Men­tal arith­metic

Ev­ery dol­lar on men­tal health re­pays $3.50 to NZ

Sunday Star-Times - - News -

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.

Newspapers in English

Newspapers from New Zealand

© PressReader. All rights reserved.