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.
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.