Holding out for hope

Amal* has been trying to see a clinical psychologist since January, to no avail.

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counselling barely scratched the surface. ‘‘Exercising and journalling and mindfulness doesn’t cut it,’’ Amal says, ‘‘I have given them a real go, but it is not enough.’’

In January, she started to deteriorate again. That was when she started calling all the clinical psychologists around Nelson. In April, she made an appointment with her new GP, but the doctor said she couldn’t prescribe medication because she did not know her well enough. She told Amal to go to the emergency department if she was in crisis again. She left the appointment more distressed than when she walked in.

In the four years since she tried to end her life, suicidal thoughts had never left her, but now they surged to the front of her mind.

‘‘It’s not necessarily that you want to do it, but when things are so hopeless and no-one is willing to help, sometimes it seems like the only option.’’

She changed GPs and was prescribed medication once more, which has helped her function again. She goes to work, is in a relationship, and has friends. But deep down she is still unwell. ‘‘Depression isn’t something that has ever gone away. Sometimes it is big, sometimes it is small, but it’s always there.’’

She has frequent bouts of panic and struggles to connect with people around her. Sometimes she is too anxious to drive. Covering up her anxiety takes a lot of work. She feels exhausted.

This colours her relationship with her partner. ‘‘We are getting better at recognising when I am in a low mood. Now he just takes it when I am screaming because he knows it is not me, it is my illness.’’

After nearly a year trying in vain to see a psychologist, Amal is not sure what to do. She understands why so many had to close their wait lists, but wishes there was a gentler process to turn people away.

‘‘I feel like [the medication] is a Band-Aid and I don’t want to be on medication for the rest of my life. I am never going to know what is wrong and how to get better unless I talk to someone.’’

Transforming the system

It’s not a new problem. The idea that New Zealand’s mental health services were in crisis started to take hold in 2017. Staff and patients became increasingly vocal about overhauling the system and opposition political parties started to campaign on the issue.

After winning power that year, Prime Minister Jacinda Ardern’s Labour-led Government launched a mental health and addiction inquiry. Its report, He Ara Oranga, was released the following year, and the 2019 ‘‘Wellbeing Budget’’ signalled mental health was finally a priority. But frontline workers today report that little has changed. If anything, they say, things are even worse.

In 2019, in response to one of He Ara Oranga’s recommendations, the Government allocated $455 million over five years for mental health and addiction services that people could access at their GP surgery or in the community.

There was no extra money for specialist services though – the ones treating the more severe cases – outside of forensic services. The hope was that catching people early would ensure many would not deteriorate to the point of needing specialist services.

The Mental Health and Wellbeing Commission’s first independent report found the service was running in only 237 general practices – 23 per cent of GPs – by June 30 this year. The rollout for Mā ori, Pasifika and youth services was even worse.

It needed ‘‘urgent and dedicated focus’’, the report said. Recruitment had been a challenge, especially for kaupapa Mā ori and Pasifika services. Progress needed to continue ‘‘at pace’’ despite pandemic delays, and more funding was needed to treat severe cases in the community.

Meanwhile, demand for specialists such as clinical psychologists, psychiatrists and inpatient treatment is showing no signs of slowing down. Association of Salaried Medical Specialists executive director Sarah Dalton says funding for specialist services is set on the assumption that 3 per cent of the population will need them, but data spanning 15 years suggests the real need is closer to 5 per cent.

But Mental Health and Wellbeing Commission chair Hayden Wano is not advocating for a funding boost for specialist services that ‘‘feel they have missed out’’. He would rather invest in alternatives provided in the community, such as peerled residential care. ‘‘What I am resisting saying is: Put money there and it will fix the problem,’’ he says.

Undermining progress even more is the chronic underinvestment that preceded the Government’s flagship $1.9b 2019 Budget announcement, Robinson says.

‘‘The Government loves to round numbers up and make it sound big, but you need to compare that $1.9b investment with the level of underfunding already existing.’’

Signs of progress?

In the 10 years to 2019, demand for services outstripped funding by 39 per cent, according to research done by the Health and Disability Commission. ‘‘That is a lot more than $1.9b. I’m not going to sugarcoat this – the investment is not enough.’’

Health Minister Andrew Little says funding is being increased, but he’s frustrated by people saying more money is needed without saying how much more. Something, though, is better than nothing.

And Robinson is heartened to see at least some progress after decades of inaction. In addition to the rollout of primary services, several long-term programmes have started, including establishing a Suicide Prevention Office in 2019, repealing and replacing the Mental Health Act, and upgrading dilapidated mental health hospitals.

Robinson agrees with Wano that just throwing in more money won’t solve a chronic crisis. He likens the mental health system to a stool – increasing access to services is only one of three legs. The second leg attacks the root causes of mental distress (poverty, housing, family violence, racism), and the third supports people to better look after their own wellbeing. He despairs that so little has been done on this last leg, where the most rapid gains can be made.

Yet another complicating factor is public perception. When a government throws a lot of money at a problem, people expect it to be fixed. When that doesn’t happen, frustration grows. ‘‘There is clearly a level of frustration and concern that not everything that was hoped for has been seen on the ground,’’ Wano says. ‘‘Some of it is about timing and expectation and some of it is real.’’

Transformation will take time and leadership. Like Robinson, Wano says staff shortages plagued mental health services long before the Government committed more money, so there is a ‘‘sense of playing catch-up’’.

In September, as part of its response to He Ara Oranga, the Government released Kia Manawanui, a 10-year plan to tackle the causes of mental distress. It sets out short, medium and long-term actions, but Robinson says it doesn’t have any clear targets. ‘‘You can read this plan and not know what will happen next, when it will happen and who will be responsible for making it happen.’’

He believes Health Ministry officials panicked after the ‘‘big hoopla’’ around the 2019 Budget, and pushed money out the door before considering how best to spend it. ‘‘I know there were officials within the ministry who were frustrated with this . . . piecemeal approach.’’

* Names have been changed.

See the next part in the We Need to Talk series in tomorrow’s Sunday Star-Times. The project was created with financial support from a nib Health Journalism Scholarship.