2016 has been a breakthrough year for mental health reporting around the country. Yet a draft report leaked to Jess McAllen – herself a mental health reporter – shows that Mental Health Services are anything but welcoming of the scrutiny.
An editor once told me mental health stories were “unsexy”. Silky, lacy numbers like car crashes and cancer go to Victoria’s Secret, suicidality and negligent care are chucked over a shoulder into the daggy $5 g-string bin at Cotton On.
But things are changing. In the past, the news cycle was often in the hands of balding middle-aged men who couldn’t name two types of psychiatric drugs but would offer a cup of concrete at the hint of emotion. Despite pockets of excellent reporting, recent years have seen a wider range of journalists working on the mental health beat with vigour, sending District Health Boards scrambling.
I was recently leaked a document from a nationwide meeting of the DAMHS (Directors of Area Mental Health Service) who are worried negative media coverage is – in a convoluted roundabout way – causing staff to become more draconian. Turns out there are “increasing concerns” from higher-ups about the journalism being practised within the sector over “recent months”.
Mental health reporting – with the exception of a few journalists – has traditionally been tied to murder cases or high profile tragedies like Charlotte Dawson or Robin Williams. It’s not that this past year has seen a rise in suicides, missing persons, coercive practices or other questionable behaviour . Rather, the media has been reporting on the above, constantly and with vigour.
It’s been a banner year for mental health coverage in the mainstream media. Ashleigh Stewart consistently ran stories for The Press on post-earthquake Christchurch’s mental health (breaking embarrassing stories about funding woes). Kirsty Johnston raised public concern regarding Ashley Peacock, the 37-year-old who has been in seclusion for five years. Nikki Macdonald reported on a patient who committed suicide at a Wellington mental health facility and whose family then had their privacy breached thanks to a staff-wide email. It’s possibly worth awkwardly mentioning that I’ve done my fair share of mental health reporting in the last year too.
There’s also been educational accounts of mental illness, such as Tess McClure on anxiety, Rebecca Kamm on Selective Mutism and ADHD, Holly Walker on Post-Natal Anxiety, Ruth on Borderline Personality Disorder, an interview – by, er, me – with someone who has Obsessive Compulsive Disorder.
It’s been a welcome break from the over-familar “no one talks about suicide – We Must Talk” 300 word article that runs every time a public speaker specialising in mental health comes to town. Watching the past year’s analytical mental health journalism expand beyond faux-concern has been reassuring, not as a journalist but as a mental health consumer who is so used to having her narrative pushed aside.
This era of increased depth and sophistication of reporting on mental health issues is the backdrop to the leaked report, which indicates that the sector, far from welcoming a more thorough analysis, is instead shrinking from the moment.
Here’s some of the main points from the report, a draft briefing paper intended for the Ministry of Health “The Current Health of the Mental Health and Addiction Sector (MHAS)”:
There has (apparently) been “a growing level of inaccurate and biased media coverage of issues” and a lack of effective “counter discourse” to the coverage due to lack of funding and pressures within the Ministry of Health.
DHB leaders are worried about interest groups who repeatedly call for inspections and inquiries and allegedly run “personalised social media campaigns targeting individual clinicians, service leaders and staff”.
Growing public criticism of the mental health sector (and subsequent pressure from politicians and DHB boards) is resulting in “increasing levels of stigma and discrimination”, “perverse changes in care with increased levels of coercion”, decreased staff morale and “major recruitment and retention problems”.
Mental health leaders are seeking an appointment with Minister of Health Jonathan Coleman to discuss their concerns and pitch a “political sponsorship of a major quality improvement initiative” that would “reassure the general public that the sector is focusing on increased quality and safety of services” and provide opportunities for service improvement.
At first blush – and keeping in mind this is a draft – it seems like DHBs are using increased public awareness about mental health treatment as a scapegoat for failing initiatives. In the report they make clear there’s no panacea for the complex problems that arise in the mental health sector, but what initiatives they do have they say are being undermined by “a culture of blame and in some areas personalised attacks on staff and services when things have not gone as expected”.
The report says the result of this is “a degradation of the quality and humanity” of mental health and addiction services.
It’s a far stretch – and a cop-out.
For context, it feels like this report is a not-so-subtle dig at cases like Nicky Stevens – the high profile suicide of a young Waikato man who went missing from the Henry Bennett centre in Hamilton after taking unescorted leave. His family have been very vocal in their grief – a way of healing is hoping to make a change – on social media and in newspapers. A few weeks ago another patient, a young woman, died in a similar way after also taking unescorted leave.
The knee-jerk reaction from the public and politicians is to ask: why are patients at risk of suicide allowed to leave the one place they should be safe? But mental health patients aren’t prisoners and being locked up isn’t necessarily going to help anyone get better.
And things have been getting more restrictive, according to a woman who was at the Henry Bennett centre last year.
“Things have changed significantly,” she told me, “processes have changed, some for the good and some for the not-so-great.
“Ward 35 now has a big fence around it. Before you could go out there and if you really did want to, you could jump the fence and go to town. They’ve locked the door from the ward out onto the courtyard. If they’ve got anybody that’s at risk the door is locked and you have to ask staff if you can go out to the courtyard.”
The narrative of a mentally ill person used to be (more) easily dismissed in the same way a man might speak of all his “crazy” ex-girlfriends. This added an extra element of difficulty to reporting on the sector. Who would believe the person that gets delusions – even if only for one week a year – over the carefully crafted words of a communications professional?
There was also the “who cares” factor. I once spoke to a journalist who spent a day at court where the parents of a young girl who committed suicide were trying to make a case for negligent care. She told me there was no story because “if she was going to kill herself, she was going to kill herself”. The damaging idea that nothing can be done to help suicidal people is pretty insulting considering how many people get past the point of suicide once they get adequate help.
Basically, media pressure means politicians and senior health people are supposedly pushing those on the ground to take a harder line to minimise risk, which then leads to Ashley Peacock-type stories about a lack of human rights. It’s a life-risking merry-go-round.
None of this is to suggest that the sector isn’t working its hardest to improve, nor that they don’t have a ferociously difficult job to do. The professionals at inpatient facilities have to make judgement calls every day on whether someone is well enough to be allowed out on unescorted leave (at-risk patients aren’t allowed to take it) but the people making such judgements are only human.
This doesn’t mean that grieving families should be blamed for DHB boards coming down hard on mental health nurses or the media chastised for reporting on such cases and getting politicians worried. Rather, the DHBs should be looking internally at what protocols they have for risk assessment. A review of mental health services would also be nice some time this century.
The report says criticism has resulted in an “increased level of pressure brought to bear on clinicians and services by politicians, DHB boards and CEOs, to be more reactionary and coercive in certain policies and practices.”
Without the jargon, they are basically saying: we don’t want to lock mental health patients up like animals but if we let someone out and they kill themselves the media beats us up about it.
Not all media have been that great in coverage of mental health. Beyond the Herald, some of the coverage by other media outlets in relation to the Ashley Peacock story amounted to naked and uninformed fear-mongering. However, the Mental Health Foundation usually call out such disasters and hold them accountable. If the DHBs think the public have lost faith in them, then my advice would be: don’t shoot the messengers – listen to them.
Canterbury DHB were approached for comment when their Chief Psychiatrist Sue Nightingale chaired a recent meeting regarding concerns outlined in the draft briefing paper. The DHB said it would be “inappropriate to comment before there’s been an opportunity for the Ministry to review it”.
Where to get help:
Lifeline – 0800 543 354
Suicide Crisis Helpline (open 24/7) – 0508 828 865 (0508 TAUTOKO)
Depression Helpline – 0800 111 757 – this service is staffed 24/7 by trained counsellors
Samaritans – 0800 726 666
Youthline (open 24/7) – 0800 376 633. Text 234 for free between 8am and midnight, or email talk@youthline.co.nz.
0800 WHATSUP (0800 9428 787), Open between 1pm and 10pm on weekdays and from 3pm to 10pm on weekends. Online chat is available from 7pm to 10pm every day at www.whatsup.co.nz.
Healthline – 0800 611 116
For more information about support and services available to you, contact the Mental Health Foundation’s free Resource and Information Service on 09 623 4812 during office hours or email info@mentalhealth.org.nz