Government-appointed reviewers "don't want to" to visit mental health services stranded at Christchurch's derelict Princess Margaret Hospital because they "sound awful".

Some of the South Island's most vulnerable people are being treated at derelict Princess Margaret Hospital (PMH), but it's too "awful" for government-appointed reviewers to visit.

Urgent plans to move the remaining mental health services from PMH have been in bureaucratic limbo for more than two years, despite staff and patients describing the facilities as "disgusting" and "appallingly depressing". The rest of the services shifted out last year.

About 31 patients from the youth mental health, mothers and babies, eating disorders and long-term rehabilitation units were stuck at the facility, which the Canterbury District Health Board (CDHB) described as "substandard" and "not appropriate".​

IAIN MCGREGOR/STUFF The youth mental health ward is in a state of disrepair at the derelict Princess Margaret Hospital (PMH) in Christchurch.

The reviewers tasked with assessing the services before they could move met with CDHB officials in June, but declined to visit the premises because they "sound awful, we don't want to go there".

READ MORE:

* 'Urgent' plans to move facilities stranded at derelict Princess Margaret Hospital delayed

* Mental health services stranded at PMH

* Disgust at mental health care conditions at Christchurch's PMH

* Burnt-out mental health staff raise 'horrifying' concerns about conditions at Christchurch's Hillmorton Hospital

* Christchurch's specialist mental health services 'on a knife edge'

They also said the mothers and babies and eating disorder services needed downsizing.

IAIN MCGREGOR/STUFF A toilet window near the main reception area at PMH, where mental health services are stranded.

The services, which treated life-threatening eating disorders and mothers suffering severe post-natal depression with their babies, were in high demand with a total of 13 beds to service the whole South Island.

The reviewers' report, which was released on Tuesday, supported all services left at PMH moving to Hillmorton Hospital, but asked the CDHB to first complete another review to justify the extent of its mental health services, delaying the move further.

After the June meeting, CDHB mental health general manager Toni Gutschlag​ wrote to the Ministry of Health (MOH) to "formally raise concerns" and asked for confirmation the reviewers were practising health professionals. The MOH has said they were a senior psychiatrist and a mental health manager from the North Island.

IAIN MCGREGOR/STUFF Patients' families have described rooms in the adult rehabilitation ward as "appallingly depressing".

Clinical leaders who attended the review left the meeting "despondent and somewhat distressed", Gutschlag wrote.

"Now it seems we need to embark on a new planning process."

The CDHB spent an extra $2.5 million each year to mitigate risks with minimal medical and nursing back-up on-site since the rest of PMH's services moved out to Burwood in June 2016.

IAIN MCGREGOR/STUFF Walls are shored up with big planks in a communal room in the adult rehabilitation ward.

Some PMH walls were shored up with big planks and covered in visible cracks.

Critical structural weaknesses were identified in PMH buildings after the February 2011 earthquake and engineers recommended making seismic upgrades. Officials decided to keep services at the facility only until they could be moved.

MOH director of critical projects Michael Hundleby​ said the reviewers' report agreed relocation of the services from their "currently highly unsatisfactory facilities" was necessary.

IAIN MCGREGOR/STUFF The hospital cafe closed after older persons services moved out of PMH last year.

The reviewers said another review of the models of care for most of the services was needed.

"There needs to be robust examination of the different ways these services could be configured for the South Island into the future before we make a 50-year investment," Hundleby said.

"For example, it may be that a young person in Dunedin with an eating disorder might not have to travel to Christchurch for specialised care if their local DHB could be supported to deliver that care closer to home."

IAIN MCGREGOR/STUFF A mental health patient smokes outside a communal area in the adult rehabilitation ward at PMH.

Gutschlag said mental health services based at PMH were "very small" and any bed reductions would have "a significant impact in terms of access by the people of the South Island, cost of the service and potentially the viability of maintaining a core of specialist expertise".

The CDHB submitted a business case in late 2016, but the Government rejected it as it lacked key information, including the source of funding, and requested a clinical review of the services.

Correspondence between the CDHB and the MOH showed the CDHB would have to come up with at least $30m to relocate the services as no Crown funding would be available.

IAIN MCGREGOR/STUFF Staff walk through the corridor in the youth wing.

New Zealand Nurses Organisation Canterbury mental health organiser John Miller said the reviewers' refusal to visit the services was "morally bankrupt".

"If the people charged to review the services won't go there for a couple of hours because it sounds 'awful' then how do they expect people to work in it, live in it and visit relatives in it?"

Moving the services out of the derelict facility was "clearly urgent".

IAIN MCGREGOR/STUFF An empty room in the abandoned part of PMH.

"Word fail me in how appalling the process is."

Miller said any reduction in bed numbers in already stretched services would be "concerning".

TIMELINE

1970s: Mothers and babies and eating disorder services move into Princess Margaret Hospital. Facilities were refurbished at the time, not purpose build, and were considered to be temporary.

1994: Child services move in.

2001: Youth services and adult rehabilitation services move in.

2010: Canterbury District Health Board presents a business case to move all PMH services to various other locations.

2011: After the earthquakes, the Ministry of Health commissioned PwC to write a new business case for the services' move.

End of 2012: PwC submits business case to Cabinet for approval – the CDHB says it did not have a chance to see it before submission and that it left mental health services out.

2013 to 2015: CDHB repeatedly raises concerns with senior MOH staff about the clinical and facility safety risks of operating from the derelict PMH.

September 2015: CDHB and MOH meet and agree to "progress with speed" with a single-stage business case and a transition plan for additional funding to be considered.

November 2015: CDHB provides a strategic stage assessment (SSA) of the services and is advised that a two-stage business case is actually required.



December 2015: CDHB advises the MOH it will not need Crown funds for future developments.

March 2016: CDHB provides a draft business case, but the Government refuses to consider it because it does not identify the funding source and asks for a clinical review. MoH tells CDHB there will be no Crown funding for the services.

June 2016: Bulk of PMH services move to Burwood, leaving mental health services stranded there without appropriate medical back-up.

November 2016: CDHB submits a new business case, but it is still missing key information including source of funding.





June 2017: Clinical reviewers meet with CDHB officials and say the bed numbers in the mothers and babies and eating disorders services are "too high".



July 2017: Report from clinical reviewers agrees the services need to move out, but asks for another review of the services before the business case can be "refreshed" and presented to government for approval.