Image: Tina Tiller
Image: Tina Tiller

SocietySeptember 7, 2021

Why I’ve had enough of mental health awareness

Guest writer
Image: Tina Tiller
Image: Tina Tiller

Mental health awareness isn’t going to help the families with suicidal children who wait six months for an appointment, or the desperate people who are turned away with nowhere else to turn. More clinical psychologists will, writes Lucy McLean, who is training to be one. 

The end of this month marks the beginning of Mental Health Awareness Week, and quite frankly, I’ve had enough of awareness. Awareness is important, sure – it has a very important role in starting conversations, be those interpersonal or political, and I deeply value the work that groups do in this space. But the mainstream conversations around mental health awareness have been going on for a decade now. The 2017 mental health and addictions inquiry, He Ara Oranga, could perhaps be described as the biggest national mental health awareness project. But four years on, we are still seeing the pain caused by poor workforce and system planning, and I’m getting sick of awareness without any sustainable, sustained action. 

Awareness without access to mental health support is kind of like noticing you’re thirsty but having no water. Noticing the thirst may help you seek out the water, but if you are in a situation where there is literally no water, then you are probably better off trying to forget about the thirst. I’m not sure I can stomach another Mental Health Awareness Week where people are encouraged to reach out, get into nature, but absolutely nothing is done to help those people who have been desperately trying to do that, those people who have been coming up against closed doors. For some people in New Zealand, awareness is still valuable (and there are many appropriate resources available for people facing less severe mental health challenges), but there are many people who are well past awareness and what we actually need is some help. 

All I want for mental health awareness week is systemic change, but I realise that’s a big ask. When I was talking with Paul Skirrow from the New Zealand College of Clinical Psychologists, he said he thought fixing the mental health system was probably at least as hard as fixing the housing crisis – read, pretty hard. If I can indulge the reader with the extent of my wishes for mental health awareness week, I’d like to start with wealth redistribution through capital gains tax, land back, prison abolition, and a new bicycle. The social determinants of health are extremely important in understanding mental health at a population level and creating systems that produce equitable mental health outcomes. New Zealand’s high rates of mental health challenges are reflections of our system failures. Yet, you can’t always get what you want for Mental Health Awareness Week, and so I have been working on adjusting my expectations. 

All I want for Mental Health Awareness Week is systemic change.

All I want for Mental Health Awareness week is more psychologists. 

I often have lavishly equitable dreams that still feign extensive hope in the Labour government to turn mental health awareness into healing. It’s a rude awakening when I realise that systemic change has not, will not, happen over night. So in sobering morning showers I’ve turned my attention to one of the broken cogs: we keep telling people to reach out, get support, but there are nowhere near enough mental health professionals. 

I am training as a clinical psychologist. Psychologists are one of many valuable types of mental health professionals. Psychologists work in varied scopes of practices and have thorough training in understanding, assessing, and providing treatment for people experiencing a range of psychological difficulties. Psychologists’ therapeutic practices are guided by best available local psychological research and theory, and adapted to meet the needs of each client and family. Psychologists also play key roles in training and supervising other health and mental health professionals. A friend of mine, Saara Cavanagh, describes her work as a psychologist like this: 

I work with my clients to help them find the tools that are going to help them overcome the challenges in their lives. They might come to me with all the information about their lives, their expertise on what’s helpful for them, and then I’ll combine that with all the things I know about psychology and what the research says and then together we can make a plan about what’s going to be the most helpful for them.

It is estimated New Zealand is short about 1,000 psychologists. 

I am training as a clinical psychologist and I am in a class of 12. Over 90 people applied to be in my cohort, and there would be well enough work for all of us if we could get trained. So even though I’m grateful to be in this training programme, I am scared. And so are my classmates. What does it mean to be a psychologist working in a field with such a pronounced shortage? It means knowing there are families with suicidal children who wait for six months to get an appointment, or seeing someone 12 months after they were put on a waitlist for attempting to take their own life, it means seeing people after they have spiralled into the depths of something that could have been prevented, it means always putting out fires rather than being able to provide therapy, it means replying to emails to tell people you cannot help them and, even though they are desperate, you don’t know who can. For many it means an express lane to burnout, which means one fewer psychologist able to see a full workload of clients. 

About a year ago the ludicrousness of this problem set me in motion. I began having conversations with people to try to get to the bottom of why we could have such a severe and dangerous shortage of psychologists while there was a clear bottleneck in training more. There are two key parts to the bottleneck – the universities don’t have enough resources to train more students, and the DHBs don’t have enough resources to supervise more students towards registration. Both problems seem solvable if we throw enough money and care at them, and if we don’t break this bottleneck, well, nothing changes… in fact, things probably get worse. Eventually this transpired into a petition to grow the psychologist workforce. 

We are delivering our petition tomorrow and as it stands we are at 11,600 signatures. We’ve been on the news, we’ve been all over Eli Matthewson’s Twitter, and Nigel Latta even gave us a shout-out. What I am most proud of in this campaign, however, is that we have started collecting the stories of people most affected by this workforce shortage. We put out a survey to our petition signees about their positive experiences working with psychologists and we have started sharing their stories on our Instagram and Facebook page. 

The responses support what we already knew about how dire the mental health system and wait times to see psychologists are. Our campaign group consists mainly of psychology students and between us we have ample experiences working in the mental health sector, and trying to navigate and access mental health support ourselves. We already knew things were bad, but these quotes further illustrate our stories. 

We have heard stories of young people being made to wait nine months to access treatment for eating disorders. We’ve heard from people who were discharged from the emergency department only to wait six to 12 months to see a psychologist, or get any psychological support for that matter. We’ve heard from someone who contacted 18 private psychologists over a few days to find support for a family member but none of them had availability. Some of our respondents even reported how stressed the psychologists who turned them away seemed, not being able to offer them any help. 

In light of all of this, we also asked our respondents to tell us about the positive experiences they have had with their psychologists, and these are the stories that truly remind us how important well-trained and skilled professionals are at the front end of our mental health system. People have told us about how they valued the way psychologists helped them piece together their story and understand why they were feeling as they were, how the therapies psychologists could provide were so effective, how they finally felt seen and accepted. There are wins happening in therapy spaces every day, there is hope, and there are definitely some clear ways for us to move forward. 

More Reading

    I am not sharing these stories for more awareness, I am sharing these stories because I want something to change. 

    All I want for Mental Health Awareness Week is a better, more just, mental health system. And if that’s too much to ask for, then at least give us more psychologists. 

    If you also want this, then feel free to join us by signing the petition and attending the handover this Wednesday at 11am. 

    Keep going!
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    Getty Images

    SocietySeptember 7, 2021

    My miscarriage was hard. A stretched health service made it so much worse

    Guest writer
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    Getty Images

    I know that nobody at the DHB wanted to exacerbate an already traumatic experience. But the truth is, because of under-staffing and overwork, they did.

    There is a midwife shortage at Capital & Coast DHB, the health service for the Wellington region. I know this because I was recently pregnant. I also now know what it’s like to experience the process of losing my pregnancy without any support from a lead maternity carer because there simply wasn’t one available.

    When I discovered I was pregnant, a much-wanted and joyful experience, I reached out to three midwife teams that theoretically covered my expected due date and my location. In over a fortnight of waiting, and with a gentle nudge to each of them, I heard back from one of those three teams. They said they couldn’t take me and suggested I reach out to one of the teams that I was yet to hear from.

    Still, I enjoyed this news. I cuddled my husband. I marvelled at the weird sensations I felt in my body. I was starting to 3D print a person. It was strange and wonderful.

    When Google becomes your lead maternity carer it’s impossible to know what’s normal and what’s not. Everything is both a sign of a healthy early pregnancy and a symptom of a miscarriage. So, when I suspected something was wrong with my pregnancy, late on a Friday evening as my husband and a friend sat in our lounge, I didn’t have anyone to call except for Healthline.

    When I explained my symptoms to the kind nurse on the other end of the line, she asked me what my midwife thought about the pain and bleeding I was experiencing. When I said I couldn’t find a midwife, and couldn’t make heads or tails of what was happening using Google, she heard in my voice what I wasn’t able to say aloud quite yet: just tell me what to do, please.

    After receiving from Healthline the only clear piece of advice we were about to get for the next several days – go to the hospital – my husband and I awkwardly bundled our guest out of the house and left for the Wellington Emergency Department.

    Once I was triaged, I was walked through the bowels of the hospital and into a pitch-black ward and – this part feels as weird to type as it will be to read – they put me in what felt like a storage cupboard.

    For the next five hours, I sat, lay, and writhed in bouts of dull, radiating pain, on a rock hard gurney that was shoved into what looked like a storage space that had been haphazardly retrofitted into an assessment room. It had rows and rows of gynaecology equipment stacked on shelves, an old microwave, and a forgotten mug of something. The cabinets were covered with ‘reminders’ for staff, written in some thrilling font choices, but I wouldn’t have thought they were the sort of notes you put in rooms meant for patients. In fairness to CCDH, it’s important to say that they’ve since responded to a request for comment to say that the room is not a converted storage area. But it felt like a particularly unwelcoming space.

    While the whole cupboard situation made for some welcome distraction and humour at the time, I suspect more normal people wouldn’t find the concept of a miscarriage cupboard to be quite the piece of black humour that my husband and I did.

    After several hours, I was finally seen by some doctors. They once again asked me whether I’d contacted my midwife. “Oh yeah,” one of them said when I explained I couldn’t find one, “there’s a real issue with that at the moment.”

    The tests came back ambiguously bad, and while the three doctors who crowded into my “cupboard” and solemnly shut the door behind them seemed to be telling me I was having a miscarriage, they wouldn’t actually say it. Everything they said to me was cancelled out with “but it could be fine” or “we can’t know”, and, in the end, despite cramping, bleeding, feeling dizzy and having an alarmingly low HCG (pregnancy hormone) level, the only clarity I was left with upon discharge was to go and get some blood tests first thing on Monday.

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    My husband and I spent the next 48 hours in a thick, soupy mist of confusion and grief and uncertainty about the appropriateness of our grief. We cried. We watched the warmhearted and dorky 2008 caper drama series Leverage. We ate our body weight in pizza.

    During that time my symptoms intensified and I simply and unceremoniously realised my pregnancy had left me. The feeling of heavy fullness slipped away and I felt less laden, less swollen, less full of growth. I drafted emails to my clients letting them know I would be off the grid for a bit. I drafted cancellations for the antenatal classes and breastfeeding lessons I’d had to book months in advance to secure a place. I drafted emails to the two remaining midwife teams that had still never got back to me and said that they never needed to. I cried.

    On Monday I had my tests and called the hospital later that day for my results, when they were meant to be available. I was told they might not have answers for me because the laboratory was short-staffed and closing early. I contemplated the anxiety of more waiting and called back out of desperation an hour later. Thankfully, they now had my results.

    My pregnancy hormone levels, which should double every two days in a normal pregnancy, but drop in a failing pregnancy, were exactly the same as they had been 48 hours earlier. I’m not a medical professional, but to me, along with my bleeding and cramping and no longer feeling pregnant, this measurable stasis of growth screamed “Bad; Frozen; Not going anywhere; This is over.”

    But, like some fun new genre mashup of body horror and groundhog day, the hospital midwife on the other end of the phone said simply “These results are extremely strange, I don’t know what this means,” followed by the real kicker “You’ll need to wait for another 48 hours and go back and have more tests.” Then she all but hung up on me to get back to what was clearly another overstretched day in a sea of overstretched days. CCHDB has since confirmed that this was indeed a particularly busy day for them, and that contributed to the rushed call I received.

    In desperation, I called my GP and begged her to contact me as soon as she could. My GP was a women’s health specialist for several years but she now only works part-time after spending over 30 years serving one of the most diverse and complex communities in New Zealand. She’s also been my GP since I was seven, and I knew I could rely on her to see how desperate I was for any kind of answer.

    In a perfect world, she’d have been my lead maternity carer. In a less strained health system, she’d have appointments available sooner than every two to three weeks. But everything I read said how stretched GPs were and how midwives were the best option because, unlike GPs, pregnant people were their sole focus.

    My GP called me, listened to me explain what happened and heard me tear up as I told her all I wanted was a steer on what was happening. I asked that if she couldn’t give me a definitive answer, could she please take an educated guess.

    Full of warmth and sadness, she simply said: “I’ve seen the results, and I’m sorry to say that I’m 99% certain you’re having a miscarriage. Sometimes pregnancies just aren’t goers, my darling.”

    As much as this might sound strange, the primary feeling I had at hearing I had lost my baby was just relief. At least now I knew that I was allowed to grieve. At least now someone could tell me what was happening to me, what was coming next and what I needed to do to get through it.

    She explained in her no-nonsense but nurturing way that I “just have to strap on in and ride it out with some painkillers and a warm bed”. She said there would need to be one more round of blood tests in two days, and also confirmed that yes I was allowed to have some Lorazepam. She muttered that if I happened to have a wee sip of whisky to help the latter go down, she’d turn a blind eye. I laughed. I thanked her. I booked to see her at the end of this week from hell to check in.

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    For the next couple of days, I had that Lorazepam, drank a liberal amount of whisky, ate half a crescent of unpasteurised blue cheese and sent those emails in my draft folder. I archived my “Baby Stuff” Trello board. I howled in grief and pain doubled over in my bed. I placed my hands over my belly and I wished deep peace for what was previously alive in me. I asked its wave to return to the sea. For a moment, I felt something outside of myself and my own magic, step into my grief and cradle me gently in what felt like old, distaff love.

    I told my close friends and family. When they knocked on my door with soup and stew I answered the door with my hair in a Trunchbull bun and realised I’d forgotten to brush my teeth that day. I took the food they made me and we had cups of tea and laughed. I hugged my mum. She brought me a remembrance plant.

    I had the follow-up tests to track that my miscarriage was taking care of itself. The results came back showing that my HCG levels had halved and my GP explained that with every passing day my pregnancy was ending and my body was doing what it needed to do.

    As she foreshadowed, the pain got worse. It became a miniature labour as I contracted and cramped and emptied. I bundled up in bed with my cat who laid their paws across my stomach and purred into me. My husband brought me more cups of tea than any human should drink. He curled behind me, pressing on my aching back to ease the pain of contractions as they came and went.

    At some point in the haze of pain, wobbly legs and too much sleep, the second and last contact I had with a midwife occurred. I woke up from a fitful nap to find that a hospital midwife had left me a rushed and impersonal voice message to tell me that I was having a miscarriage.

    But she didn’t even say that. She said: “Your HCG levels have fallen substantially. Call back if you need to.” This news came without further explanation, a full day after my results were available to the hospital, and (thankfully) after my GP had outlined them to me a day earlier. CCDHB has since apologised for this delayed response.

    Friends sent more care packages. Gourmet food and flowers that felt like hugs from afar. I answered the door blurry-eyed and pantsless to a florist who’d clearly seen it all before.

    The haze of semi-labour began to ease, my bleeding slowed, and my husband and I had our end of the week GP assessment to confirm that I was coming out the other side.

    I was. I am. Things are slowing down, returning to normal. My body has done it all by itself, as it was made to if it needed to. I feel in awe of my body. A horrible thing happened, and it’s winding down from having got me through it.

    I am okay. I have quite truly been through worse and I suspect I am beginning my swim to the surface of this. I am philosophical about kids and pregnancies and the reality that not everyone can or will have them. I have no opinion about what my future holds in terms of babies, but I do know that I am lucky enough to have a child already, even if not biologically. I have a stepchild who brings me all the parental joy, frustration and pride anyone could ever ask for.

    If I happen to have a baby in the future, that’s great. If I happen to be unable to, well, my house is already full of love and a drive to do as much as we can for the world around us. If we have too much free time on our hands as we get older, my husband and I joke about getting matching Kathmandu tramping gear and becoming the sort of people that spend a lot of time in Nepal and are insufferable about it. So, Namaste to that.

    My hope is that people who have less support than I do don’t have to experience what I did with CCDHB. Midwives should not be in a position where they make someone’s miscarriage lonely and confusing because they are so overworked. The idea of providing warm, personal and timely healthcare should not be an unrealistic goal for maternity carers.

    I don’t believe that any person becomes a midwife with the hope that their career will one day entail leaving a voicemail on a stranger’s phone to deliver test results 24 hours after they were needed, not quite tell them they’ve had a miscarriage, then hang up. I don’t believe that the sort of people who want to be midwives enjoy setting up practice teams only to never get back to potential patients. I don’t believe that the people who work in gynaecology wards are thrilled about needing to assess patients inside a storage room. I do believe something is broken at CCDHB, and I hope it gets fixed soon.

    It’s important for me to state that sharing my perspective is meant to support better resourcing of midwives and maternity care at CCDHB, and not attack an understaffed and stretched workforce trying to provide important care as best they can. CCDHB has apologised to me for what happened, and I appreciate that.

    Where to get help

    Miscarriage Support has information on miscarriage, including links to counselling services and support groups

    Sands New Zealand is a network of nationwide miscarriage support groups which also offers support by phone and via private Facebook group chat

    Society