While mental health is an easy issue to campaign on, it’s hard to get right, writes Jess McAllen.
This story first appeared on The Wireless. Read the rest of the series here.
Ten years ago, when Labour was in charge, I was 14 and losing grip with reality fast.
My parents took me to a counsellor and paid for a session but I was beyond her expertise so we were fast-tracked to Child and Adolescent Mental Health Services (CAMHS) in Hamilton. I recently requested my notes from that time under the Privacy Act, and there in writing is a damning indictment for anyone who thinks National is solely to blame for the current mental health crisis: “Jess faces a six month wait.”
There’s never been a golden period for New Zealand mental health. Ever since asylums (which breached human rights for many people) were finally farewelled in the late ‘80s and early ‘90s, we’ve been struggling to catch up due to inadequate planning. The result? Many people with mental illness living on the street, a suicide rate that’s remained stubbornly high (though we aren’t yet at the peak of 1998) and a crisis every year since.
I watched mental health become an election issue with great interest this year. Then I had a serious depressive episode in June, only rivalled by my suicidal one in 2014. I wondered why all the people talking about the system weren’t actually going through it themselves?
Soon I realised mental health was an easy topic to campaign on; it appeals to people’s emotions, and a lack of general knowledge about the complicated system makes it hard to challenge. You also come across as a dick when you try and criticise the discussion — after all, we’ve had such little progress, we’re told, surely we should be grateful for even the tiniest sliver of extra attention? A friend recently described it as “treating suicide like a bad STD we have to get on top of”.
The reality is that suicide is complicated, and mental distress is exacerbated by factors like financial difficulty, trauma and demeaning attitudes towards those who weren’t born with privilege. This is all stuff that doesn’t fit into the mental health category, but wider problems with society.
I go through community mental health. We’re meant to be 3% of the population (although increased demand now has us at 3.5%). We’re the ones who can’t be treated with the free six to eight counselling sessions you can get at a GP, who require something more long-term or professionals who can deal with complicated trauma, severe depression, episodes of psychosis, hallucinations, mania and so on.
Counselling isn’t a cure-all but it helps a lot of people and I haven’t had any in 10 years, despite professionals putting me on waiting lists and telling me I’d greatly benefit from it. I have, however, subjected my body to a carousel of drugs that are meant to help in the meantime.
This year my community mental health centre had no psychologists for six months. There are free and low-cost counselling centres out there but it’s quite hard to find them if you don’t know where to go. I feel stuck in a black hole of community mental health and I’m an articulate person who has a platform, regularly interviews mental health professionals and has in-depth knowledge of the system. If I’m struggling to get help, what about all the other people who aren’t as privileged as me?
The only parties that directly mention community mental health services are National, Greens and United Future. Labour’s pilot policy about primary mental healthcare is great because it’s a widely acknowledged problem that those who fall in the gap between mild and serious mental disorders aren’t being dealt with adequately. However, it does concern me that none of their policies are focusing on the dire gaps in community mental health services. Considering around 40% of suicides are by people who accessed specialist mental health in the 12 months prior to their death, this seems like a big omission. Not that counselling necessarily stops suicide, but it sure would help a lot of people.
I caught up with Labour’s Health spokesperson, David Clark, at a recent mental health debate in Auckland and asked him about Labour’s lack of focus on specialist services. His response was that Labour is committed to funding DHBs adequately, which he admitted sounded easy to say, but implied it would have an effect on all care.
I’m glad that National are wanting to increase Youth One Stop Shops, this year I wrote about how important Evolve in Wellington is after they had to temporarily close their books due to increased demand. However, under National similar services have shut down, so take this with a dose of scepticism. I’d like to see a similar dedication to places like The Clubhouse and Courtenays, drop-in centres for adults which were shut down a couple of years ago in Wellington. These centres were good for the homeless community or those who were unemployed as it provided a place to socialise and take part in activities. They had hot drinks, a pool table, and computers.
National also changed ACC laws to make it harder to get compensation for families left behind after a suicide.
In 2001, Labour changed the Accident Compensation Corporation Act so that entitlements were paid to families of victims whose suicide was the result of mental illness. In 2008, this was extended to cover all suicides. This meant families could receive a funeral grant, a survivor’s grant of around $5000, funding for counselling, and a share of income-related compensation for dependents.
In 2010, National’s Nick Smith changed the law so families of suicide victims could only receive entitlements if ACC established the person who killed themselves was not able to appreciate the consequences of their action, or that a previously covered mental injury caused or contributed to the suicide.
After the law change, between 2010 and 2017, 481 claims were confirmed to be suicides but did not meet criteria to receive entitlements. Meanwhile, 295 claims were confirmed to be suicides and able to meet the criteria to receive entitlements. The law appears to have stopped people applying for compensation. In 2009, before it changed, ACC received 350 claims for suicide compensation and last year it received 79. This information was provided by ACC.
Another interesting policy from National is putting in $4 million to support people in an acute mental health crisis to sustain their tenancy as unstable housing is a proven contributor to mental distress.
National is also floating the idea of letting nurses and pharmacists prescribe certain long-term medications. If you can’t afford GP visits and are not with a free community mental health psychiatrist, it can be a costly five-minute appointment to get a script refilled for long-term medication. The other side is that this would have to be carefully monitored as certain medications like benzos and sleeping pills can be addictive and are recommended short-term. Also, the advantage of seeing a regular doctor is they can notice whether the medication is having an adverse effect or the dosage needs to be upped or decreased.
I’ve spoken to school counsellors who are concerned about the idea of a nurse in every school. When teenagers are referred to Child and Adolescent Mental Health services they face lengthy wait times so unless there is a specific policy to address that, nothing much will change. It seems there is nothing to stop the six-month wait I faced when I was 14 and in the throes of a crisis.
Another factor missing here is that our high youth suicide rates generally come from people aged 20-24 (this was the age bracket with the highest number in the recent provisional statistics at 79 suicides). The number of suicides in the age bracket of 14-19, in the last year, was 38. The policy also ignores the fact that there are teenagers who will have left high school early.
Labour’s pledge to include mental health workers in pay equity claims is a crucial policy. While many parties talk about increasing mental health workers, the reality is that the sector is significantly understaffed and this is predicted to be a problem in the next 10 years. Mental health workers are often underpaid and have demanding hours so making the industry attractive to enter and stay in is important to fixing the mental health system.
There does seem to be a significant lack of planning for addressing Māori suicide. Māori are nearly twice as likely to die from suicide than non-Māori and the youth suicide rate for Māori more than double that of non-Māori. The self-harm rates for Māori female youth has risen 77% since 2004.
Michael Naera, project leader in Rotorua for Kia Piki te Ora, the Ministry of Health’s national Māori suicide prevention programme, says he’s concerned that parties are disregarding culture in their mental health policies.
“Labour and National policies are less desirable,” he says.
“I know they are wanting school-based mental health services but the current Prime Minister’s $60 million Youth Mental Health fund covers SWISS (Social Workers in Schools), school health clinics and real psychological services. I’m not sure committing to an overkill of services would solve the issue either.”
What the politicians are promising
National
In the May Budget an extra $224 million was allocated to mental health and in August 17, new initiatives were approved by Cabinet to take up $100 million of the funding. It’s estimated half will be ready by 2018. Technically any other party is bound by these as the money has already been allocated.
Enhanced e-therapy options for pre-teens, adolescents and young adults
E-therapy for young prisoners (under the age of 25)
Package of tailored telehealth pilots
Ensuring support and follow-up for those who attempt suicide ($5 million)
Expanding and enhancing primary and community mental health and addiction care ($25 million). An estimated investment of $5 million per year will help:
- The training of approximately 250 youth peer support workers and approximately 125 community care workers with a focus on youth people
- Approximately 250 health professionals such as nurses, social workers and other allied health professionals to train in therapies such as CBT (Cognitive Behavioural Therapy)
- An additional approximately 13 clinical psychology intern positions
- Expanding access to mental health services for children, adolescents and young people such as Youth One Stop Shop services and Child and Adolescent Mental Health Services
Support service for people in acute mental health crisis to sustain tenancies ($4 million)
Wraparound and step-up/step-down care trial — this helps patients who are discharged from hospital with going back into the community ($4 million)
Multi agency co-response service for people who ring 111 for Police or Ambulance requiring a mental health response ($8 million)
Strengthening self-regulatory skills in early childhood ($3 million)
Pilot frontline mental health provision in schools ($11 million)
Improve learning environments and build resilience ($8 million)
Electronic HEEADSSS assessment and brief intervention for young people ($1 million)
Supportive housing models for youth with a mental health condition ($5 million)
Strongest Families Pilot ($6 million)
Culturally responsive trauma-focused CBT for children following experience of family and/or sexual violence ($4 million)
Enhancing mental health and neurodevelopmental capacity in Gateway assessment teams and associated service pathways ($4 million)
Improving the evidence base about New Zealanders’ mental health and interventions that work ($5 million)
The rest of the money is set to be used for:
- $4.1 million for the Ministry of Social Development to trial integrated employment and mental health services
- $11.6 million to help the Department of Corrections better manage and support prisoners at risk of self-harm
- $8 million in Vote Māori Development to extend the Rangatahi Suicide Prevention Fund
- $100 million for DHBs to support local mental health and addictions services are part of their total new budget spend through Vote Health.
Also, in their policy booklet on health, is an interesting one: “enabling qualified nurses and pharmacists to prescribe certain medicines, benefiting patients with long-term conditions”.
Labour
The Labour Party says it’s committed to reversing National’s $1.7 billion of health cuts.
Establish a two-year pilot programme of primary mental health teams at eight sites across the country to help those with mild-moderate mental health issues.This will be an investment of $43 million over two years, funded through the commitment to reverse the $1.7 billion in health cuts. Labour says it is expected to help 40,000 people get the help they need for each year of the pilot. A full review will be taken two years after the pilot with the idea of rolling it out nationwide. It is expected to mean:
- Increased capacity for GPs to conduct interventions and make appropriate referrals
- Mental health service co-ordinators to be based with primary care providers
- NGOs to provide social assistance such as help getting a job or finding somewhere to live
- Increased access to counselling
- Co-ordinators to facilitate shared care between GPs and DHBs
A student can go to a health professional in their school and either have all their needs met on-site, or be referred to youth health services, Child & Youth mental health services, or their own doctor. ($40 million)
An extra 80 health professionals to provide mental health services in primary and intermediate schools in Christchurch and other earthquake-affected parts of Canterbury, including Kaikōura, for an initial three years (expected to cost $10 million a year)
In Labour’s first 100 days, the party will initiate a review of mental health and addiction services to identify gaps in services
Re-instate the Mental Health Commission (I can’t find this in any of the official policies but Health Spokesperson David Clark said it at a recent mental health debate. When asked for clarification on whether more workers would be added to the commission than the commissioner who already exists he said he was unsure of the exact details).
Making sure mental health workers are a priority when it comes to equal pay negotiations
Green Party
Improve inpatient and community support services for women with postnatal depression and other mental health disorders. Inpatient facilities need to include facilities for mother to have baby with her.
Increase funding and support for early intervention for children and young people with behavioural and mental health issues.
Ensure mental healthcare training and practice is grounded in holistic, humanistic perspectives that recognise each individual as whole.
Encourage mental health providers to work within multi-disciplinary teams that hold the well-being of the client at the heart of their practice. Wherever possible, clients have a primary provider who remains with them through their recovery process.
Utilise client-assessed outcome measurement tools to compare service effectiveness.
Fund innovative initiatives that indicate high recovery rates with low/minimal drug use
Ensure physical health needs of people with mental health needs are also well met. 6. Ensure both inpatient and community (including residential) services are well resourced.
Māori Party
Expand Oranga Rangatahi — the Rangatahi Suicide Prevention Strategy
Provide more funding for specialist services, treatment and support for those affected by sexual violence and abuse
Introduce free GP visits and dental care (including after hours and weekends) for those under 18 years of age
Increase in kaupapa Māori services: Drug and alcohol residential treatment centres and community-based programmes; Mental Health residential centres and community-based programmes; Hospice facilities, homecare services and programmes to support terminally ill patients and their whānau
Resource whānau to be equipped to work together and develop their own solutions to suicide in both prevention, post-prevention and health promotion approaches (Waka Hourua Māori \and Pasifika suicide prevention)
Resource and implement the Turamarama Declaration (this was launched at the World Indigenous suicide Conference in Rotorua last year by Sir Mason Durie)
Lower the threshold to access appropriate support for individuals experiencing distress
Appoint mental health youth workers in schools
NZ First
Increase the options of mental health services available, working towards a community views instead of a medical view of services
Provide additional resourcing for child and youth mental health services, and the necessary resources and funding to address the continuing appalling state of mental health services by completing the full implementation of the recommendations of the Mason report
Increase the number of acute and non-acute beds and accommodation units for the mentally ill and modify the process of judicial review of decisions to release mentally ill patients into the community
The Opportunities Party
The Opportunities Party (TOP) recommends increasing the legal age for alcohol purchase to 20 years, and increasing the price of alcohol by an average of 10% through excise tax. The $300m revenue from this will be used to provide a much needed injection of funds into community based youth mental health support and drug and alcohol treatment.
ACT Party
Increase awareness of the services available to people who may be depressed through public information campaigns and the placement of mental health professionals in all secondary schools.
United Future
Increase the number of community-based mental health workers
Improve workforce development and funding available for youth-focused counselling services as the first line of defence
Fund research to address mental health issues, especially those that affect our youth
Increase our resources for mental health professionals to ensure that those who are the most vulnerable have their needs properly assessed and treated
Encourage government agencies to work together on early intervention, prevention, treatment and rehabilitation
The Opportunities Party
Pay $200 per week to everyone aged 18-23
This story first appeared on The Wireless. Read the rest of the series here.
WHERE TO GET HELP WITH MENTAL HEALTH
Need to talk? Free call or text 1737 to talk to a trained counsellor, anytime.
Lifeline: 0800 543 354
Suicide Crisis Helpline: 0508 828 865 / 0508 TAUTOKO
Depression Helpline: 0800 111 757
Samaritans: 0800 726 666
Youthline: 0800 376 633 or email talk@youthline.co.nz
Healthline: 0800 611 116
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