Mental health inquiry - line in the sand

The government’s inquiry into mental health and addiction is being welcomed with excitement and hope by a sector that is ready for change. Matters of Substance asked four sector leaders what outcomes they’d most like to see from the inquiry.

Sheridan Pooley
Matua Raki Consumer Leadership Group Chair

Sheridan Pooley wants to see some “blue sky thinking” from the inquiry.

“We should be helping people to make the changes they want to make, when they want to make them, with a much more diverse range of options available. At the moment, if you’re not comfortable with the principles of AA or Narcotics Anonymous, there’s not much else in the community.

We have to meet the whole continuum of needs, from the person who thinks they might have a problem through to someone whose life has fallen apart. Let’s get creative – a shop front on K Road, social media apps for teens – whatever it takes. Helping people earlier is more cost-effective too.

We need to ensure all the services are connected and have a map of what’s available because it’s really difficult for people to navigate their way through the system. The amount of people who say, “I wish I’d known about your service, I would’ve come sooner”. If you tried to draw that map now, it would look like a maze.

Currently, our services are set up to deal with acute episodes, but addictions require a chronic care model to provide cushioning in between.

I believe it’s crucial that we take a behavioural health approach to recovery. More important than finding out, ‘Why am I like this?’ is learning practical tools to change our behaviour. That’s the hard part.

So much of what we have in place is about accountability and compliance. Recovery needs to be the focus. The inquiry should investigate how our systems support or stymie that so we can refocus our efforts.”

Kyle McDonald
Psychotherapist, Nutter’s Club host and a key instigator of Action Station’s People’s Mental Health Report

Kyle McDonald says improved access is the key outcome for the inquiry.

“People should be able to access treatment when and where they need it. Our inquiry found the first problem people faced was getting into the system. Then they weren’t able to access the right or preferred kind of treatment. Lack of availability was the main problem, with wait times of up to 12 months.

The mental health system is so fragmented that access really depends on where you live. There’s huge variability nationwide and even within Auckland where community mental health services are divided into four areas. Some provide clinical psychologists; some don’t or have fewer. Access literally depends on which street you live in. If you move, you’re expected to transfer to a different team. Nationally, the picture gets even more fragmented, and it’s just as bleak in the addiction sector.

The inquiry needs to look at how the entire system is structured, the number of DHBs, how they interact with each other and how they contract out services to NGOs. A comprehensive map and plan as to how services are going to be provided would be a huge step forward.

The commitment to reinstate the Mental Health Commission, disbanded in 2012, is actually going to be the biggest factor that creates change, because it will mean an independent body, outside of the political system, will oversee and ensure the recommendations are implemented.”

Dr Vanessa Caldwell 
Matua Raki National Manager

Dr Vanessa Caldwell says the national addiction workforce development centre welcomes the inquiry and is geared for change.

“The outcome I’d most like to see is that we eliminate the barriers to treatment. As a community, we need to do a better job of letting people know where to go for help. Our care systems need better integration. At the moment, we’ve got 20 different systems depending on which district health board area you live in.

Care needs to be consumer focused, based on what people are seeking help for rather than a clinical diagnosis dictating the pathway of care.

Addiction treatment should not be seen as a tack-on to mental health. We treat addiction as a behavioural health issue and have a recovery focus. As part of someone’s care we assist them with all the components that contribute to overall wellness such as safe housing and building community networks. A multi-disciplinary team approach is the way to go.

I’d also like to see the scope of treatments extended to include low-threshold interventions. A huge number of people with mild addictions or anxiety can, with the right information and tools, treat themselves.

We urgently need a larger workforce. Our nationwide workforce of 1,500 has a capacity of 45,000 people a year, and that’s constantly maxed out. The estimated demand is 150,000, so people have to wait until crisis level for help. Crisis intervention is being done by Police who are doing a brilliant job, but it’s unacceptable they’re in that position.”

Phyllis Tangitu
General Manager of Māori Health at Lakes District Health Board in Rotorua

Phyllis Tangitu says better leadership is needed around reducing inequalities in a system that is failing Māori.

“There has been significant development of kaupapa Māori mental health services in the 30 years I’ve worked in the sector. The changes have been driven by Māori wanting to develop their own solutions for Māori, but in recent years, we’ve lost leadership support and kaupapa Māori has dwindled. Given how highly Māori figure in the statistics, it should be a priority.

I believe we can develop a community mental health service model that is embedded within a kaupapa philosophy that will meet the needs of all. The Māori way of doing things works well for everyone because it isn’t just about the mental and physical issues that may be occurring for the individual. We acknowledge them alongside their whānau and within their wider community, culture and environment. We recognise the importance of spirituality, rituals like karakia, our environment and how we exist within it.

We’ve got to weave whānau ora into all that we do, empowering our iwi to work within whānau and hapü to build resilience, particularly around suicide, where there is much more work to be done.

We need to listen to the voices of our service users and whānau and ask them, ‘Are we doing OK for you? Are we respecting what it is you need to recover?’

The Mental Health Commission developed the blueprint of what the mental health service need was per 100,000 population and how it was going to be funded. That blueprint was the catalyst for change. I hope that happens again with this inquiry.”