identified a severe need for healthcare in its clients - as well as food and shelter - over the last few years, which led to a partnership with the Auckland DHB.
The Calder Centre opened in 2008, and in its first year had 588 patients - now, it has 1621. On average, the patients have to see a doctor 11 times a year - that's three times the national rate.
Now the Mission and the Auckland DHB are about to add a full-time mental health nurse, part of whose job will be to assist the team who go out on the streets and visit rough sleepers, and encourage those who are ill to visit the clinic.
It's a very important role, as mental health emergencies are the most common the Calder Centre doctors encounter.
"[We deal with] people who are maybe at risk of harming themselves, people who are hearing voices and losing control of their lives," Auckland City Mission doctor Richard Davies says.
Dr Davies says the challenges include working out how a patient will pay for their subscription, and if they are sleeping rough where they can keep their tablets.
Auckland DHB nurse director for mental health Tracy Silva Garay says people with precarious living arrangements will often present to doctors at their most ill because their mental health isn't a priority.
"For people who are vulnerable, it's often really difficult to access services - there's a lot of other things they have to deal with, so they leave the mental health to the end."
Maia says those visiting the Mission can be volatile, and methamphetamine is a factor.
"You have to be a special kind of person with a big big heart to work here - I couldn't work here."
But the Calder Centre staff know it's somewhere they can make a difference, and that their patients have nowhere else to go.
*Maia is not her real name.
Newshub.
