Men­tal health re­port big wake-up call

Rotorua Daily Post - - Business -

The New Zealand men­tal health sys­tem is bro­ken. We didn’t need an in­quiry to tell us that — but without an in­quiry, we would likely never have heard the ex­cru­ci­at­ing de­tails of just how badly the sys­tem is fail­ing.

The He Ara Oranga Re­port was re­leased this week; the re­sult of many months of in­ves­ti­ga­tions, con­sul­ta­tions, hui and sub­mis­sions from the pub­lic and the sec­tor. It’s 219 pages of painful, graphic and (thank­fully) ul­ti­mately con­struc­tive read­ing.

What emerged most clearly to me as I read the re­port was a pic­ture of a coun­try that is only do­ing the bare min­i­mum to ad­dress its cit­i­zens’ men­tal health needs. Sure, the sys­tem will (some­times, but not al­ways) even­tu­ally kick in when things be­come bad enough to meet a cer­tain thresh­old, or if a pa­tient has been di­ag­nosed with a se­ri­ous, life­long men­tal dis­or­der, but for ev­ery­one else — the vast ma­jor­ity of peo­ple seek­ing men­tal health as­sis­tance — get­ting help re­lies on a lucky roll of the dice.

The way the cur­rent sys­tem op­er­ates re­quires it to fo­cus on pro­vid­ing spe­cial­ist ser­vices for ap­prox­i­mately 3 per cent of the pop­u­la­tion, while one in five will ex­pe­ri­ence men­tal ill­ness in any given year. Ma­jor gaps oc­cur for those whose men­tal health strug­gles are not deemed to be “se­vere”. Mild to mod­er­ate and mod­er­ate to se­vere men­tal dis­tress is largely ig­nored by the sys­tem.

It’s dif­fi­cult to read the re­port as any­thing other than damn­ing. The sto­ries that are con­tained within its pages are har­row­ing. One woman’s story of the cir­cum­stances sur­round­ing her son’s death made me gasp as I read it.

“I stated that [my son] was not safe overnight and that I had real con­cerns un­less some­one in­ter­vened. The hospi­tal called the Cri­sis team . . . they were busy and un­avail­able to come . . . the doc­tor told us . . . that [my son] should be given a zopi­clone sleep­ing pill by the hospi­tal and that we should drive him over to [town] first thing in the morn­ing . . .

“My daugh­ter and I took this ad­vice as hav­ing full weight and med­i­cal au­thor­ity. So we ac­cepted. I wish more than any­thing that we had re­fused . . . While we were all still asleep, in the early hours of the morn­ing, [my son] went to the garage and hung him­self. So now we have no op­tions . . . This was a pre­ventable death.”

There have been far too many pre­ventable deaths.

What was frus­trat­ing for me was that many of the con­cepts that were dis­cussed in the in­quiry’s re­port have been taught at un­der­grad­u­ate level in New Zealand uni­ver­si­ties for some time.

I know this be­cause I was taught — seven years ago as part of my psy­chol­ogy de­gree — about the flaws of the bio­med­i­cal model and the ben­e­fits of a biopsy­choso­cial ap­proach (a par­a­digm that en­com­passes med­i­cal, psy­cho­log­i­cal and so­cial con­texts) or, even bet­ter, the Whare Tapa Wha¯ model (which em­pha­sises that true health re­quires phys­i­cal, men­tal, spir­i­tual and fam­ily well-be­ing to be balanced and con­nected to the foun­da­tion of the land and the nat­u­ral world). See­ing the dis­con­nect be­tween the now decades-old re­search that has long pro­vided a blue­print for bet­ter men­tal health frame­works and the re­al­ity of a men­tal health sys­tem that hasn’t been able (or in some cases will­ing) to im­ple­ment these strate­gies is mad­den­ing.

Many of the ideas pre­sented by the in­quiry are not new. As the re­port notes: “Im­por­tant mod­els, prin­ci­ples and direc­tions are talked and writ­ten about, but are not im­ple­mented and fol­lowed. As a re­sult, we have not made the sys­tem shift that has been sig­nalled for sev­eral decades.”

Quite sim­ply, this re­port is an enor­mous wake-up call. It makes clear just how out-dated, un­der­funded, over­loaded and out of touch our men­tal health sys­tem is. It lays bare the stress a largely ded­i­cated and pas­sion­ate men­tal health work­force is un­der, to the point where their own well-be­ing is at risk.

The last Gov­ern­ment must take some re­spon­si­bil­ity for this. I’ll never for­get, for ex­am­ple, the boss of the Can­ter­bury DHB plead­ing with the Gov­ern­ment in 2016, ex­plain­ing that the men­tal health ser­vice in Christchurch was “close to im­plod­ing”. Fis­cal pru­dence was of­ten given as a rea­son for fund­ing de­ci­sions that forced DHBs to make do with less, but at what price? How many sui­cides could’ve been pre­vented if ser­vices had been ad­e­quately funded?

The cur­rent Gov­ern­ment must also grap­ple with the di­ag­no­sis of a dis­or­dered and dys­func­tional men­tal health sys­tem pre­sented by the in­quiry. As a na­tion, we have an op­por­tu­nity to de­velop a worldlead­ing and rev­o­lu­tion­ary men­tal health sys­tem. We have a chance to change our leg­isla­tive frame­work around drugs and al­co­hol so sub­stance users are pro­vided with path­ways to health rather than puni­tive jus­tice re­sponses. We have an op­por­tu­nity to recog­nise that so­cial de­ter­mi­nants like poverty, child­hood trauma and abuse are hav­ing a dev­as­tat­ing im­pact upon the well-be­ing of our na­tion, and to do some­thing about them.

The sixth Labour Gov­ern­ment could be re­mem­bered as a vi­sion­ary ad­min­is­tra­tion that com­mis­sioned the Pater­son In­quiry and fixed the men­tal health sys­tem, or it could be re­mem­bered as the Gov­ern­ment that com­mis­sioned a re­port and then failed to do any­thing more.

On that front, it needs to look sharp. I don’t buy that the Gov­ern­ment can’t re­spond to any part of the re­port un­til March. Cer­tainly, it will take time to de­liver a full re­sponse, but some of the ar­eas of con­cern pre­sented by the re­port are too ur­gent to de­lay for three months. How many peo­ple will die dur­ing that time? The sui­cide pre­ven­tion rec­om­men­da­tions pre­sented by the in­quiry should be fast-tracked. Lives de­pend on it.

The era of the am­bu­lance at the bot­tom of the cliff needs to end as quickly as pos­si­ble. We need to build not only fences to pre­vent peo­ple from fall­ing into the abyss, but also launch­ing pads to help them to flour­ish. Men­tal health shouldn’t just be the ab­sence of di­ag­nos­able ill­ness. It should be liv­ing a life in which you can thrive.

"It makes clear just how out­dated, un­der­funded, over­loaded and out of touch our men­tal health sys­tem is."


Lives de­pend on the sui­cide pre­ven­tion rec­om­men­da­tions pre­sented by the in­quiry be­ing fast-tracked.

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