Victim of assault and truck crash struggles to get help for mental health

• Family blames head injuries for triggering mental illness in man
• ACC says his ongoing difficulties due to mental problems, not injuries
• Health NZ says it continues to offer support for his health needs
• Advocates say people with traumatic brain injury struggle to navigate system

The father of a man assaulted with a steel bar as a teenager and then hit by a truck has been battling ACC for 10 years for recognition those traumatic brain injuries triggered his debilitating mental illness.

ACC said it sympathised with the man's difficult position, but there was no evidence his mental health issues were caused by physical injuries.

Kade Steffensen vividly remembers the assault in November 2014, which changed his life.

He had just turned 18.

"I seen him coming and put my arm up and he broke my arm and cracked my head a bit on that side, the left.

"He went for me again he broke my right hand and got me in the head again, and I ran off.

"From that moment, I've been dealing with lots of bipolar symptoms."

His dad, Wayne Steffensen, took him to Thames Hospital the next day where X-rays showed his left forearm and right hand were broken.

Medical notes described swelling and bruising to his face and bloodshot eyes.

The Steffensens insist there were no scans of Kade's head at the time, and there was no follow up of potential concussion.

However, according to radiology reports in the ACC case file, a facial X-ray identified a faint line that could be a fracture, but a CT scan found nothing of concern.

A discharge summary said the patient had been advised not to drive, but his X-rays had been put on CD in case his GP needed to organise follow up in Wellington.

"So Kade went to Wellington the next day - drove with two broken arms - and did everything you're not meant to do with a head injury or concussion: partying, driving," Wayne said.

Kade's behaviour became increasingly erratic.

"Kade was crashing his own car, the one he had done up, crashing it just to crash it. It got really scary."

The outgoing teenager, who loved going to the gym and fixing up cars, stopped seeing his friends, started talking and crying to himself, blanking out for long periods then lashing out violently.

Kade had little insight into his own state of mind, but he knew something was wrong.

"Mood swings, not knowing what I'm doing sometimes, not knowing who I am - that started when I got poled.

"My family noticed because I started destroying the house, picking fights with them and that. I'm not like that."

In June, he was admitted to Hutt Hospital's in-patient psychiatric unit under the Mental Health Act.

Wayne said the focus was on treating his psychotic symptoms - staff did not know about his head injury.

The day after Kade's discharge - a year since the assault - he was hit by a truck on the Desert Rd.

There were multiple calls to 111 in the 10 minutes before the crash describing a man of Kade's description walking down the centre of the northbound lane.

"Ripped off the door handle with my face, my eye was down here," said Kade, indicating his left cheek, "shattered my elbow and my ankle."

Wayne said his son had five plates put into his skull.

"The surgeon said he couldn't get everything back together properly because he was trying to put broken eggs back together on top of broken egg shells.

"That's how we knew there was a previous fracture."

Health NZ MidCentral told RNZ the CT scan at Palmerston North Hospital on 10 November, 2015 showed no evidence of previous trauma.

Following the crash, Kade received an $11,000 lump sum payment from ACC.

However, in the decade since, Wayne said he had struggled to get wrap-around support for his son, who had been in and out of mental health facilities and emergency accommodation all over the country.

When RNZ visited the Steffensens, they were camping in a house in Palmerston North, which had been gutted for renovation, having just been turned down by another community housing provider because Kade's needs were too complex.

They have since gone to Auckland, where they were staying with Wayne's cousin on a temporary basis.

In 2017, Kade was diagnosed with paranoid schizophrenia, complicated by frontal lobe injuries and substance abuse.

His patient records chronicle the back and forth between ACC and the health system over which had responsibility for Kade - with clinicians divided over how much his problems were to do with the mental illness and how much to do with brain injuries.

A neuropsychiatrist and a neurologist (who assessed Kade for ACC) found no evidence there had been a traumatic brain injury. But they agreed if there had been, it was "resolved" and Kade's ongoing symptoms were caused by pre-existing, unrelated mental illness.

However, a psychiatrist specialising in brain injury, a clinical psychologist and a prison psychiatrist argued there was evidence Kade continued to be affected by his head injuries when his mental illness was controlled by medication.

In 2021, an occupational therapist noted Kade was stuck in the psychiatric ward because he needed supported accommodation.

"He seems to be falling between the cracks between the DHB and ACC."

After robbing a liquor store at knife-point, Kade ended up in prison for two years, two months.

When he came out in October 2024, Wayne lodged another application with ACC for a mental injury claim, and Kade had an assessment by a neuropsychiatrist in April.

But once again ACC declined cover.

The specialist said there was no clear evidence Kade suffered mental illness before the assault in 2014, but it was not possible to say his mental illness was caused by a brain injury.

He noted a 2019 MRI brain scan showed no structural damage to the brain.

"It is impossible that the anatomical insult/injury would be so subtle as to not show up on MRI or to have any other aspect of neurological function affected, but to be so severe as to cause Mr Steffensen's profound disability through his schizophrenia."

The specialist acknowledged Kade needed help from somewhere.

"Mr Steffensen's suffering and disability are very real and deserve focused and evidence-based treatment. He would also clearly benefit from a structured environment."

The association between head injuries and the onset of mental health problems was well-established.

One study involving 100,000 people found a severe head injury or one occurring between the ages of 11 and 15, increased the risk for subsequent schizophrenia by 65 percent, the risk of depression by 59 percent, the risk of bipolar disorder by 28 percent, and the risk of organic mental disorders by more than 400 percent.

ACC records released to the Steffensens this year revealed Kade also suffered a minor head injury as a 10-year-old, when he had to be taken to hospital after a collision in the playground.

In a written response to RNZ, ACC's head of service operations, Phil Riley, said he sympathised with Kade's difficult position, but his need for housing support was "primarily due to his diagnosis of schizophrenia and ACC can only provide support for injury-related needs".

"The medical evidence, including assessments by a psychiatrist, did not support that Kade's schizophrenia was caused by his physical injuries, and we declined funding."

The family had asked for the recent decision to be independently reviewed, he noted.

"In the meantime, although we have not covered the schizophrenia, Kade continues to have cover for other injuries and can get in touch with us anytime if he needs support for those injuries."

A Health NZ spokesperson said relevant clinicians across all districts had "appropriate awareness of Kade's needs in relation to his health and are working to ensure these needs are met".

"Health New Zealand recognises that Kade has experienced a life-changing trauma and is in a vulnerable position. It is appreciated that it can be difficult to navigate the support available for people in his situation, especially when there are several government agencies involved."

If the person also had disability needs not covered by ACC, the Ministry of Social Development could provide additional assistance, he said.

Auckland-based advocate Stacey Mowbray from Headway said ACC offered "amazing rehabilitation and support" where cause and effect were easily identified, but complex cases like Kade could fall between the cracks.

"The fact is we have these disconnected systems - ACC, Health NZ and MSD [Ministry of Social Development]. For someone with a brain injury, trying to navigate between the three of them is extremely challenging."

Wayne said they had yet to recover.

"We're still trying to get somewhere, be somewhere and put ourselves back together.

"I actually want somewhere for Kade to live, to call home and not actually have to move anymore. Just be."

The Steffensens asked for an independent review of ACC's decision, which would be heard later this month.

No criminal prosecution

No-one was ever prosecuted over the assault on Kade, despite multiple attempts by his father to get police to reopen their investigation.

In a written response to RNZ, Detective Inspector Graham Pitkethley from Waikato District said a detective senior sergeant reviewed the 2014 case at the family's request in 2021.

"The two individuals were initially charged with assault; however, those charges were withdrawn following not guilty pleas.

"Police are unable to comment on the reasons for the withdrawal or the absence of further charges, as the case file has since been destroyed in accordance with the Public Records Act 2005 and its prescribed retention timeframes."

The review in 2021 concluded (and acknowledged to Kade's family) the matter should have been referred to an investigation team to assess whether the man who hit Kade was making a "necessary and proportionate" response to Kade's own actions.

"This aspect was discussed during the 2021 conversation with the family member. However, it was communicated that new charges could not be considered several years after the incident.

"Police also note that the medical discharge notes provided at the time did not document a skull fracture or injury to the skull."

Where to get help:

• Need to Talk? Free call or text 1737 any time to speak to a trained counsellor, for any reason
• Lifeline: 0800 543 354 or text HELP to 4357
• Suicide Crisis Helpline: 0508 828 865 / 0508 TAUTOKO. This is a service for people who may be thinking about suicide, or those who are concerned about family or friends
• Depression Helpline: 0800 111 757 or text 4202
• Samaritans: 0800 726 666
• Youthline: 0800 376 633 or text 234 or email talk@youthline.co.nz
• What's Up: 0800 WHATSUP / 0800 9428 787. This is free counselling for 5 to 19-year-olds
• Asian Family Services: 0800 862 342 or text 832. Languages spoken: Mandarin, Cantonese, Korean, Vietnamese, Thai, Japanese, Hindi, and English.
• Rural Support Trust Helpline: 0800 787 254
• Healthline: 0800 611 116
• Rainbow Youth: (09) 376 4155
• OUTLine: 0800 688 5463
• Aoake te Rā bereaved by suicide service: or call 0800 000 053

If it is an emergency and you feel like you or someone else is at risk, call 111.

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