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A chance to take mental health seriously

Among many other lamentable features, depression plays havoc with memory.

Events bleed into each other. So I couldn’t tell you exactly when it was, but at some point over the past two years I was struck with a bout of depression and anxiety serious enough to seek help at a 24-hour GP clinic on the Kapiti Coast.

My experience with Kiwi GPs had been uniformly poor when it came to dealing with depression but, after placing multiple unanswered calls to Lifeline, I didn’t have many others options. Sadly, the Paraparaumu-based GP was no better informed about managing a mental health crisis than his colleagues had been — which is to say he possessed marginally, but only marginally, more knowledge than the average layperson.

In fact, bereft of better ideas, he handed me the phone and suggested I try Lifeline again, which I did. Finally getting through, the woman on the other end of the phone went through her script effortlessly, conveying exactly the right blend of concern and empathy. Because I was unwilling to declare myself actively suicidal, she said, there wasn’t much they could do. But they would stay in touch. They had opened a file. “Kevin,” she reassured me, “you don’t have to do this on your own”. Since my name is not Kevin, it’s perhaps unsurprising the warm assurances of follow-up never came to anything.

Experiences like this are why the Ardern Government deserves unalloyed praise for making mental health front and centre so early in its tenure. The timing of the new review gives confidence that PM Jacinda Ardern, Health Minister David Clark and their colleagues are genuine in their eagerness to pursue long-overdue reforms in the treatment of mental illness in New Zealand.

There is always a danger that reviews such as these descend into tinkering or, worse, window dressing — showcasing a problem without the requisite resources or political will to actually solve it. Another inherent risk is that forces of the status quo will rally against meaningful reform, even as they ostentatiously cheer the process along.

“Kevin,” she reassured me, “you don’t have to do this on your own”. Since my name is not Kevin, it’s perhaps unsurprising the warm assurances of follow-up never came to anything.

Given mental health consumers are a disparate bunch — generally poor and poorly connected — we don’t stand a chance against the medical establishment, the pharmaceutical lobby and change-averse bureaucrats. Finding ways to elevate the consumer perspective in order to mitigate these structural disadvantages seems essential to me.

If there is one aspect of mental health where New Zealand arguably excels, it is in awareness campaigns designed to destigmatise mental illness. John Kirwan, Mike King and others have done God’s work bringing discussion of depression and anxiety into the public sphere, tackling reluctance to seek help, especially among New Zealand’s notoriously taciturn men. Such efforts save lives.

But awareness campaigns alone are no substitute for a comprehensive mental health policy. Yes, Kirwan and King deserve plaudits for getting Kiwis to own up to their mental health challenges, but getting inside the GP’s rooms won’t amount to much if you're met with blank faces and handed the number of a volunteer-staffed helpline.

Think about it this way. If you’re injured at work or on a sports field, your recovery is supported at every step through subsidised physio and other remedial treatments. And yet, when we present with an illness of the mind — no less debilitating, and often greatly more so, than a physical injury — you are more or less left to the voluntary sector, if not your own devices.

The public system will activate a crisis response if you’re suicidal, but this focus on building guardrails on top of the cliff seems as much an admission of failure as anything else. The best the public health system can offer is to stop you from killing yourself — otherwise, get used to being a charity case, Kevin.

Psychiatry is an infant science, and the treatment of depression, for example, is often a series of hits and misses with different combinations of treatments. In New Zealand, as it currently stands, both pharma and non-pharma treatments are extremely limited either because of Pharmac purchasing rules, prohibitive cost or inadequate capacity in the sector. For the 50 percent of patients who exhibit some or total resistance to the paltry range of antidepressants available in New Zealand, this is cold comfort.

Will they revisit deinstitutionalisation, a road paved with good intentions that has led many of society’s most severely ill to social isolation, poverty, homelessness and, way too often, incarceration?

For this review panel, my hope is they aren’t tempted simply to double down on awareness efforts as a means to avoid the many knotty public policy challenges that come with the territory. Critically, will they expand Pharmac-style subsidies for non-pharmacological treatments like cognitive behaviour or talk therapy, while also extending and modernising the range of drugs available under the scheme? Will they recommend a protocol to fast-track promising new treatments such as transcranial stimulation, the use of certain stimulants and hallucinogens, even cannabis derivatives?

Will they look across the ditch and consider duplicating Medicare’s funding of six (and up to ten) free counselling sessions a year for any eligible adult? Will they raise their sights even higher, proposing parity legislation such as that passed under former US president Barack Obama, which demands that state and federal governments, as well as public and providers, treat mental health as no less urgent or deserving of treatment than afflictions from the neck down?

Will they revisit deinstitutionalisation, a road paved with good intentions that has led many of society’s most severely ill to social isolation, poverty, homelessness and, way too often, incarceration?

There is much to love about New Zealand’s public health system, but our treatment of mental health is a glaring anomaly.

A panel that faces up to that reality, in tandem with a government willing to back their recommendations with the necessary reforms, could be a game-changer.

That Prime Minister Ardern deems the subject worthy of such attention is greatly encouraging. Nothing less than advocacy from the very top makes the tough slog of reform possible.

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