For the first time in many years, this week’s Mental Health Awareness Week is tinged with hope, hope that our beleaguered mental health system may at last be in line for change.

In 2017, the Government announced it would hold a national inquiry into mental health and addiction (Oranga Tangata Oranga Whanau) with the ultimate goal to improve outcomes in those areas for New Zealanders. The panel was asked to look at how mental health is promoted and supported in New Zealand, and how interventions and services could be transformed to respond more effectively to the needs of people experiencing mental health and addiction challenges, including people affected by suicide.

After receiving more than 5500 submissions from more than 2000 people, the panel of the Government Inquiry into Mental Health and Addiction has now entered its deliberation phase. And it has much to consider.

Since the groundbreaking Mason Report in 1996, which provided an influx of ring-fenced funding for mental health and created the Mental Health Commission (disestablished in 2012, re-established in 2017) to oversee mental health service delivery, the demand for mental health services has grown, but per capita funding has not.

In a country which has once again climbed to near the top of OECD nations’ suicide tables, this is simply not acceptable.

When National cut funding to mental health and did not respond to a call for a mental health inquiry, a group of concerned stakeholders’ crowdfunded in order to explore a system which they believed to be in crisis. Over 500 people responded to a call for submissions and the People’s Mental Health Report was published in 2016.

Issues that emerged at that time revealed an underfunded system where many people faced unacceptable waiting times for treatment. While recognising many well-meaning health professionals worked within this system, they appeared to be overstretched and under considerable strain themselves. Suicide and self-harm rates were rising, and people reported considerable duress due to trauma, and social and economic strain. This all occurred within a backdrop of concern that there may not be coherent oversight of the whole system following the disestablishment of the mental health commissioner position.

There are several challenges facing New Zealand as a society when it comes to mental health or distress:

– We have funding that is often reactive, responding to crisis.

– We’re not very good at funding prevention.

– Most of the non-government organisations that provide services like counselling have difficulty with funding and the uncertainty that comes with on-going renegotiation of contracts.

– We have less access to resources that treat people as a whole beings – those resources that may prevent a person from getting to a point where they require mental health services.

– We come in too late.

Despite recent initiatives such as the Like Minds, Like Mine programme and more people acknowledging living with mental distress (thank you, John Kirwan), stigma still thrives. People are often said to be more “disabled” by the stigma surrounding mental illness than by the illness itself.

Our mental health systems have traditionally come from a medically oriented, disease perspective of mental illness, where attempting to cure a person from symptoms of their mental illness has been the focus. This has mainly been done through use of psychotropic medications, and in some well-resourced areas, counselling or therapy.

But mental wellness or illness does not occur in a vacuum. A lot of what we currently see likely stems back to economic reforms of the 1980s as we moved away from the state providing care for people and focused more on managerial meeting of targets. We have incredibly high rates of child poverty, family violence and child abuse that are so discordant with being in such a beautiful place in the world. We also have the ongoing effects of colonisation being felt still in terms of the disproportionate number of Māori impacted by mental illness, suicide and addiction. The social determinants of health are also very real for mental health – the cracks that exist in an uncaring society show up strongly here.

So if there is hope, what may it be for?

It has already been heartening to see the re-instatement of the mental health commissioner position. There is also hope that Te Pou, the government agency charged with developing the mental health workforce, is currently “refreshing” what it believes to be key skills, values and knowledge required for working in this area. It states that there has been a considerable shift in ideology within the past 10 years, with more of an emphasis on a different kind of “recovery”. This recovery sees people being treated holistically and recognises that people can live well, even flourish, while living with a mental illness. The focus is not on a clinical cure, but rather encouraging people to focus on a strengths-based, culturally appropriate and whānau-inclusive approach to overall wellbeing.

Progress will likely be advanced through a focus on things that make us all well. This may include actions like targeting interventions that bring children up in environments where they have food, shelter, love, and they aren’t abused. This may include proper funding, so we get access to more resources that invite people in for treatment rather than try to keep them out. Finally, true progress will be made when we realise that this isn’t about “them”, and that in fact, “them” is “us”.

Dr Barbara Staniforth is Director of Social Work at the University of Auckland.

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