Sunday 17 September 2017

A Policy A Day: Mental Healthcare

In the lead-up to the election, we are examining a policy a day. We're exploring a variety of policy areas, explaining the background and analysing some of the policy options, with a mixture of technocracy and values-based approaches. Inevitably, some opinion will make its way in and we make no apology for that - after all, we're voters too. A list of all the articles is available hereEnjoy!

Today's post is by Lauren Watson

If you are at risk and need help, please contact one of these wonderful organisations who do so much and can really help you through:
Lifeline: 0800 543 354
Suicide Crisis Helpline: 0508 828 865 / 0508 TAUTOKO
Depression Helpline: 0800 111 757
Youthline: 0800 376 633

The Problem
This year has really highlighted our shameful quality of mental health support. In May, the Public Service Association released a survey that found 60 percent of New Zealanders thought the government wasn’t doing enough for mental health. In 2013, suicide was the third-leading cause of premature death in New Zealand after heart disease and lung cancer, and New Zealand has the highest rate of youth suicide in the world.

Currently, people who are struggling with mental health are directed towards their GP. There, they can discuss their symptoms, be treated, and establish ways to manage their issues. Some District Health Boards have targeted specialist Community Mental Health Services, but you normally need a referral from a GP. University students may have access to limited but funded counselling services. Private psychiatrists are also available for those that can afford them.

However, these current access points have the same issues as most health systems in Aotearoa: accessibility and capacity. There aren’t enough GPs, the services they are meant to refer you to suffer from a severe lack of counsellors, and there is a massive underfunding of most mental health services. Support has not kept up with need, with an increase of 60 percent in mental health service users but only a 28 percent increase in funding since National came to power. The problem is exacerbated by poverty; when people cannot afford the copayment (the fee to see a GP), the loss of time at work or school, or cannot get transport.

Additionally, our social expectations around mental health have a strong influence. It is much harder for guys to go to the GP to talk about how they are feeling, in a country where men are not encouraged to express their feelings openly. This leads us to the much higher rates of suicide amongst men (double the rate of women), despite women having double the rate of (reported) depression. These issues don’t operate in a vacuum, and there are a multitude of risk factors that increase the likelihood of someone to commit suicide. Those with the highest levels of deprivation (based on the things that households lack) are significantly more at risk of suicide.

The Government
In terms of what policy is needed in order to improve the mental health of our communities, like most policy questions, there is no duct tape to fix it. Rising mental health issues in New Zealand are a symptom of many underlying problems across the facets of our society. The Ministry of Health’s new suicide prevention strategy is yet to be fully released, but the suggested actions from their hui have been:

Fostering connectedness
This is because most mental health problems are caused or exacerbated by a loss of support, whether that be from family or the community. So, trying to increase those bonds in communities decreases rates of depression. This is the hardest action point to achieve considering it’s so vague. Targeted programs such as getting groups of teenagers together outside of the pressures of school can be helpful for building communities and can target specific groups, such as young Māori men who are at greater risk of committing suicide. This leads in particularly well to the next action point.

Developing mentoring programs
The notion behind this is straightforward in that it helps ensure a safety net for two groups of teenagers going through transition periods: year 9s coming into high school and year 13s who are moving out of their high school communities. Mentoring programs can be utilised to ensure that both groups build relationships of support, which are key to establish networks that people can reach out to. However, the quality of these programs will depend on the school, and schools that have high bullying rates may not think that this is appropriate as it may be a way for students to be isolated and picked on.

Training parents on how to talk to their children about suicide, depression, and self-harm
Whānau is another protective factor when it comes to mental illness, so building capacity within families is crucial for helping teenagers communicate the different problems they may face in their lifetimes. However, this intervention will only benefit those that have strong family networks and will increase the disparities between those with and without parents that can take time to explain these concepts.

Teaching resilience and coping skills in schools.
This is another tough one to implement considering teachers already have so much to work into their curriculums. Additionally, as with most universal systems, the ones that need to learn are the least likely to be the ones that pick up the skills, particularly in a classroom setting where peer pressure is at work. However, when put in conjunction with a mentoring system you could better focus these messages to those that are most at risk.

The Parties
To be brutally honest, no one term government is going to fix our mental health services. Jacinda cannot wave her magic wand and hope for instant improvements, and National have shown that in their three terms the mental health outcomes have only gotten worse. Both major parties have similar policies regarding increasing funding both to DHBs and nationwide health spending, but this is a long-term issue. We need more GPs so that wait times for second mental health appointments aren’t after 8 weeks.

NZ First want to conduct a mental health inquiry, Labour wants to reestablish the Mental Health Commission, and the Green party wants to do both. The Green Party also recently announced that they would provide free counselling to all under 25-year-olds, part of a $263 million youth mental health plan. The Māori Party have strong policy support for mental health reform, particularly because their constituents and communities are heavily affected by it. National want to continue what they’re doing and take a social investment approach to mental health, although they have acknowledged their shortcomings during the Budget proposal at the start of the year.

Ultimately the key theme for the political parties is: more. Only through the funding of successful programs within schools like mentorship, reaching out to parents, and training teachers to communicate mental illness symptoms and coping mechanisms, can we start to address this issue where it is worst. At the same time, we must introduce interventions that minimise the social disillusionment that some groups face, bringing communities together to create better support structures for people to fall back on.

Regardless, the policy of any incoming government needs to address this as soon as possible. The more we undercut the little effectiveness that we have in our mental health services, the more suicides we will have in our communities.

Lauren Watson a second year Law and Health science conjoint majoring in population health at the University of Auckland. She is a volunteer for UN Youth and also writes for Craccum.

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