Mental health report a huge wake-up call
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 wellbeing 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 outdated, under-funded, 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 wellbeing 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 wellbeing 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.