Every dollar on mental health repays $3.50 to NZ
Every dollar spent on mental health services will repay the nation with $3.50 in productivity gains and other savings, the report from the Government Inquiry into Mental Health and Addiction has found.
But that’s peanuts compared to the potential impact on the personal finances of people currently not getting access to the mental health services they need.
‘‘A physical illness is one step down from a physical injury, but mental illness is two steps behind,’’ says Matthew Nuttall, a digital marketing specialist who has personal experience of extreme anxiety.
He describes the impact on personal finances of mental illness thus.–
❚ Break your back, and ACC covers the treatment, and the majority of your lost income.
❚ Get cancer, and your treatment is covered by the health system, but your lost income is not.
❚ Experience mental distress so acute you need treatment, and lose your income, and not only is the income not covered, but often the treatment you need isn’t available either, so you have to self-fund it, if you want it.
Nuttall experiences bouts of extreme anxiety, which he traces back to being chronically bullied at school, and emotional turmoil at home caused in part by his parents’ parlous finances when he was very young.
His experience of mental health services, which is echoed in the inquiry report, is that people going through an acute mental health crisis can access services, but are largely on their own once theemergency has passed.
‘‘It gets you out of a crisis so you can self-sustain,’’ Nuttall says.
It is also far too focused on medication, which, while important, did not help to fix the underlying causes, he says.
Sustaining a healthy personal financial life is a real challenge for people suffering from mental ill-health.
One of the triggers for Nuttall’s anxiety is the fear that he will see his finances collapse around him, which, ironically, increases the chances of it happening.
Chronic anxiety, he believes, is as misunderstood as depression used to be.
It manifests in him both through repeated patterns of debilitating negative thought, but also through physical exhaustion, which dramatically reduces his performance at work.
Nuttall has been fortunate in having employers who had high awareness of mental health.
This has left him convinced of the importance of workplaces as a forum where empathy, support and advice are available.
He’s been able to self-fund some treatment, but he cannot afford to selffund the sustained psychiatric treatment to address the underlying causes of his anxiety.
His impressions are backed up by the inquiry report.
‘‘Problems of access, wait times and quality were reported all over the country – having to fight and beg for services, not meeting the threshold for
treatment, and the cruelty of being encouraged to seek help from unavailable or severely rationed services,’’ it says.
‘‘Gaps in services, limited therapies, a system that is hard to navigate, variable quality and shabby facilities added up to a gloomy picture of a system failing to meet the needs of many people.’’
The report accounts for the national cost of mental illness – appealing to a national sense of economic loss from untreated mental distress – but spends little time on its effects on people’s personal finances.
‘‘The economic costs of mental illness are substantial,’’ it says.
‘‘Recent estimates for OECD countries are that mental illness reduces gross domestic product (GDP) by approximately 5 per cent, through disability leading to unemployment, work absenteeism and reduced productivity, and the additional costs of physical health care among people with mental health problems.’’
The report makes the national case for investing in better services, again on a national accounting level.
‘‘Cost-effective treatments are available for common mental disorders for which the savings through restored employment and productivity outweigh the costs,’’ the report says.
‘‘For example, for every $1 spent treating depression, $2.50 of productivity is restored and $1 of physical health care cost is saved.
‘‘In high-income countries it has been estimated that increasing coverage (particularly of psychological treatments) to an additional one quarter of people experiencing mental health problems by 2030 would cost an additional 0.1 per cent of GDP.’’
Poverty, low incomes, low-status insecure work, and poor housing are all contributing factors to New Zealand’s mental health crisis, the inquiry heard from submitters.
‘‘People said that unless New Zealand tackles the social and economic determinants of health, we will never stem the tide of mental health and addiction problems,’’ the report says.
‘‘There are clear links between poverty and poor mental health. People need safe and affordable houses, good education, jobs and income for mental wellbeing.’’
The report identifies insecure finances as contributing to poor mental health.
One non-government agency working in the field told the inquiry that ‘‘sadly in New Zealand childhood exposure to maltreatment and relational trauma is extremely common and along with poverty can most often be found in the narratives of children diagnosed with mental health conditions.’’
They also make it harder to recover, the report says.
‘‘It’s hard for people struggling with poverty, abuse and deprivation to take steps to become well. Yet, every day, people recover from distress, overcome addictions and strength in their lives.’’
But all too often, personal wealth and income deficiencies are exacerbated by mental ill-health.
‘‘I’ve always been broke,’’ Gayleen Maurice says.
She was raised in a home without money, or security, and her mental health in adult life has helped ensure she lives just above the breadline.
Maurice has a masters degree in specialist education, but she also experiences anxiety, depression, and is a hoarder.
Her conditions have made it hard for her to manage money, or sustain a profitable work life, though she has served almost continually in the voluntary sector, and is a current trustee of the Walsh Trust, which supports West Aucklanders with mental ill-health.
Her financial struggles have resulted in a long relationship between Maurice and Work and Income, which at times has lacked empathy, or understanding for her difficulties. However, this has improved in recent months.
The report notes this as a frequent theme in evidence submitted to the inquiry.
‘‘We know how hard building a consumer-centred system is, but during this inquiry far too many people told us they were not treated with kindness, dignity and respect.
‘‘These types of stories are not restricted to the health system – people dealing with other government agencies and social services, such as Work and Income, often feel belittled and unsupported,’’ it says.
Maurice’s anxiety can manifest in physical symptoms, including in difficulty walking.
She says Work and Income has not always shown empathy and understanding, recalling how hard it was for her to go to interviews in large, open-plan offices. One incident is scarred in her memory.
‘‘I crawled to the desk, and then sat down because my anxiety had left my legs not working,’’ she says. ‘‘There was absolutely no dignity.’’ She feels the system, which seemed to need her to be available for work, faked her wellness to keep her on temporary benefits.
Shaun Robinson is the head of the Mental Health Foundation. He lives with bipolar disorder, but his personal finances have thrived because his periods of mental distress have not prevented him from being high-functioning at work.
Robinson says American psychologist Dr Corey Keyes speaks of people either ‘‘flourishing or languishing’’, and those with mental health challenges too often found themselves languishing.
Anyone experiencing protracted mental ill-health was too often languishing, especially if a family break-up was part of the mix.
‘‘A lot of people fall out of the workforce, and are unable to get back in because there’s not enough support to be able to support them in employment,’’ he says.
‘‘You don’t have to be a rocket scientist to see how difficult the costs will be.’’
Episodes of mental distress can lead to economic damage to individuals, though Robinson feels fortunate not to have experienced that.
‘‘I did occasionally get selfdestructive and break things, but I was working, and always working on a reasonably paying job. That was a critical difference.’’
Work, he says, always remained one of the few things he felt good about in his life.
‘‘I didn’t have the added costs of poverty thrown into it.’’
But he acknowledged he could have gone into a major downward spiral, and avoided the debt that can be an unfortunate side-effect of severe mental distress.
The inquiry also found a strong link between mental health and lifedamaging substance abuse.
‘‘Over 70 per cent of people who attend addiction services have coexisting mental health conditions, and over 50 per cent of mental health service users are estimated to have co-existing substance abuse problems,’’ the report says.
Robinson is heartened by changes in attitudes among employers.
‘‘Not a week goes by when we don’t have one, two, three, four or five new employers or associations coming to us wanting support on how to promote mental well being in their workforce.’’
A government inquiry into mental health services has found that investment in mental health treatment would benefit the economy.
Medication plays a role, but addressing underlying causes of some mental health problems involves having to self-fund treatment.
Labour has made mental health a priority, and has moved fast since attaining power.
Shaun Robinson, head of Mental Health Foundation.
Matthew Nuttall has fought chronic anxiety.