Content warning: This story discusses abuse and suicide.
A teenager who has spent his entire life in the care of the state says the government is failing to address the mental health of young vulnerable people.
A report from the Mental Health and Wellbeing Commission found that one in four young people in need of mental health care were being admitted to adult services due to a lack of age-appropriate units around the country.
Read the full report: Te Huringa Tuarua Youth Services Focus Report (6MB)
Ihorangi Reweti-Peters, 17, has lived in care since he was only a few months old.
His memories of foster care were a 'living nightmare', the Christchurch teenager said.
"I had a rough time in care. I was faced with racism, discrimination, physical, emotional and on one count sexual abuse.
"Those experiences in family homes, in foster homes were awful and no young person should have faced what I have."
Reweti-Peters spoke last year in the Abuse in Care Royal Commission of Inquiry about his experience.
He said his mental health suffered.
"During that time, I had very bad anxiety and I was struggling with building relationships and trusting people.
"My mental health was quite poor, and I wasn't provided with any mental health and or counselling support," he said.
And without support, reality became too much, he said.
"In 2020 I attempted to take my own life, and following on from there I attempted to take my life more times."
Reweti-Peters was one of many tamariki struggling to find adequate mental health support according to a recent report from the Mental Health and Wellbeing Commission.
The report showed despite specifications for age-appropriate mental health care for children and teenagers at DHBs, only three units in the country offered the service - Auckland, Wellington and Christchurch.
The 2018 government Inquiry into Mental Health and Addiction heard concerns about the practice of admitting young people to adult services.
Mental Health and Wellbeing Commission chief executive Karen Osborn said sending children to adult inpatient units could be harmful.
"These [adult inpatient units] really aren't appropriate for young people," Osborn said.
"They're not age appropriate and what people have told us is that it exposes young people to what can be quite distressing behaviour and people may be harmed as a result of being admitted into those services and having those experiences in it.
"So, it impacts them quite deeply."
The latest Youth19 Rangatahi Smart Survey heard from more than 7000 young people from all walks of life about their emotional and mental health.
Read the full report: Rangatahi Smart Survey Initial Findings - Hauora Hinengaro/ Emotional and Mental Health (2MB)
Of those surveyed, 23 percent had significant depressive symptoms, 6 percent had attempted suicide, and 19 percent said they struggled to get help when they needed it.
Child psychiatrist and paediatrician Dr Hiran Thabrew said although there was no data in relation to the potential harm in treating a young person in an adult service, the consequences could be damaging.
"It is concerning to us that there's still one in four young people admitted to adult services," Thabrew said.
"In an adult ward, they'll be exposed to people of many different ages, with potentially more severe mental health problems, and there are concerns about the effects of that environment on them [young people] when they're already in the vulnerable state, including becoming secondarily traumatised or more distressed than they were when they were admitted to the ward."
For Reweti-Peters the mental health system for young people needed to be re-designed.
"I felt that the system in general has failed me, but most importantly has failed my brother and sisters.
He said young people needed a system where having a heart for young people was central to the organisation.
"I wish that I wasn't faced with abuse, but also wished state provided me adequate and appropriate mental health and all counselling support.
"I wish down the years to come, that every young person in care is provided with the appropriate and adequate mental health and counselling support."
"We will continue to work hard" - Te Whatu Ora
Through a statement, Te Whatu Ora's national leader for mental health as well as hospital and specialist services Karla Bergquist said apart from the three specialist acute inpatient units there were also specialist community child and adolescent mental health services delivered locally in each of the regions around the country.
"Inpatient care occurs in only a small percentage of situations where community care is not possible. The three inpatient units provide this level of care to the local services across their regions," Bergquist said.
Decisions to admit rangatahi to hospital-level care were not made lightly and not before all other options were explored with whānau, she said.
"If admission to a bed in one of the three specialist rangatahi units was not possible, admission to an adult unit may be considered.
"There are times when it may be better and safer for a young person in crisis to be cared for in an adult inpatient unit, which might mean faster treatment and for them to be treated closer to their home and whānau."
She said there could be many reasons why young people were admitted to adult wards.
"Whānau may want them close to home, they need short 48-hour respite admission, or, as is the case with some young people, they are too unwell to travel and need urgent local treatment."
Bergquist said when a young person was admitted to an adult unit, all possible measures were taken to ensure their safety.
"This might include housing them in a separate part of the ward, ensuring additional staff were with them at all times and enabling whānau to stay with them or nearby.
"We will continue to work hard to increase the capacity of specialist mental health and addiction services to help young people with more acute needs."
"There's work for us to do there" - Oranga Tamariki
Oranga Tamariki chief social worker Peter Whitcombe said the agency was working to improve its connection with young people.
"There is enormous opportunity at the moment with the agreement of the Oranga Tamariki Action Plan - which is a multi-agency plan that says 'hey collectively across all of the agencies that work with children and families, we have to do things that prioritise and support this group of young people and make it easy for them to get the things that they need'," Whitcombe said.
Whitcombe said Oranga Tamariki had a range of services and support internally to help social workers to straighten their relationship with young people.
"[That's] to make sure that their [young people] safety and well-being needs are met, but also to help access the right kind of specialist support that they might need to, through child and adolescent mental health services."
He said the role of the social worker could often be of a bridge connecting young people to the help they need.
"We know that there is always more that we need to do and in terms of how our social workers are supported to be able to recognise and respond in the right way.
"There's work for us to do there, but what I would say is that we do have specialist support services there for social workers to tap into."
