Mental health ranks as one of New Zealand’s major health issues. While there have been many innovations and improvements over the years, we still have some intractable and serious problems we must get on top of. We have one of the highest youth suicide rates in the world; high rates of seclusion and compulsory treatment; a great deal of variation in access to services for children and young people in particular, and in waiting times for access to mental health and addiction services. We have gaps in services to respond to people with common but often debilitating metal health and addiction issues, and too much variation in the quality of inpatient treatment services available to those who need them.
As the relevant Minister at the time, I was responsible for the development of “Rising to the Challenge”, the Government’s mental health plan from 2012 until earlier this year. It is currently being refreshed and updated by the current Minister. When “Rising to the Challenge” was being developed, I set out my priorities as improving the quality of services and the level of access for families and whanau, and for communities. I wanted more effective linkages and co-ordination between District Health Boards and the large number of community agencies active in the mental health and addictions space, both to develop services better tailored to people’s needs and also to bridge, wherever, possible, gaps in service provision.
Although there has been progress over the last few years and a significant increase in funding for mental health services, too many of the old problems remain. Our youth suicide rates are still intolerably high; the demand for addiction services remains strong, and services generally are still too disjointed and sometimes inflexible.
While all this is properly an issue for the Government, it should not be diminished into a political issue. Of course, it is proper to expect, and pressure, the Government to develop solutions that will address the public’s concerns, but it is most improper to turn this into a shallow political debate, with an arid emphasis on statistics, and who said and did what, way back when. We should never forget that behind every mental health case is not an abstract statistic to be tossed around, but a real, vulnerable human being, often with a family, struggling for a genuine solution to the problem oppressing them. Politicians seeking to capitalise on these situations are really trawling the most murky depths of the barrel and need to be called out as such. There is no honour in trafficking in human misery.
Rather, we need to be listening to the stories of the people and their families, and focusing on solutions that meet their needs. Inevitably, that is going to mean a variety of nuanced solutions, with the flexibility to account to the greatest extent possible for individual needs. This is one area where most definitely one size does not, indeed cannot, fit all.
Yet I remain concerned that we are still far too focused on broad-brush solutions, which fit within the rubric laid down by DHBs. I still believe there is insufficient recognition of the role community agencies can play in helping people overcome their mental health issues, and that we need to be encouraging greater co-ordination between the community and the DHBs on the models of care being developed.
The Government has to meet its obligations in terms of adequate funding, ensuring proper standards, and promoting public awareness, although it needs to do so alongside community agencies that are often much closer to people in their daily lives. But perhaps the most important role the Government can play is to be the listening post for the community’s stories, and then to act on those stories.
Shooting the messenger in such cases is just as bad as those vacuous politicians seeking to make political capital out of the overall situation. Human dignity is too precious and fundamental to be cheapened in this way.
A comprehensive mental health strategy should bring together all elements of society – patients, family and whanau, community organisations and government agencies. It must be as much a social justice strategy, as it is a health plan. It has to be about ensuring everyone’s right to wellness, and working across all agencies and boundaries to achieve that. After all, as the World Health Organisation has stated, “There is no health without mental health.”