Yes we care.nz
The campaign for mental health services in New Zealand.
When he left Parliament in 2016, Green Party health spokesperson Kevin Hague said his unfinished business as an MP was his campaign to improve mental health services in New Zealand.
By then, Hague had already spent a year calling for an inquiry into mental health services. This campaign was motivated by concern at New Zealand’s suicide rates and the strain of sustained underfunding on the mental health sector.
Hague’s campaign was taken up by his replacement as Green health spokesperson, Julie Anne Genter, and by a number of others outside of Parliament. Amongst them were psychotherapist Kyle MacDonald and comedian Mike King, who teamed up with ActionStation to initiate a People’s review of the mental health system. I was involved in that process both as the lead author of the People’s Mental Health Report, and as a person with my own experience of mental distress and trauma.
A crisis in mental health services
The impacts of underfunding in mental health services were already well known to PSA members, as Andy Colwell, DHB mental health specialist and co-convenor of the PSA Mental Health Committee recalls. “Eighteen months out from the election”, says Colwell, “there was an increasing awareness that mental health was in crisis to the extent that the workforce was impacted, as well as service users.”
With this in mind, PSA members were encouraged to support the People’s Mental Health Review by submitting stories. This helped ensure the review included the experiences of people working in mental health, which in turn meant that the strain on mental health workers was one of the key themes identified in the People’s Mental Health Report.
Colwell says the stories in the report don’t surprise him. “Health workers have mental health problems as well. I know someone who had to leave the DHB because of the impact of this work on their own mental health. If your workforce isn’t looked after, how can you provide good mental health services?”
Part of the problem, according to Colwell, is that mental health workers have got used to working in a crisis situation. “We’re forced to discharge people who are not well enough to go home. On the other hand, we can’t admit people who are acutely unwell because there are no beds.”
This points to the other key themes in the People’s Review, which included barriers to access and wait times, the need for a wider range of treatment options, the lack of independent oversight of the sector, entrenched problems including compulsion and the use of seclusion and wider social and economic stresses that contribute to poor mental health in New Zealand.
These themes overlap, with underfunding contributing to not only staff strain and long waiting times but also, for example, to the use of seclusion. Colwell says he would like to see seclusion done away with altogether, but that would require a significant increase in staffing, including more peer support workers who are themselves well supported.
Do we need a review?
The People’s Review picked up Kevin Hague’s call for an independent and comprehensive review of mental health, and for the re-establishment of the Mental Health Commission. The review also called for an urgent funding increase for mental health services for acute and community based mental health services nationally.
Some criticized the call for a review, arguing that the problems facing the mental health sector were already well known and understood. But as we researched the report, it became evident that although everyone was clear on the specific problems they experienced in the sector, there was neither widespread agreement on what those problems were, nor consensus on how they could be improved.
An effective campaign
At this same time, the PSA was running its powerful Yes We Care campaign, which traveled around the country with 200 life-size cutouts representing health workers missing due to underfunding and with 606 shoes, each representing a Kiwi lost to suicide.
“This was an effective campaign,” reflects Julie Anne Genter, now the Associate Minister of Health, “because it had so many different elements and different groups playing on their strengths. You had the unions with members up and down the country. You had politicians asking questions in the house. You had service users sharing their stories. You had the media holding the government to account. You had citizens showing up to debates and asking questions about mental health.”
The work isn’t over
Ultimately, New Zealanders supported this campaign with their votes and, in January 2018, the new government announced the details of an inquiry into mental health and addiction. But the work for campaigners isn’t over, says Julie Anne Genter. “There’s still a key question about how the campaign will work with the review to ensure we get results,” she says, “because we need more than tweaks around the edges. We need clear policy recommendations from this review and we need them to be funded.”
Andy Colwell agrees, and wants to see people who use mental health services working together with those who work in them, not only to highlight problems, but also to shape how services should look in the future.
In terms of what that might look like, Colwell hopes the review will result in a significant increase of funding in primary health and more resources in secondary services. “Mental health care is very labour intensive,” he explains, “It’s not about tools, it’s about people with experience.”
In the long term, he hopes, acute services could be reduced because community services had been improved and economic and social stressors reduced. But in the short term, more beds are needed, along with an overhaul of current services, “but done in a way that takes care of the workforce, and makes mental health a sector people want to work in.”
“We need a mental health workforce that is well-supported, well-resourced and listened to,” says Colwell, “and mental health workers need to recognise the importance of working with people who access the services and to ensure their experiences and views are given more than lip service.”
By Marianne Elliott
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