More on mental health
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- Date published:
12:36 pm, March 18th, 2008 - 11 comments
Categories: health, history -
Tags: health, history
After reading Steve’s piece about suicide prevention and the subsequent comments I’ve decided a short history lesson on this issue is needed.
In the late eighties and early nineties the mental health model was shifted from an institutional model to the ‘recovery model’. Effectively this meant mental health patients were shifted from facilities such as Cherry Farm and Sunny Side into the community. While this is an approach that is proven to work for many people with mental illnesses it comes at the price of loss of economies of scale and makes it expensive to monitor illness.
At the time that money was not provided and the task of resourcing that care was left to the family and friends of those lucky enough to have them to fall back on.
On top of that a lot of the cost was transferred onto the Ministry of Social Development which was not prepared to deal with these issues. One of our recent commenters, Vic, reminded me of this with this story:
‘The way the benefit system was structured he [the commenter’s mentally ill friend] had to prove he was financially independent from his parents every single year of university. Administrative delays every year meant that he went without income for weeks and even, on one occasion, more than a month. He couldn’t pay rent, couldn’t buy food at times and ended up being dependent on his mates, which was bad for all of us.’
This kind of problem was not unusual. There had been a shift in the policy at income support (which at the time was rebranded WINZ) toward providing entitlement only on demand. This meant that people with mental illness, who could not advocate for themselves and prepare their own argument and had very little advocacy support, were effectively disenfranchised. Applications would often involve providing considerable documentation and a good understanding of the Act (something that is difficult at the best of times and almost impossible for many mentally ill people.) This left many seriously mentally ill people with no care and often no income. As you can imagine, this did not bode well for society.
This situation reached crisis level very quickly and a series of high profile criminal cases involving people with mental illnesses eventually provoked a review. A turning point was the Raurimu massacre which put pressure on for an investigation that eventually turned into the Blueprint for Mental Health Services in New Zealand (PDF). The Blueprint came out in 1998 and involved an audit of every DHB in the country and increased funding to bring them up to standard to support the 3% of all New Zealanders who suffer serious mental illness.
After finding the report was going to be horrendously expensive to implement the National government quietly shelved it. One of the promises Labour made was to implement the blueprint and it has done so. But there are some serious issues with this model, most of which stem from the one-size-fits-all approach that sees funding set by population (not mentally ill population) and which is still set according to the 3% rate provided by early 90’s research. The funding is also adjusted from what was used in the previous year’s budget rather than what proper services would cost. An ex-mental health administrator I know described the situation under Labour thus:
‘They’d ask me what I’d spent, not what I would spend to provide proper services. Every year we’d scrape through with what we had and that would be the figure they’d use.’
There are also serious shortages of mental health professionals internationally and these have been exacerbated by the liberalisation of training in the 90’s we simply have not produced enough psych nurses or psychiatrists. The last word belongs with Vic:
‘I’ve seen other, less fortunate friends slip through the cracks more recently because the public system is severely under-resourced, even now. And when I say slipped through the cracks I mean they’re dead. This is something that needs to be addressed with as much as we can throw at it.’
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The problem with mental health is it is very expensive and doesn’t make for good PR opportunities. When was the last time you saw a polly do a PR set-piece in the psych-ward? Or for that matter, offer to donate the cost of their election overspend to Kenepuru’s unit… The coverage it does get is always around crime.
RS
Think you’re being a bit harsh. Coverage for mental health issues has been quite good under the “Like Minds, Like Mine” campaign fronted by John Kirwan and othe notables.
I recall MPs from the past also fonting regarding their depression and other mental health issues.
Yeah – I guess you’re right about that HS.
Good summary IB- really reinforces the fact that all of these statistics happen for socio-economic reasons and have real life affects on ordinary people.
Interesting article IB – I worked in the health sector for a number of years, under a variety of governments. The process of deinstitutionalisation started in the late 1980’s, during which time one Helen Clark was the Minsiter of Health (but we won’t go there!), and continued into the 1990’s under Upton. Deinstitutionalistion was not restricted to Mental Health – services to the elderly also came under the microscope – two groups of very vulnerable people, who caused both National and Labour no small degree of heartache.
While I was working at the Wanganui Area Health Board (as it was under HC’s 1989 reforms), I was a witness to the managed closure of Lake Alice hospital, including the National Secure Unit – The Block, as it was known. No-one would seriously want to go back to the days of institutional care for so many, but many communities around New Zealand are still getting to grips with managing the needs of the mentally ill within their community. We have a number of “mental health survivors” attend our church, and hear some horror stories about the trauma of being left to fend for themselves without adequate Community Mental Health support. We as a church leadership don’t have the skills to deal with, but often we are the only support some of these people have. It is a real dilemma, and I don’t believe anyone, let alone National or Labour has the answers.
IV2 – a step toward an answer would be another full scale review, increased funding for salaries and intervening to ensure a set proportion of nursing training positions were set aside for psych-specialisation and that a certain number of medical students were directed toward psychiatry.
One of the big issues at the moment is the lack of decent primary psych health care. Too many GPs and first-contact clinics have insufficient psych training or resource. There are a couple of PHOs that run really good models, hopefully as other PHOs establish themselves that will spread.
I don’t want to offend your faith but church-based care (especially of the fundamentalist variety) can, in some cases, be worse than no care at all as many mentally ill people have difficulty with the subtleties of religious narrative and the process of applying them to the real world.
My fear is that the continual right wing attacks on social workers as “bureaucrats” works to further devalue the role of community care and make it harder to staff the recovery model. I need to make this clear: the recovery model is the best option for most people and works very well when done properly but it costs more in the short-term to do properly. Too many people in the 1990’s saw it as a chance to transfer costs to communities and that’s never really been fixed since.
No offence taken IB – whilst our church is under the “umbrella” of a pentecostal organisation, we do things our own way, mainly because we don’t want to put the mental health of our people at risk – we too, have seen spiritual “manipulation” of the most vulnerable, and it does no-one any good. We’re more concerned with the physical welfare in the first instance, and spend time making sure people are safe, housed, fed and clothed – then get in the ear of the CMHT people. We figure that God will take care of the rest!
From what I have seen, the baby has been thrown out with the bath water with deinstitutionalisation. A severely mentally ill person I know of who was made a compulsory patient on the West Coast, spent only 3 weeks in the Acute Mental Health Unit and was then returned to the community with very little support.
The Community Mental Health Team on parts of the West Coast is available only during business hours, with the police picking up the slack at night or in the weekends.
I know of a young and very bright lad in Canterbury whose friends finally sought help for him on a Friday afternoon. The response was to send him home to his parents who were ill equipped to deal with the problem, and he was dead of an apparent accident or suicide the next day before he had got the help he needed. The lack of help for people with acute mental health problems is criminal.