Anna Rawhiti-Connell is three-quarters of the way through her psychology training, but no closer to understanding why we’re not taking serious action on our mental health crisis. It’s time the Government threw some solutions at the wall and sees what sticks, she writes. 

Aged exactly 40 years old, I stared into the bathroom mirror, absent-mindedly plucked out a chin hair and wondered what the hell I was doing with my life. It was such a shock to find myself here, cliché made manifest, and I expected no answer.

I have always thought of myself as a late developer and not particularly intrepid. Bolts from the blue are not for me, nor great leaps of faith or radical deviations from the path of life I carefully plot out, forecasting ahead to ensure the decision is right for myself and those around me.

And yet an answer did arrive, itself another cliché from the grab bag of midlife clichés you assume only exist as a plot device in films and television shows.

I realised that I wanted to do something that might help people. Possessing what I think is a reasonable amount of grit, and the kind of pragmatism that often develops with age and might be useful when working within any system you can think of, I decided to enrol in a Graduate Diploma of Psychology with a view to becoming a clinical psychologist.

I remember barely being able to whisper that to people in the early stages of discussions. It felt like I was arriving very late to the frontline, armed with half a sticking plaster and noble intent.

I am three-quarters of the way through that diploma now, delayed by the toll full-time study would take on our household finances and our quest to buy a house. As we watched the goal posts shift on our deposit requirements, I realised I needed to work as much as possible, furiously shovel money into a savings account and most definitely not present to the bank as a full-time student and part-time writer.

Since that decision two years ago, the realities of what’s involved in becoming a clinical psychologist have dawned rather sharply. I wouldn’t be able to work for five to six years. I’d be taking on a second student loan, which would total at least $60,000, and then I’d have another 10 years of 12 percent of my above threshold earnings being docked to repay that loan. The starting salary for a trainee clinical psychologist at a DHB is $56,000 – $59,000.

That pursuing this path is still within the realms of possibility for me also says something about my socio-economic status. But I’m not the only shade of clinical psychologist you’d want to see working in a system that seems to be especially failing Māori and Pasifika people.

Anecdotally I know of other people who’ve been contemplating midlife career changes to work in mental health but have been unable to do so since the postgraduate student allowance was stripped out of the mix in 2013. Based on the current financial burden training creates, we may end up with a public sector clinical psychologist workforce that looks like me and not a lot like many of the people who might need the services it provides.

There is currently a shortage of clinical psychologists in New Zealand, as there is a shortage of nurses and other health professionals to work in our mental health system. To read Oliver Lewis’ excellent series for Newsroom on mental health was an exercise in rage suppression. The third piece in that series speaks directly to the staffing shortage, with Dr Gabrielle Jenkin describing the dominant treatment model as “meds and beds”. Many inpatient clinics don’t have a dedicated clinical psychologist and patients aren’t able to access talk therapy.

One of the realities of clinical psychology training is that there isn’t a shortage of people trying to enrol in courses, despite the overwork, demands of the job and a pay packet that doesn’t seem commensurate with the time and cost involved with training. As a friend of mine who is a clinical psychologist said, “No one is in this for the money”. The limit in how many we can produce is dictated by the demands training places on tertiary education providers and clinical internship programmes. At Victoria University, for every person who gets into the programme, nine times as many people apply. Logic might suggest we need to fund an increase in capacity but demand for mental health services is such that what looks a simple answer is fraught with the complexities of a problem ignored for far too long.

In 2019, when the Government announced a promise to set up a new frontline mental health to help 325,000 people by 2024, Dr Dougal Sutherland, a clinical psychologist from Victoria University of Wellington, was quoted in a Stuff article at the time asking ‘But who will staff this service?’ To meet the government target, the workforce would need to double in that time. He argues for a complete reshaping of mental health services.

An article in the New Zealand Medical Association Journal posits a similar question, suggesting that doubling the clinical psychologist workforce would take a decade. It goes on to suggest that it’s simply not feasible to address the rising need for mental health services based on current resources through workforce growth alone. I am sure the Government was delighted to see that its first recommendation was to address the poverty gap based on the inarguable correlation between deprivation and psychological distress.

We keep getting told by the Government that creating meaningful change, change that will stick, takes time. And I could buy that in this instance if the first flagging of this particular workforce shortage was four years ago in He Ara Oranga, the Report of the Government Inquiry into Mental Health and Addiction, in 2017. But it wasn’t.

A 2002 workforce stocktake by the Health Workforce Advisory Committee identified a range of shortages, including those within mental health. In 2006, a report published by the Ministry of Health on health workforce development flagged that “the most significant change facing the New Zealand labour market over the next 25 years is that many more workers will retire than will be recruited”.

The Te Pou report in 2015 identified a range of mental health workforce pressures, including that old ageing population chestnut, stating that “the volume of demand presenting to the system is increasing, mostly because of multiple failures in the current system”.

Unsurprisingly the immutable truths of demography were mentioned again in a 2018 workforce stocktake. “To maintain the status quo and keep pace with population growth, the secondary mental health and addiction workforce may need to grow by 4,000-5,000 FTEs over the next 10 years, largely due to workforce ageing.”

Pick a year, pick a mental health report and we have a graveyard of recommendations, some of which have no doubt been implemented, but none of which have prevented the crisis we’re in now.

When certain sectors have well-flagged workforce shortages, is it not time for the Government to reach into their grab bag of possible solutions and put a few on the table? It may be that doubling or tripling the number of clinical psychologists produced each year isn’t enough to deal to the crisis alone, or indeed for many years, but surely if we don’t start doing something tangible now, the alternative is several more years of ignoring the problems that have been well documented for years and a deepening crisis?

It’s against my very careful and deliberate nature to suggest this and it will no doubt curdle the blood of many a Wellington bureaucrat, but perhaps it’s time to throw a few things at the wall and see what sticks? Fund Mike King’s programme, fund the expansion of Te Ara Oranga, the methamphetamine reduction programme in Northland, and fund postgraduate student allowances for workforces with demonstrable shortages. Try adding clinical psychologists to the Ministry of Health bonding scheme. Try increasing the amount of funding given to tertiary education providers for clinical psychology programmes so that it reflects the resource required. Try investing in the actionable recommendations of the He Ara Oranga report knowing that they may not come to fruition for a decade. Try increasing benefits so that you might slightly narrow the poverty gap. Try staring into the mirror, plucking out a chin hair and seeing if an answer arrives!

God knows, the glib think-storming of a columnist with three-quarters of a graduate diploma in psychology is the last thing we need but when the writing has been on the wall for so long, it’s hard to ignore my careful nature and suggest that an enormous, joined up, transformative solution is just not possible. Instead, change might need to be piecemeal and incremental. It might need to involve giving things a whirl. It might need to be about enabling a whole lot of people who are giving things a whirl to get on with it. It might mean throwing money at problems without being 100 percent certain that your investment will have sticking power. Nothing is 100 percent certain anymore. Just as rapid change, volatility and uncertainty have contributed to the current demand for mental health services, so too will it alter what demand and delivery looks like five years from now. Do we truly think there’s one true centralised answer to this crisis that will surely solve everything forever if only we let it cogitate for long enough? It seems the longer we wait for the perfect, transformative solution, the likelihood of the net result being more reports for the graveyard, increases.

Despite the severity of the mental health crisis, I remain undeterred from wanting to pursue my studies. I am not asking for a free second chance education. I’d be ineligible for a postgraduate student allowance if they were reintroduced anyway, so I will throw some possible solutions at a wall and figure it out. What might be nice to see though is an indication that I was joining a workforce that was tangibly valued and not a perpetual point for noting in yet another report.

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