What mental health needs
Last week the much anticipated Mental Health and Addiction Inquiry was published. I work as a GP in a large organisation, providing healthcare and support for predominantly young people. Alongside this role, I also participate in planning conversations with groups of health providers and funders, looking at service gaps and, hopefully, improvements that can be made, at a regional level.
The biggest focus of both these areas of work for me is mental health – in fact, I suspect I spend about half my time dealing with people either directly or indirectly affected by this.
I’m not alone – a straw poll of my fellow doctors and nurses would indicate the same. Much of our working week is spent supporting people who either have a mental illness, or are suffering from high enough levels of distress that they have decided to speak about it.
We know how massive a problem this is – one in five of us will experience a mental health issue every year, and that figure is higher if you are Ma¯ ori, Pasifika or disadvantaged in some way.
At least 50 per cent of us (and perhaps as high as 80 per cent) will suffer mental health issues at some point in our lives. Suicide rates in New Zealand are among the highest in the world, with thousands of us touched by this tragic event every year.
As our population has grown and mental health issues appear to have become more prevalent, the ‘‘specialist’’ services have struggled to cope. Underresourced in staffing and finances, they have had to close, or partially close, their doors, restricting access to those at the very severe end of the scale.
These days, I often don’t send a referral letter to the local mental health team unless someone is incredibly sick, as I know from experience they will likely be told they don’t meet the threshold to qualify for assessment.
Although I understand that this represents under-resourcing and that my colleagues in the secondary care services are working just as hard as I am, this situation does leave primary care holding a vast number of often very distressed people, without the back-up or necessarily skills to deal with them effectively.
I struggle with this – not because I don’t think primary care should be a place where distressed people should come for support, but because there are inadequate services in place to enable us to actually help people and prevent their distress getting worse. Our ability to make a difference is limited.
We know that many factors other than health are big contributors to distress and mental illness.
People who have experienced adverse childhood events, such as abuse, neglect, trauma, loss, or substance misuse in a parent, are at much higher risk of suicide.
There is a clear and irrefutable link between poverty and mental health – without warm, affordable, safe housing, jobs, secure income or access to good education, it is hardly surprising that levels of distress are highest in these groups.
Add to this the sense of cultural alienation and marginalisation often experienced by Ma¯ ori, Pasifika, the LGBTQI+ community and others, and it is clear that actually, often your ‘‘genetic predisposition’’ to mental illness may have only a very small part to play.
So how could we do things differently? Firstly, I would love to see an approach that focuses on prevention, early identification and intervention.
If we accept the links between adverse childhood events, social issues and mental illness, then let’s find out where the most vulnerable people are early in their lives, and wrap support and resources around them.
This will need not just the health services, but education, the Ministry of Social Development, Oranga Tamariki and others to work together to identify our riskiest young people and their families.
Secondly, we need to acknowledge that there will never be a ‘‘one size fits all’’ solution. In many areas, there are few if any services or supports that cater for Ma¯ ori, Pasifika, young people or others.
Expecting groups with quite specific needs to engage with traditional health models won’t always work.
Developing services tailored to those groups, and using their people to help in the design, model and delivery of the service, will ensure far greater uptake and more effective outcomes.
Alongside this, I’d love to see easier, timely access to good-quality, funded support for those who are experiencing low or moderate levels of distress.
As a GP, I don’t always have the skills to talk people through some of the issues they experience, and nor is it probably the most efficient use of my time or training.
I would love to see us conversing as a whole nation about this. Mental wellness should be the norm.
However if there was a range of referral options available to me – including talking therapies, ‘‘navigators’’ to engage people with existing NGOs and social agencies, facilitated groups focusing on building strengths and resilience, parenting classes, and culturally-specific supports – my role would be so much easier, and I suspect the outcomes for patients would be much improved.
GPs could focus less on whether or not someone was unwell enough to require antidepressants or a referral to the mental health service, and more on intervening when needed, with effective support.
I know that in many areas some of these supports are already in place, but without adequate funding and sustainable resourcing, the dedicated staff working in them quickly become overwhelmed by demand.
Last, but by no means least, I would love to see us conversing as a whole nation about this. Mental wellness should be the norm. We should all be able to live a life that is happy and fulfilling, with connections, purpose, a sense of security, hope and love. Let’s aspire to that.
Last week’s inquiry is a big step in the right direction, we just need to keep the conversation going.