The "serious harm" caused by a lack of aged psychiatric care in the region was detailed in a letter by aged care commissioner Carolyn Cooper calling for "urgent attention" by Te Whatu Ora Health New Zealand (HNZ) .
She had been contacted by a clinician raising concerns, who provided examples, including physical assault and possible sexual assault, the letter said.
The letter sent in September, along with a response from HNZ chief executive Margie Apa last month, was provided to the Otago Daily Times yesterday.
Ms Apa said she was also concerned, and HNZ was working hard to try to resolve the complex issue.
The commissioner said a clinician had provided case studies where serious harm had occurred due to lack of appropriate care options.
"This includes physical assault, possible sexual assault of a resident in a care home and police involvement to de-escalate threatening and dangerous behaviours.
"The clinician has also detailed how the lack of access to appropriate care and facilities for people with dementia has resulted in the increased use of sedative medication to manage their behaviour in the community or inappropriate care settings."
The lack of inpatient and aged residential care (ARC) beds for those needing psychiatric care was specified as as a concern, along with access to psychogeriatricians.
The commissioner was also concerned that, to the best of her knowledge, no private provider was including psychogeriatric level care when building new facilities, despite the ageing population.
People with dementia were among the most vulnerable in the health and disability system, and often not in a position to advocate for themselves, she said.
"I am extremely concerned about the patient harm that is being caused to this particularly vulnerable group of consumers by the lack of access to appropriate care options.
"While I accept this situation pre-dates the health reforms, in my view this issue now requires urgent attention."
She requested HNZ provide information including an assessment of the clinician’s concerns, and details of action being taken to reduce the impact of lack of care options in Southland.
Ms Apa said a region-wide workshop about the issues of psychogeriatric care was held in September.
An action plan with time goals was being worked on and would be shared when finalised.
However the process was hindered by "significant workforce shortages with psychogeriatric and other health professional groups" and lack of space.
"From our analysis of the patient journeys, we note clear areas for improvement in relation to inpatient assessment, crisis intervention capacity, and better pathways to inpatient psychiatric beds for both dementia and functional psychiatric disorders in Southland."
HNZ and the Ministry of Health were investigating a specific complaint raised by relatives of a psychogeriatric resident, she said.
Psychogeriatric ARC beds were not controlled by HNZ, but the organisation was exploring ways to support providers in supplying them.
Data indicated Southland had a slightly higher ratio of such beds than the national average, at 1.15 per 1000 people aged over 65, compared with 1.1.
The national aged care funding model review was under way and the expected outcome was an aged care sector that was fit-for-purpose for the future.
The clinician, who spoke to the ODT yesterday but wished to remain anonymous, said he was the only psychogeritrian servicing Southland.
He did not live in the region, but travelled there for three days every two weeks.
It was an "absolutely tragic" situation, with some people being sent hours away from their homes and family for care.
"The people that we’re sending away are you and me...it can happen to anyone."
The sector was struggling nationwide, and aged care psychiatrists were all concerned about the lack of traction from HNZ, he said.
Demand was set to boom in coming years, yet the organisation’s response showed a lack of urgency.
However the local response — including the establishment of a working group — had been quite positive and he hoped it could create change.
