Around 500 New Zealanders die by suicide each year, while the effects of each of these deaths ripple through whanau, friends, colleagues and communities. New Zealand’s youth suicide rates are the worst in the OECD. The latest figures show a sharp and steady rise in demand for mental health services between 2008 and 2016.
Anecdotally, we’re told mental health services are under more pressure than ever. For the first time, the Government is undertaking an inquiry into mental health.
Rosie Gordon speaks with Dr. Barbara Staniforth, Director of Social Work at the University of Auckland.
What is the state of the situation? Can we change the discussion?
Do you think it would be fair to say New Zealand is at a crisis point with this now?
I think that we’ve been at a crisis point. I’ve been in New Zealand now for twenty-two years, and I was recruited from Canada to come work here when we were in a crisis after the Mason Report, and I think that we have been in a crisis since I got here. Things don’t seem to be getting much better though.
We’re having this discussion against the backdrop of the Government’s inquiry of mental health so I wanted to start off with some of your main concerns facing mental illness in New Zealand.
There’s the big issue of funding and a system that’s really bursting at the seams in terms of people requiring service and a lack of resources given to being able to provide service. So I think there’s a big resourcing issues. I think there’s also a focus on trying to not deal with the person as the whole but seeing them within a really specific context of the mental illness, so we espouse having a recovery approach, but in reality we have a system that’s very focused on treating illness from a medical point of view. And we have a society that stigmatises people who have mental illness, and others them. So I think that’s three issues facing people that confront or experience mental illness at this point.
So, we hear a lot about things like helplines and subsidised counselling. What’s the reality for people who are going through that process, you mentioned it’s more of a medical approach?
I think that our system responds to crisis only. We’re not very good at putting money in terms of prevention. Most of the NGOs [which] provide things like counselling have experienced difficulty with funding and on-going renegotiation of contracts. We have less access to the resources to treat a person as a whole that might prevent a person from getting to a point where they require mental health services. We come in too late.
What are those resources that would help with prevention?
The biggest things that the Government is looking at are issues to do with child poverty and the conditions that people lives within in our society. We have incredibly high rates of family violence and child abuse that are kind of staggering, really, in such a beautiful place in the world that we have situations that really are untenable for people to live within. We also have the impacts of colonisation that are still being felt in terms of disproportionate number of Māori, who are impacted by mental illness, due to, probably, living in situations that increase their stress and don’t give them the resources that they may need to cope.
The other group that often comes up is our youth. We’ve got some of the highest statistics of youth suicide in the OECD. Have you been able to figure out why that might be, or have any thoughts on why that is?
Well, certainly I wouldn’t be the expert that would provide the golden answer, and I think that the real answer is that we don’t actually know why. We do think that it’s likely as a result of having really high rates of family violence, child abuse and incredible rates of child poverty. So we have a breeding ground for the conditions that likely increase someone’s susceptibility to mental distress, disempowerment and seeing suicide as an option.
What’s it like for those medical staff on the front lines working in the system that they are?
We have medical people working within the district health boards, which are the primary, tertiary treatment settings for people that experience mental distress and mental illness, and those people really care, and they really want to do well by the people that they work with. But, they are under incredible pressure in systems that have not filled positions, lots of people trying to get in who can’t because we don’t have the staffing. We don’t have the resources to be able to provide the service that people need to be well. So we do see burnout; we see high turnover, and we do have a lot of good people working in mental health, but you can only work within that system, in such an overstretched way, for so long.
And how does that particularly manifest its self in our rural communities as well?
We’re seeing fairly high suicide rates in rural communities as well with older men. Rural communities are particularly tricky because we have such high areas that you have to cover. There’s a lot of ground to cover, so travel time takes longer, and rural areas don’t have the same access to other services, in terms of NGOs, that you might find in the city – so again we have a system that has not many resources to respond to crisis – especially in rural communities.
Would you say that perhaps the three main groups of concern would be Māori, youth, and our rural communities?
Those people are particularly impacted by societal stresses and maybe don’t have the same kinds of access to resources that other communities do, but I guess the message also needs to be that mental distress confronts everybody. And it isn’t limited to certain groups of society so certain groups are disadvantaged to start with, and that makes life a lot harder than people who do have access to resources. But it’s not a matter of just those people, and that’s a message that we all need to get out too. Mental illness isn’t limited but access to services is.
I just want to go back to the treatment process as well. What do you think of how diagnose a mental illness and the steps that follow that?
I think it’s tricky because we still work within a medical model that looks at diagnosing of presenting symptoms and that doesn’t necessarily look at the full picture of a person, within their whanau and within society. And I think that that often results in an over-reliance on medication in terms of the first mode of treatment, because it’s quick, it’s often effective, but it only treats one part of a person. We don’t offer a broader range of services and treatments that looks at the person as a whole. We also see that funding has waxed and waned depending on governments. Things like the Mental Health Commission, which probably served a really important role in terms of monitoring the state of mental health care were cut back in previous governments, so we have gone on a bit of roller coaster really.
I am wondering how we got to this point because when a lot of people think about New Zealand, they think really good social welfare policy, good clean environment, and that sort of thing. I suppose from an outsider’s point of view it’s surprising. . .
It sure is. But I think that a lot of what we see stems back to the 1980s reforms in terms of neoliberalism and moving away from the view of the state providing care for people and bringing in a more managerial meeting of targets as being what’s important rather than caring for people. And again, I think that different governments have responded to that in different kinds of ways. So hopefully with the review, that’s going on and the current government that we have we will see the importance of taking care of people.
Is there anything you’d like to see specifically come from that review?
I would really hope that we get access to more resources that are able to invite people in for treatment rather than try to keep them out due to lack of resources. I think it would be really good to reinstate a Mental Health Commissioner, in terms of having someone who is kaitiaki to taking care and ensuring that good services are provided. Targeting interventions that bring children up in environments where they have food, shelter and love and aren’t abused – would make a big difference. But again, that’s kind of a big picture thing. And again, more looking towards recovery of helping people live well with mental illness and distress rather than being so concerned with curing and risk, that come from medical models.
It’s not something you can take a pill for and be fixed, it’s something you work on overtime.
Yeah, and if we see it within the context of society rather than it being an individual issue, that idea that we all live with mental distress and mental health that fluctuates and that there isn’t this group of other people that exists but it is us and we have a responsibility to care for us and everyone else.
As a social worker who’s been working in this landscape for sometime, how do you feel about where we are at and what hope do you have going forward?
I think that many people feel very hopeful that we have this inquiry happening and we know that there have been a lot of submissions made. We also feel hopeful about the new government’s commitment to improving services for people who have mental health distress. So I think that there is hope now that we haven’t had for a while. One of the things that we see is that out of crisis comes change. Hopefully, change will be coming.
Rosie Gordon is a postgraduate student in International Relations and Political Studies at the University of Auckland. This is part one of a five-part series looking at the issue of mental health in New Zealand.