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Mental health inquiry: change long overdue

Today, the report from New Zealand's most recent mental health and addiction government inquiry is released. Teuila Fuatai reports. 

So far, New Zealand has held six mental health inquiries. The latest, which began 12 months ago, is described as “significantly different” from its predecessors because of its wide-ranging scope and inclusion of “mental health problems across the full spectrum”.

At face value, the 215-page report ticks all the boxes. It provides a comprehensive picture of the shortfalls of the current system, highlighting significant problems with access to services for people in significant mental distress, and the importance and impact of failing to have services like counselling available at the crucial time, and place, when someone who is spiralling needs it.

Stories from those who have suffered through inadequate care, and their loved ones, paint a picture of an out-of-touch and under-resourced system. The serious consequences of poorly equipped, and in some cases under-qualified staff are also included. One comment from a family member in the report said:

“[My family member] went to hospital at 5pm that night after an attempt to kill [themselves]. Less than five hours later [they were] assessed and released with no way of getting home.”

Further into the report, a grieving mother shared her family’s story:

“I stated that [my son] was not safe overnight and that I had real concerns unless someone intervened. The hospital called the crisis team ... they were busy and unavailable to come ... the doctor told us… that [my son] should be given a zopiclone sleeping pill by the hospital and that we should drive him over to [town] first thing in the morning.

“My daughter and I took this advice as having full weight and medical authority. So we accepted ... While we were all still asleep, in the early hours of the morning, [my son] went to the garage and hung himself. So now we have no options ... This was a preventable death.”

The unavailability of services for those in regional parts of the country is also covered, as well as the stigma around seeking and discussing mental health problems and its impediment to quality care. 

Importantly, the impact of social circumstances like poverty, poor housing, employment and good quality education on mental health were discussed. “People saw poor mental health and addiction as symptoms of poverty, social exclusion, trauma and disconnection,” the report said.

“Threats to basic needs” like affordable and safe housing, good jobs and a steady, decent income were acknowledged as causing “chronic stress” for families, whānau and individuals. This had a negative impact on mental health, the report said.

Continuing this theme, the role of alcohol and drug use, as well as addiction and ease of access to harmful substances and normalisation of behaviours like gambling, was looked at. One service provider, advocating for tougher rules around the sale and promotion of alcohol, particularly to young children, was reported as saying:

“What a great way to induce suicide, depression and multiple episodes of interpersonal violence. What a wonderful way to traumatise children - just have their parents exposed to alcohol in their early teens so that their problems are well established by the time they have kids.”

Unsurprisingly the inquiry also recommended that addiction needed to be treated as a health issue, rather than a criminal justice one - with an emphasis placed on dealing with “root causes” like trauma, abuse and anxiety. Significant parts of the report also looked at the experience of Māori and Pacific within mental health services, and concluded many of the mainstream treatment approaches did not resonate with non-Pākehā individuals and families, exacerbating problems around communication and misinformation about health problems.

Overall, the report provided thorough evidence for changes in strategy and practice needed to amend the array of problems which exist within mental health services. Notably, it drew on research and reports which have, over the years, repeatedly pointed out the shortfalls in various areas of New Zealand’s approach to mental health.

In terms of getting practical change, feedback from those working in the health sector provided clear information about what needed to be done. For those workers, and perhaps some of those familiar with the ins-and-outs of the health system, it would have sounded all too familiar:

“We heard calls to shift resources from DHBs to NGO providers, which are closer to the community and better equipped to provide the services and supports that people need,” the report said.

“People saw DHB-provided services as institutional and bureaucratic, driven by rules that reflect the priorities of the organisation such as fixed budgets, deficits and competing health services rather than the priorities of individuals and families in need. Many feared that mental health services have a permanent Cinderella status among other DHB services and that addiction services are Cinderella’s poor cousin.”

Further in, the report also touched on the lack of progress in addressing mental health service shortfalls, noting resistance to shifting away from hospital-centred services.

“Within the health sector, the limited investment and lack of development in primary and community care has negatively affected the options available,” the report said. “This is despite strong evidence for focusing on primary and community care and early intervention and support, and the policy intent, expressed may times over the years, to target this growth area.

“By failing to provide support early to people under the current threshold for specialist services, we’re losing opportunities to improve outcomes for individuals, communities and the country.”

Looking forward, the inquiry panel - headed by Professor Ron Patterson - has echoed what so many health researchers, experts, patients and families have said before: “New Zealand needs to stop talking about the need for a continuum of services to address mental health and addiction needs across the spectrum and make action a priority”.

As the Director General of Health, Dr Ashley Bloomfield said in an interview with Newsroom three months ago, waiting for action from the inquiry was not an option:

“I’m interested to see what comes through from the inquiry report - but the changes that are needed are already part of our thinking. Whether there was an inquiry or not, those are the sorts of things that we would be thinking about and inviting the Government on.”

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