In the year to June 2020, 654 Kiwis died by suicide. With such staggering rates, non-governmental organisations (NGOs) like the Mental Health Foundation are playing a crucial role in holding the Government accountable in implementing the recommendations in He Ara Oranga: Report of the Government Inquiry into Mental Health and Addiction (2018).
The recent spat between the Foundation and the Ministry of Health shows on the one hand a resistance to criticism and on the other the need to cultivate practices of listening between all stakeholders in the mental health sector.
Historically, a culture of silencing has always characterised the sector. Historian Petteri Pietikäinen described such a culture as “the most unfortunate legacy of the Age of the Asylum”, when patient voices were often manipulated and mostly silenced.
I remember reading a letter in an overseas archive that proved the insignificance of patients’ voices. In 1893, Sajan Curim wrote to complain to the Bombay government after he was released from an asylum in the city. His letter noted that basic facilities were absent, medication was lacking and staff were abusive. But the superintendent in charge nonchalantly dismissed the letter, calling it a sign of Curim’s ‘insanity’. Curim’s voice mattered little even beyond the asylum walls.
We have come a long way since the Age of the Asylum but still need to disrupt such legacies. So, while the process of transforming the mental health sector involves additional resources and personnel, it also needs a transformation in approaches and institutional cultures.
This is why NGOs play such a crucial role in representing the voices of mental health sufferers and their families. By holding the Government accountable in implementing He Ara Oranga recommendations, they are bringing about much needed change in approaches to mental health sufferers.
He Ara Oranga was a step in the right direction of enshrining a culture of respecting the voices of mental health sufferers. The report had a whole chapter dedicated to listening to their voices and those of their families. The report’s inquiry team described the practice of hearing the voices of the community, people and those with lived experiences of mental health and addiction challenges as their “first job”.
The report also called for a shift from ‘big psychiatry’ to ‘big community’. A big community approach is one that focuses on wellbeing and is committed to partnerships at all levels. Listening is the key to growing that partnership and building relationships of trust across the sector.
Organisations like the Mental Health Foundation have done well in criticising the Government and pressuring it to take decisive action. In doing so, they have simply reiterated what He Ara Oranga noted, that “Honouring the voices of the people means decisive action is needed”.
One suggestion to ensure all stakeholders are heard is to appoint a minister to look after mental health, following the example of countries like the United Kingdom and Japan. This would help the Government become more focused on implementing He Ara Oranga recommendations and speed up the reform process.
As a country facing a mental health crisis and with a youth suicide rate that He Ara Oranga calls a “national shame”, silence is not golden; it is simply unaffordable.
Dr Sarah Pinto is the author of Lunatic Asylums in Colonial Bombay: Shackled Bodies, Unchained Minds (2018).