When terror struck in March, there was already a programme in Christchurch schools to help anxious children. David Williams reports.

Not Christchurch. Not again.

When the March 15 terrorist attack happened many people around New Zealand shook their heads, feeling the southern city had suffered enough. It was feared anxiety levels, frayed from years of earthquakes, would reach new heights.

And what of the city’s children? Previously they were uncertain if the ground under their feet would continue to shake. Now they were dealing with a story of unspeakable violence. For too many it wasn’t just a story.

The city’s most vulnerable, once again, were questioning their safety.

But even as Christchurch schools were locked down on that Friday afternoon – with kids confined to classrooms and parents unable to collect them – there was already a programme, Mana Ake, in place to help.

“He was very anxious and upset and refused to go to school for a while because he associated the lockdown with, ‘If I go to school I might not come home’.” – Christchurch mum Pip

Christchurch mum Pip says the mosque shootings were a setback for her eight-year-old son, who attends Hornby Primary School, in the city’s industrial south-west. A couple of years ago, when he was diagnosed with autistic traits, he was an “absolute nightmare” and would refuse to attend school. “He wouldn’t sleep, he wouldn’t eat, he was waking up at 4 o’clock in the morning ready to go.”

But he has made steady progress with the help of a teacher’s aide a few hours a day and through an introduction to disability services organisation LifeLinks. The boy was attending school for the whole day on Wednesdays and Fridays.

“But then the shooting happened and they had a lockdown, and they were at school a heck of a long time,” Pip says. “For him, he was very anxious and upset and refused to go to school for a while because he associated the lockdown with, ‘If I go to school I might not come home’.”

He has since been referred to Mana Ake – which means stronger for tomorrow – and is bouncing back. Fridays are now full school days.

Pip says the programme is new to her and she doesn’t know much about it. And while her boy is happy, settled, and in a steady routine, she might not have to call on it. But should his switch turn from “on” to “off” – “when he’s off he’s almost like a devil’s boy, to be honest” – she’s sure Mana Ake would be there. “It’s just like a safety net.”

Hornby Primary principal Gary Roberts says Mana Ake has been positive for his school. “It’s taken pressure off classroom teachers and also leadership within schools.” And while the shootings didn’t have a major effect on his school and local community, he says: “I would not want to be without it.”

Angry and anxious

Since the 2010 and 2011 earthquakes in Canterbury, not to mention the 2016 Kaikōura quake, there have been increasing concerns about the mental health of children. Five-year-olds are turning up to school anxious, angry and sometimes soiling themselves.

Since 2011, there has been a 100 percent increase in children and young people in Canterbury seeking help for severe mental health issues, leading to vastly increased waiting times for treatment. A years-long University of Canterbury study of 300 children found they were five times more likely to show symptoms of post-traumatic stress disorder than other Kiwi kids. That’s a huge concern in a country with consistently the worst youth suicide rate in the developed world.

Roberts, the Hornby Primary principal, says there was a growing trend across Christchurch of kids starting school with a variety of learning, social or behavioural problems, which teachers and schools were struggling to deal with. “At our cluster meetings, basically this was always top of our agenda.” For years, school principals and public health officials lobbied their respective ministries for extra money to deal with Canterbury’s mental health crisis.

Carolyn Gullery, Canterbury DHB’s general manager of planning, funding and decisions support, says: “The international evidence is quite strong about the impact of a natural disaster such as the Canterbury earthquakes and how it would particularly impact children who are under the age of five at the time, and children who are transitioning from primary school to secondary school.”

The province’s mental health crisis – described in 2017 as a “time bomb” – bubbled to the political surface in that year’s election campaign.

A month before the election, National Party Health Minister Jonathan Coleman announced 17 specific mental health initiatives, including an $11 million pilot in selected schools. Labour leader Jacinda Ardern countered with a $28 million, three-year programme to employ 80 mental health workers for children in years zero to eight in Canterbury and Kaikōura. The idea was to help kids suffering from mild-to-moderate issues before they became full-blown mental health problems.

Wigram MP Megan Woods, the Christchurch Rebuild Minister, says of Ardern: “She’d been hearing really clearly from schools that kids were suffering, that there were developmental delays, there were behavioural issues and there were anxiety issues.”

Ardern formed a coalition Government, of course, and became Prime Minister. Her Canterbury mental health promise was symbolically announced as Government policy on February 22 last year, the eighth anniversary of the quake that killed 185 people.

Designing the ship as it sails

Former High Court judge Sir John Hansen is independent chair of a body called Canterbury Clinical Network. Formed in 2010, it’s a way for clinicians to ensure other sectors of society – including those with the worst health statistics, like Māori, Pasifika, and immigrants – can have a say about how to improve the province’s health services. It came in handy after the quakes and was the obvious choice to turn Labour’s promise into reality.

Mana Ake was on a tight timeframe. A pilot programme started in April last year. A single practice framework, an agreed doctrine of how it would work, needed to be agreed by the 13 non-government organisations supplying the workers – organisations like Barnados, Christchurch Methodist Central Mission, and Pasifika Futures. Thought had to be given to how best to evaluate the programme, at the end of the three years. A new reference website, called Leading Lights,  for teachers and parents, was created.

Hansen: “We actually had to design it and start delivering it at the same time.”

First, schools were surveyed. It found teachers overwhelmed by having to deal with kids who were anxious, skipping school, and distressed. The kids needed help but, in the main, not specialist mental health services.

Gullery, of the Canterbury DHB, is a member of the network’s leadership team. She says some schools, in desperation, tapped into external counselling services, such as the Red Cross “and a whole random range of people”.

A meeting was called and about 60 people – representatives from the Ministries of Health and Education, as well as Canterbury District Health Board, police, Oranga Tamariki, and a range of non-government organisations – met to decide what was needed. Early on, the focus on mental illness was broadened to include wellbeing, so it wasn’t just about kids who were “sick” but also building and strengthening kids’ mental toughness and self-reliance.

That broadening of mandate meant the programme could employ people with a range of skills, called kaimahi – like youth workers, social workers, occupational therapists, and even ex-teachers. Woods, the Wigram MP, says: “We always knew it was going to have to be multi-disciplinary – there weren’t 80 child psychologists floating around looking for a job.”

Hansens says renaming the programme Mana Ake, with a more positive message, made it easier to deliver.

Canterbury schools have lobbied for better mental health support for years, Somerfield School principal Denise Torrey says. Photo: David Williams

Hansen shoulder-tapped Somerfield School principal Denise Torrey, a former president of the Principals Federation, to get schools on board. It was decided teams of kaimahi would be attached to clusters of schools, or kāhui ako.

There were teething problems. One Mana Ake team had all their workers away at the same time temporarily, on various types of leave. Given the range of deciles within clusters, Torrey says there were “equity discussions” about which schools had the greatest need for such a limited service.

Some schools had to create a system of working together, she says, and then discuss how best to work with kaimahi. At Somerfield’s cluster, Kahukura, special needs coordinators across the schools already met regularly. But in some cases, groups of schools were brought together just for Mana Ake.

“That is a challenge,” Torrey says. “When you’re used to advocating just for your school, now having to think about everyone else’s school when you sit around the table. That for some is challenging but that’s coming on. I think we’re starting to see greater understanding about how collaboration can work across schools.”

Mana Ake coordinator Clare Shepherd was cognizant the programme is only for three years. The main job of kaimahi is to work with children – with the parent or caregiver’s approval. But they’re not the solution, she says, they’re just part of it. Teachers are “step one”, Shepherd says. They might not be trained in mental health interventions, but there are simple things they can add to classroom routines that can help.

“They’re the people who are supporting children every day. So if they feel confident about the things they’re doing it’s easier for them to do them well, and to persevere.”

“It’s not perfect, it’s never going to be perfect, but it’s better than not having the resource.” – Denise Torrey

Late last month, Woods and Health Minister David Clark announced Mana Ake was now available in Canterbury’s primary and intermediate schools. Incredibly, a loose bunch of government agencies and interest groups had, in 12 months, designed and rolled out a mental health support system, staffed by workers from 13 NGOs, across 219 schools. That’s “quite extraordinary”, Hansen says.

The latest figures are that the programme has helped 820 children individually and another 475 children in groups. Programme coordinator Shepherd says the three highest “presentations” have been for children who are anxious, have poor social skills, and can’t regulate their emotions. “There’s a very clear mandate for us to be supporting children.”

Hansen says Mana Ake is solving problems that were “clogging up the system” previously.

Somerfield School’s Torrey says the programme is highly complex, still evolving and its efficacy is variable across schools because it’s so new. “Our own school, we’ve put in some groups and had some really good feedback from parents on the kids that have gone into those groups,” she says. “It’s not easy building something from the ground up. It’s not perfect, it’s never going to be perfect, but it’s better than not having the resource.”

Canterbury DHB’s Gullery says kids are already turning up to school more often and are more willing to learn. Feedback from schools and parents is “uniformly positive”, she says. “One comment that we have here from one mother was that ‘it’s demonstrated to my daughter that we as her parents love her, because she’s getting the focused attention she needs’.”

Lynda Stuart, the president of the largest education union, NZEI Te Riu Roa, says when she’s been in Christchurch people speak highly of the programme. Meanwhile, Sue Bagshaw, an adolescent primary care specialist, says Mana Ake is probably the best use of a limited resource. “I’m all for it.”

One way of measuring the programme’s success is through a commensurate drop-off in people using specialist mental health services. “Given the programme’s only been going a year and has only just reached the last schools, we’re probably about six months away from being able to see if there’s a change in the trend.”

Waiting times are improving, but it’s something the DHB was already working on.

Spike in referrals

When Christchurch schools were locked down on March 15, some kaimahi were in classrooms and able to reassure children directly. Many worked that weekend, preparing material for schools and teachers, and updating the Leading Lights website. Messages put out were similar to those used in England after the Manchester bombing at an Ariana Grande concert in 2017, and in Norway after the 2011 terrorist attack

Mana Ake covered only 75 percent of schools on March 15 but its support was offered to the worst-affected schools, even if they weren’t officially covered.

Hansen says there was an initial spike in referrals in the first two or three school days after the attack. Some children had pre-existing conditions or anxiety that was escalated by the trauma of the terror attack. Demand soon eased. After 10 days it was back to the usual level, Hansen says. But he notes: “We’re going to see the impacts for some considerable time.”

Shepherd, the Mana Ake coordinator, says when it comes to managing children’s anxiety, adults are key. “What we saw mostly after the 15th of March was a real escalation in adult anxiety. A lot of the work we did was meeting with parents, meeting with teachers around their anxiety, and helping to understand and normalise the responses that children might be having.”

It’s important to understand when something is scary or different, that it’s normal to be upset and nervous. “That doesn’t mean there’s a pending problem,” Shepherd says.

National was slow to respond to Canterbury’s mental health crisis, Waimakariri MP Matt Doocey says. Photo: David Williams

The politics over mental health in post-quake Canterbury have left deep scars.

The National-led Government shocked school leaders by announcing the closure and merger of quake-damaged schools in 2012. “It was disgusting what happened to our communities,” Torrey says. Five years later, the Education Ministry apologised after an Ombudsman report criticised it for lacking transparency and blindsiding schools.

A day after announcing Labour’s election policy in 2017, Labour leader Ardern clashed with Finance Minister Steven Joyce in Parliament. Joyce said the National-led Government wouldn’t back Labour’s plan, preferring its own plan to support vulnerable children. “We are committed to assisting not just the school children of Christchurch and Canterbury, who are important, but also school children around the country.”

(At the time, two-thirds of Canterbury wait more than three weeks for the first appointment with mental health services and 92 percent referred are waiting more than two months for their second appointment.)

Fast-forward to today and National’s mental health spokesman Matt Doocey, the Waimakariri MP, says he hears Mana Ake is doing great work. But there’s concern and frustration there’s not more help for children with complex mental health needs. “My expectation is if that programme was to continue, from any government of the day, then what we should expect after three years is a model that can then just be replicated in the other regions without having to go through that journey of piloting again.”

(The change in political fortunes is illustrated by Doocey, last week, writing a letter for a local primary school that wants money to provide its own counsellor. In 2017, Ardern asked Joyce if the Government’s mental health investment was so significant, why was one Christchurch school funding its own counsellor.)

Doocey, who trained in counselling psychology and worked in Britain’s National Health Service for 15 years, won’t say what National would do differently or commit his party to expanding the programme nationwide. “It’s not my role to announce policies for the next election.” But he admits National was slow to respond to Canterbury’s mental health crisis. “In saying that, I think DHBs have a big responsibility in this area. They are responsible for the health needs of the community they serve.”

(Gullery says the Canterbury DHB repeatedly raised the issue of mental health – “most particularly on children” – after the earthquakes. In February of this year, Health Minister Clark put DHBs on notice about their financial performance, as total deficits of about $346 million loomed.)

National’s not the only one being vague, however. Asked if the Government will expand Mana Ake, Wigram MP Woods says it will monitor the programme’s results and “think about what the future is”.

Is Mana Ake a pilot?

What happens now?

As always with governments that depends on how hard it’s listening and its priorities. But there appears to be an expectation that Mana Ake is a pilot.

Somerfield School principal Torrey says the Mana Ake governance group realises it’s being watched carefully around the country. “Because if this model that we’ve developed works here then it might work in other parts of the country.”

There appears to be a need. Coordinator Shepherd says some of what is happening for children in Canterbury is reflected in other parts of the country. Canterbury Clinical Network chair Hansen notes that beyond the significant earthquake-related elements upsetting the province’s school children, a lot of kids’ anxiety relates to being a kid in the modern world.

A mental health inquiry released last year called for early support for those who don’t reach the threshold for specialist services.

Ahead of May 29’s education mega-strike, NZEI has been pushing for better support for children with additional learning needs. There’s a teacher shortage crisis caused in no small part by the job’s stress and workload. Last week, NZEI’s annual health and wellbeing survey shows that in two years, threats of violence had increased by 57 percent and actual violence shot up 70 percent.

NZEI president Stuart says a growing number of pupils need support for mental health issues, trauma, and challenging behaviours. “We’re finding that support is not necessarily available. I’m not just talking about Christchurch, I’m talking about across the country.”

Is Stuart expecting anything in this month’s Budget? “I would hope so. This is a Wellbeing Budget, so I would be hopeful that we will see some increased support for our vulnerable children.”

“We almost need Mana Ake for the whole community.” – Sue Bagshaw

Bagshaw, the adolescent primary care specialist, is a director of 298 Youth Health and is one of the driving forces behind a Christchurch youth hub to help vulnerable young people. She’s calling for more Government investment in the training of mental health workers – particularly in the 13 non-government organisations supplying workers for Mana Ake. She thinks the programme could be extended to high schools.

But what she’d love to see is a shake-up of the mental health system. The “illness system” isn’t working, she says, so it’s best to differentiate health from illness.

“Yes, we need to treat mental illness but, actually, we also need to be creating and maintaining mental health.” Much more needs to be done in the community, “so people don’t have to actually become ill”, she says. “We almost need Mana Ake for the whole community.”

Back in Hornby, mum Pip is just grateful for the help her whānau’s received from their primary school. She doesn’t know where they’d be without them.

Principal Roberts hopes the powers-that-be will see the value in Mana Ake and continue to fund it when the initial three-year term expires.

Pip’s goals, meanwhile, are more personal. They’re about her eight-year-old’s continued stability and the hope that society continues to accept people who are different.

“I’m sure he’ll be fine,” she says of her eight-year-old. “He says he doesn’t like being a child because he’s got such limitations – he’s only allowed to do certain things because of being a kid.

“I think once he goes to high school and becomes an adult he’ll have more options available to him, and he will probably thrive … He will invent something or make something easier.”

David Williams is Newsroom's environment editor, South Island correspondent and investigative writer.

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