Addressing issues in our mental health system - a position paper

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Time for change – addressing the issues in New Zealand’s mental health system

A position paper from the Mental Health Foundation of New Zealand

Introduction

Over the last three decades, New Zealand has made significant advances in its response to improving the mental health and wellbeing of our people. Within our mental health services, there are thousands of people working hard to support people experiencing mental distress and helping them to recover. Public awareness campaigns have made it more acceptable for New Zealanders to talk about mental health problems and to seek help.

However, there are many areas in which we can and must do better. Our growing and changing population, increased awareness of mental health issues and changing pressures in society are increasing demand for services and raising challenges for communities.

People who use, and work within, mental health services have been vocal about the need for change over many years. The limitations in our current system have been made clear by research, mental health and suicide statistics, mortality reviews, service monitoring data and advocacy led by people with lived experience of mental illness.

While some are calling for an inquiry into the mental health system, the Mental Health Foundation (MHF) considers this would not give us new insight and would divert funding, resources and attention away from the issues that need to be addressed.

What needs to change?

The MHF believes that the challenges faced by the mental health system must be addressed by investing in positive mental and emotional wellbeing and preventing mental health problems and suicide.

We must not continue to accept that individuals experiencing mental health problems will inevitably become so unwell they will need to be hospitalised. This trajectory can be averted for most people. We will not create better mental health within New Zealand by continuing with an imbalanced focus of resources on acute mental health services. Instead, New Zealand must increase its efforts in promoting wellbeing and preventing mental health problems from occurring.

We must also improve access to quality, effective support for people who are mentally unwell. To do this, we need to give people a range of support options, and to address the pressure points within mental health services.

Outcomes for Māori must improve. Although there have been some gains in Māori health, Māori continue to be over-represented in negative health and social outcomes. The MHF agrees with Māori authors that there are systemic issues for Māori in society and within the mental health system. There is a need to focus not only on social deprivation, but acknowledge the influence of institutional racism, cultural competence in practitioners, and colonisation as significant in the way mental health services assess and treat Māori. The MHF will continue to work alongside whānau advocating for an integrated system of culture and health, creating positive lifestyle changes that support flourishing whānau.

Ten point agenda for change

The MHF has identified 10 issues that are widely acknowledged by people with lived experience of mental illness, communities and people who work in mental health services as needing significant change. We intend to work with communities, the government, the health sector and the private sector to bring about change in these areas.

  1. Increased investment in prevention: Programmes that promote and teach wellbeing strategies have been proven to be effective at improving mental and emotional wellbeing and growing individuals’ capacity to respond well to life’s problems. It’s now time for national-level campaigns and action to support individuals, whānau and communities to care for their mental wellbeing. This should include continued efforts to reduce stigma and discrimination associated with mental illness. 

  2. Supporting individuals to help each other: Many of us will, at some point, feel concern for the wellbeing of a friend, whānau member, neighbour or colleague. Most New Zealanders feel deep concern and dismay at our suicide numbers. We will all experience challenges in our lives and go through periods of mental and emotional distress; nearly half of us will experience a mental illness in our lifetimes. The support of loved ones can be critical in recovering from mental health problems – our whānau, friends and community are often the real first-responders when someone needs help. We must build a social movement that empowers individuals and communities to have the knowledge, skills and support to have courageous conversations with those who may be experiencing mental or emotional distress and help them on the journey of recovery. Each of us should know what we can do to assist each other and feel that we can safely offer our support. 

  3. Easier access to talking therapies and early-intervention services: We need increased access to free or heavily subsidised counselling and other early-intervention therapies and supports (including peer support) so they are accessible and affordable for all New Zealanders. These supports must be available in a variety of forms including face-to-face, online and via telephone, as well as through schools, GPs and community organisations so individuals and whānau can get mental health support quickly and affordably. There must be increased promotion of and continued investment into effective e-therapies such as The Journal and SPARX. 

  4. Strengthening the role of primary health care providers: When an individual is unwell, their GP may be the first person they reach out to. GPs need ongoing training to ensure they can effectively respond to people experiencing mental and emotional distress. GPs should be enabled to spend more time with patients who need extra support and should be able to make urgent referrals to counsellors and other mental health supports. 

  5. Adequate staffing levels across all mental health services in all DHBs: In light of rising demand for services over the last decade, DHBs need to prioritise an adequate and stable mental health workforce in hospital and community settings. This will ensure that people are receiving the support and care they need to recover and can have access to an appropriate mix of home, community or hospital-based services. Improving staffing levels would reduce the pressure on mental health workers and ensure they have safe and supportive working conditions. 

  6. Integrated, person-centred crisis responses: In a crisis, any door should be the right door and lead to high-quality, integrated support. We know this is currently not the case; crisis responses vary in effectiveness depending on how and where individuals first access support – whether it be through the police, hospital emergency departments, mental health crisis teams, GPs, alcohol and drug services or helplines. Some of these points of access are currently stretched. They should be adequately resourced and staff should be trained to help support people in crisis without judgement. Individuals should not be turned away from services because there is no capacity to help them – they must be supported to access adequate and appropriate care when they need it. 

  7. Eliminating seclusion, minimising restraint and reducing use of the Mental Health Act: Compared to other, similar countries, New Zealand makes high use of compulsory treatment for individuals experiencing mental illness, which removes individuals’ rights to decide on their own medical treatment. Across the country, many services continue to use non-therapeutic practises such as seclusion and restraint, causing distress to both patients and staff. The use of these practices differs significantly between DHBs and across population groups (Māori, for example, are far more likely to experience seclusion than Pākehā). As a country we must take swifter steps to entirely eradicate the use of seclusion, minimise the use of restraint and reduce the use of compulsory treatment under the Mental Health Act. 

  8. Joined up, recovery-focused services: Many clinical services remain too focused on diagnosis and the subsequent treatment of symptoms without prioritising a need to understand the full picture of each individual’s life circumstances and experiences. It is essential that services are oriented to expect recovery, and that individuals are given the holistic social and clinical support they need to function well and control their own lives. Mental health services should connect with other medical services to provide joined-up care for people with more than one diagnosis (e.g. a mental illness and a drug or alcohol addiction). Services should connect and work alongside social services such as housing, Whānau Ora, employment and education to support individuals to lead lives where they have choices and dignity. 

  9. Services that include and value family, whānau and culture: Services are more effective when they understand and respect individuals’ support circles and identities. A person’s connection with their family, culture and identity can be a source of strength and recovery. Staff training, flexible systems and inclusive practices are needed. This is true for all people and is especially relevant for Māori, Pacific, Asian, Deaf and LGBTI communities. 

  10. Local research about what works: While change is clearly needed, we don’t have all the answers. As New Zealand designs campaigns, systems and services to improve wellbeing for all of us, we need to evaluate new approaches and share successes across the country.

Finally, the MHF emphasises that there must be political, community and individual will to tackle the social issues that can contribute to poor mental health.

It is disingenuous to simply treat the symptoms of mental health problems without addressing the causes of mental ill-health. It’s time for a joined-up community response to issues such as discrimination, misuse of alcohol and drugs, poverty, unemployment, child abuse and family violence. New Zealand has many advantages as a country, but these issues are significant barriers to progress toward a New Zealand where we can all live and function well.