Action required, not more words

Jessica McAllen sat in on public meetings of the Mental Health and Addiction Inquiry. She gives her take on this week’s report of the inquiry.

At the Dunedin meeting of the mental health and addiction inquiry, a man told the panel: ‘‘You can’t be mentally healthy if you’re dead.’’

Sure, he was objecting to the pre-meeting stop, drop and hold earthquake advice, but his words applied to the official inquiry report, which was published on Tuesday.

The report, which mentioned the word ‘‘wellbeing’’ 200 times before I gave up counting (it had started to blur into ‘‘warbling’’), laid out New Zealand’s bold new future to help people in distress. It had a strong focus on prevention in its 40 recommendations.

Hopefully, the Government doesn’t cherry pick the easy solutions at the expense of the sometimes messy truth of longterm mental health and addiction.

The background

During the 2017 election campaign, many health professionals were concerned about the prospect of another mental health inquiry if Labour won. But their voices were drowned out by vocal campaigners – some of whom have gone very quiet this year – and labelled as bureaucratic stiffs. Even one of the panel members, former mental health

commissioner Barbara Disley, was sceptical. Earlier this year she told me she changed her mind because the panel was tasked with a short timeframe.

In 2017, Mental Health Commissioner Kevin Allen appeared before a select committee stating an ‘‘urgent need for action’’ rather than another costly review. We already know the solutions, he said.

In a letter backing up his submission, he said: ‘‘Funded treatment and care options for the approximately 17 per cent of people with mental health needs who do not qualify for specialist services are limited.’’

He should be heartened to see the panel recommended specialist services – which cater for 3.6 per cent of the population – be expanded to cater for 20 per cent. Although, maybe he will be annoyed that this is something people already knew needed to be changed. We could have spent the intervening year figuring out a plan to increase the workforce to deal with such a change.

An inquiry is an easy promise because it stalls time – it will be 17 months since Labour came into power by the time the Government formally responds in March.

While we waited for the results of the inquiry, it would have been useful to increase funding to Mental Health and Addiction Services, but the Government opted to wait until the inquiry was released. It would have been useful to test out pilot programmes.

The irony that the report recommended a police and mental health worker response to emergency callouts (instead of solely police, a process that can be traumatising) won’t be lost on those who were dismayed to see a proposed pilot cut this year.

Many organisations also held back on planning, waiting to see what direction the inquiry was going to follow. In the meantime, our suicide rate jumped to its highest since 1999.

Labour inherited a broken mental health system, so perhaps it’s unfair to be too critical. But National inherited one too. Then Labour before that. This has long been an under-resourced and ignored area until a particular tragedy ignites public outrage.

There are many people to take into account when discussing mental health. The 3.6 per cent who use specialist mental health services and often have a longterm mental health issue; those whom the inquiry calls ‘‘the missing middle’’ who don’t qualify for mental health and addiction services, but can’t be adequately helped by the free 6-8 sessions that primary health organisations offer.

There are people who won’t have a mental illness but, due to a life circumstance – bereavement, job loss, and other stresses – find themselves in significant distress.

Health Minister David Clark will be feeling immense pressure right now. But this can’t be a surprise. Labour campaigned on mental health, particularly youth suicide. Former health minister Jonathan Coleman was called ‘‘the doctor of death’’ by Labour’s Kelvin Davis.

There was even the odd linking of immigration to youth suicide on the Labour Party Facebook page. Jacinda Ardern made headlines when attending the PSA’s ‘‘Yes we care’’ campaign, which toured the country to raise awareness of suicide. She said she wanted to bring the suicide number down to zero: ‘‘Because anything else suggests we have a tolerance for loss to suicide in New Zealand.’’ The report recommended a 20 per cent reduction by 2030.

I’m not defending National here. It’s a testament to how much it pretended suicide wasn’t an issue that there is such a level of excitement about Labour simply having an inquiry. But you can’t campaign on mental health and suicide, raise people’s hopes – people who are often ignored – and not bring in truly meaningful change.

For many, the incessant politicking and moral panic about teenage suicide was not helpful. Multiple stories a day, multiple social media posts – these can become overwhelming when you are already depressed, especially if you see people with similar life stories. For others,

the increase in coverage was a relief – they felt seen, heard, after years of screaming into a void. This was reflected at the public inquiry meetings – for some, it was the first time they had told their story. Some of the attention on suicide last year excluded significant groups – the inquiry report notes that the greatest loss through suicide is among people older than 24, particularly men aged 25-44. Our suicide rate – although too high – had remained stable since 2012, yet due to the confusing data, people were reporting it as the highest in history.

‘Big psychiatry’

The inquiry report has a very strong anti-medication sentiment. This came up a lot in public meetings and, as someone who takes psychiatric medicine, I must admit it made it hard for me to keep to my regime.

Yes, GPs often prescribe medication too quickly, and people are on it far longer than necessary. The issue of forcing someone to have psychiatric medication when they don’t want it is also significant. But for some, it works.

People spoke to me in private interviews about this because they felt embarrassed that they took pills. It’s not that they enjoyed the side-effects – from weight gain, hand tremors to even more depression – but they weighed up those risks.

The term ‘‘big psychiatry’’ comes from former mental health commissioner Mary O’Hagan’s Wellbeing Manifesto submission, which seems to be a big influence on the whole report. O’Hagan, who has written a book about her experience with the mental health system, is a respected advocate for people with mental illness – known as ‘‘consumers’’.

Remember that term. The consumer movement is likely to have a big role in the implantation of these recommendations. Codesign is mentioned a lot, which is the process of working with people at every stage of a new service – although the Ministry of Health’s premature transformation working group for the inquiry seems to indicate people with lived experience were more of an afterthought.

Many organisations say they embrace co-design, but really have already made up their minds and simply consult people with mental illness at the end of the process – true co-design is having a voice at the table every step of the way.

The problem with some of the consumer advocacy groups is that they are out of touch with current services. They can afford private mental health help, or the organisations they work for pay for counselling. The people who come from asylum backgrounds can be strongly against medication and diagnostic labels – this influence is again seen on the report.

Being diagnosed with a mental illness can reduce you to symptoms and create self-stigma, but other people at the inquiries, particularly those with complex illnesses such as bipolar disorder (BPD) and obsessive compulsive disorder (OCD), spoke to me about their relief in knowing other people go through the same. That they aren’t crazy.

Jack Taylor, from part one of the inquiry, said: ‘‘Because I’m a very logical thinker, it’s good to be able to put labels on it. I know for other people it doesn’t help, but I like those labels because I can go online and look up other people’s experiences.’’

A sense of immediacy?

Many of the solutions are going to take years and require new laws. Repealing the Mental Health Act is quite a risk, especially if Labour doesn’t get a second term. There is a strong move from some for more coercive care. People will be angry if there is no longer a way to detain patients under the Mental Health Act when they are refusing treatment. Repealing such a law is likely to turn into an ugly public discussion and has the possibility to flip into more coercive care.

The report is vague in parts. The suicide prevention section is particularly weak. The main recommendation is to finish the Suicide Prevention Strategy. This was put on hold last year after the draft went out for public review, when Mike King quit the advisory group, calling it a ‘‘masterclass in butt-covering’’.

The report also urges increased funding, but doesn’t suggest a number (unlike previous reports). This gives the Government room to avoid being held accountable. It will increase funding, but how will people know it is enough to make significant change?

The panel

The panel had an incredibly short timeframe. Following the inquiry around to 15 meetings was exhausting for me – I can’t imagine what it was like having 26 public meetings and 400 private ones. Let alone being the face of supposed change. The panel were there to bear witness, but many cried and yelled and begged for help and direction.

Cynically, I can see the Government increasing mental health funding, but not by nearly enough, and adding a bunch of prevention and promotion campaigns. Perhaps the repeal of the Mental Health Act would become an election issue in 2020.

But people have done enough waiting – in emergency departments, for rehab clinics, for specialist services or to get a coroner’s findings of their loved one’s death.

At the public meeting in Hamilton, Kauma¯ tua Ron (not to be confused with panel chair Ron Paterson) closed the night.

‘‘The panel has been tasked with change. Anything else is putting a plaster on the system already there.’’