Conflating 'addiction' with mental health in the new inquiry could impose inappropriate solutions on a field with very different drivers, argues the University of Auckland's Peter Adams
Jacinda Ardern's announcement of Labour’s promised government inquiry into mental health and addiction services was good news for the mental health field, but I fear it will be a mixed blessing for the addiction field.
While a nationwide review of the extent and quality of our responses to addiction is long overdue, placing the word “addiction” next to mental health sets off a very loud warning bell.
The challenges we face with addictions may, on the surface, appear to resemble those encountered in mental health: they both involve someone caught in an overpowering emotional vortex; they both impact severely on families; they both contribute significantly to our appalling suicide statistics – and many people struggle with both mental health and addiction issues.
However, the similarities here are misleading. They mask some fundamental ways in which these two fields are different.
First, the most common forms of addiction, to alcohol, nicotine and gambling, owe much of their force to the legalised industries which package, advertise and promote their products. There is no equivalent to this in mental health.
Second, the consumption of addictive products is deeply embedded in our society. For example, the manner in which a society values and celebrates alcohol plays a big part in how problems emerge and what we do about them.
Third, while addictions have strong health impacts, they also have much broader social and societal impacts in terms of crime, violence, corruption, poverty and social disruption.
And finally, the treatment approaches between the two fields are based on very different ways of thinking about how people change. For example, while treatments for mental health tend to focus on ways of caring for and protecting people from harm, treatments for addiction place far more emphasis on strategies that promote self responsibility.
In my 40 years of involvement with both fields, I have been dismayed to watch planning for addictions being repeatedly tacked onto, and then wrapped up in, what are essentially plans for what is required in mental health.
For example, the Mental Health Commission, in its two previous Blueprints, simply subsumed planning for addictions into their documents with very scant regard for its specific needs. Similarly, in hospital services, mental health leadership has repeatedly incorporated addiction services under a mental health umbrella, leading to regrettable losses in terms of treatment integrity and innovation.
The formation of the committee for the current inquiry has assembled a group of people with experience and expertise around mental health. None of the committee have recognisable backgrounds with addictions. There is every reason to suspect the recommendations from this committee will repeat the imposition of inappropriate recommendations on the addiction field.
Ideally, at this juncture, the inquiry should be broken up into two separate processes involving two separate committees made up of members with appropriate expertise. Since the current arrangement is already well underway, I suspect this preferable solution will not be considered.
If two committees are out of the question, then the single committee could undertake a number of measures. They could include people with addiction expertise in their membership. They could form a sub-committee to look specifically at the needs of addiction. They could be tasked to provide two separate plans, one for mental health and the other for addictions. They could also look at separate consultation processes around the appropriateness of the recommendations in each of the two reports.
There are some other strong advantages to the whole inquiry in separating addiction from mental health. In comparison to mental health, the addiction field has a strong focus on the upstream determinants of health, particularly as it relates to poverty, justice and inequalities. Progress has already been made in areas such as harm prevention and reduction, and in developing effective ways of engaging general practitioners and other primary health professionals.
So, in an ideal world, the inquiry would run as two parallel but independent streams, each enriching the recommendations of the other in the final reports. With such an approach, we would avoid the pitfalls of imposing mental health solutions inappropriately on a field which has very different drivers.