

The Government's long-awaited Mental Health and Addiction Inquiry report was released this week. Jessica McAllen looks at what it all means.

ANALYSIS: At the Dunedin meeting of the mental health and addiction inquiry, a man told the panel: "You can't be mentally healthy if you're dead".

Sure, he was objecting to the pre-meeting stop, drop and hold earthquake advice, but his words applied to the official inquiry report, which was released to the public on Tuesday.

He Ara Oranga: The report of the Government Inquiry into Mental Health and Addiction was released on Tuesday

The report, which mentioned the word 'wellbeing' 200 times before I gave up counting (it had started to blur into 'warbling'), laid out New Zealand's bold new future to help people in distress. It had a strong focus on prevention in its 40 recommendations. Hopefully, the Government doesn't cherry pick the easy solutions at the expense of the sometimes messy truth of long-term mental health and addiction.

READ MORE:

* The story of NZ's mental health inquiry

* How to understand the mental health system

* Stacey Kirk: Politics, money and lives - Govt torn three ways on mental health

* Mental Health and Addiction report: What you need to know

* Major new target to boost access to mental health services

THE BACKGROUND

TE KĀEA A Māori health provider is slamming the new Mental Health and Addiction Inquiry report released by the government. Te Rau Matatini chief executive Maria Baker says Māori have the worst outcomes but recommendations fail to give them a voice.

During the 2017 election campaign many health professionals were concerned about the prospect of another mental health inquiry if Labour won. But their voices were drowned out by vocal campaigners - some of whom have gone very quiet this year - and labelled as bureaucratic stiffs. Even one of the panel members, former mental health commissioner Barbara Disley, was sceptical. Earlier this year she told me changed her mind because the panel was tasked with a short time-frame.

In 2017, Mental Health Commissioner Kevin Allan appeared before a select committee stating an "urgent need for action" rather than another costly review. We already know the solutions, he said.

In a letter backing up his submission he said: "Funded treatment and care options for the approximately 17 per cent of people with mental health needs who do not qualify for specialist services are limited."

New Zealand Department of Internal Affairs This animated video summarises the recommendations of He Ara Oranga: Report of the Government Inquiry into Mental Health and Addiction.

He should be heartened to see the panel recommended specialist services - which cater for 3.6 per cent of the population - be expanded to cater for 20 per cent. Although, maybe he will be annoyed that this is something people already knew needed to be changed. We could have spent the intervening year figuring out a plan to increase the workforce to deal with such a change.

An inquiry is an easy promise because it stalls time - it will be 17 months since Labour came into power by the time the Government formally responds in March.

While we waited for the results of the inquiry, it would have been useful to increase funding to Mental Health and Addiction Services, but the Government opted to wait until the inquiry was released. It would have been useful to test out pilot programmes.

The irony that the report recommended a police and mental health worker response to emergency callouts (instead of solely police, a process that can be traumatising) won't be lost on those who were dismayed to see a similar proposed pilot cut this year. Many organisations also held back on planning, waiting to see what direction the inquiry was going to follow.

In the meantime our suicide rate jumped to its highest since provisional suicide statistics were first recorded in 2007/08..

Labour inherited a broken mental health system so perhaps it's unfair to be too critical. But National inherited one too. Then Labour before that. This has long been an under-resourced and ignored area until a particular tragedy ignites public outrage.

There are many people to take into account when discussing mental health. The 3.6 per cent who use specialist mental health services and often have a long-term mental health issue. Those who the inquiry call "the missing middle" who at the moment don't qualify for mental health and addiction services, but can't be adequately helped by the free 6-8 sessions that Primary Health Organisations (PHOs) offer.

There are people who won't have a mental illness but, due to life circumstance - bereavement, job loss, and other stressors - find themselves in significant distress.

Health Minister David Clark will be feeling immense pressure right now. But this can't be a surprise. Labour campaigned on mental health, particularly youth suicide. Former Health Minister Jonathan Coleman was called "the doctor of death" by Labour's Kelvin Davis.

There was even the odd linking of immigration to youth suicide on the Labour party Facebook page. Jacinda Ardern made headlines when attending the PSA's 'Yes we Care' campaign which toured 606 shoes across the country to raise awareness of suicide. She said she wanted to bring the suicide number down to zero: "Because anything else suggests we have a tolerance for loss to suicide in New Zealand". The report recommended a 20 per cent reduction by 2030.

I'm not defending National here - I've reported for years on their failures. It's a testament to how much they pretended suicide wasn't an issue that there is such a level of excitement about Labour simply having an inquiry. But you can't campaign on mental health and suicide, raise people's hope - people who are often ignored - and not bring in truly meaningful change.

For many, the incessant politicking and moral panic about teenage suicide was not helpful. Multiple stories a day, multiple social media posts, these can become overwhelming when you are already depressed - especially if you see people with similar life stories. For others the increase in coverage was a relief - they felt seen, heard, after years of screaming into a void. This was reflected at the public inquiry meetings - for some, this was the first time they had told their story.

Some of the attention on suicide last year excluded significant groups - the inquiry report notes that the greatest loss through suicide is among people older than 24, particularly males aged 25-44. Our suicide rate - although too high - had remained stable since 2012, yet due to the confusing data sets people were reporting it as the highest in history (this was the second highest rate according the Coroner's annual report, but that only goes back to 2008).

'BIG PSYCHIATRY'

The inquiry report has a very strong anti-medication sentiment. This came up a lot in public meetings.

Yes, GPs often prescribe medication too quickly and people are on medication far longer than necessary. The issue of forcing someone to have psychiatric medication when they don't want it is also significant. But for some they do work. People spoke to me in private interviews about this because they felt embarrassed that they take pills. It's not that they enjoyed the side effects - from weight gain, hand tremors to even more depression - but they weighed up those risks.

The term 'big psychiatry' - referenced a few times - comes from former Mental Health Commissioner Mary O'Hagan's Wellbeing Manifesto submission, which seems to be a main influence for the whole report. O'Hagan, who has written a book about her experience with the mental health system, is a respected advocate for people with mental illness - known as "consumers".

Remember that term. The consumer movement is likely to have a big role in the implementation of these recommendations. Co-design is mentioned a lot, which is the process of working with people at every stage of a new service - although the Ministry of Health's premature transformation working group for the inquiry seems to indicate people with lived experience were more of an afterthought. Many organisations say they embrace co-design, but really have already made up their minds and simply consult people with mental illness at the end of the process - true co-design is having a voice at the table every step of the way.

The problem with some of the consumer advocacy groups is that some are out of touch with current services. They can afford private mental health help or the organisations they work for pay for counselling. The people who come from asylum backgrounds can be strongly against medication and diagnostic labels - this influence is again seen on the report. Being diagnosed with a mental illness can reduce you to symptoms and create self stigma, but other people at the inquiries, particularly those with complex illnesses such as borderline personality disorder (BPD) and obsessive compulsive disorder (OCD), spoke to me about their relief in knowing other people go through the same. That they aren't crazy.

Jack Taylor said: "Because I'm a very logical thinker, it's good to be able to put labels on it. I know for other people it doesn't help, but I like those labels because I can go online and look up other people's experiences."

A SENSE OF IMMEDIACY?

Many of the solutions are going to take years and require laws to be passed. Repealing the Mental Health Act is quite a risk, especially if Labour doesn't get a second term. There is a strong move for more coercive care from some people - particularly family members. People will be angry if there is no longer a way to detain people under the Mental Health Act when they are refusing treatment. Repealing such a law is likely to turn into an ugly public discussion and has the possibility to flip into the opposite of what the inquiry panel recommended.

The report is vague in some of its direction. The suicide prevention section is a particular weak link. The main recommendation is to finish the Suicide Prevention Strategy. This was put on hold on May last year just after the draft went out for public review, when advocate Mike King, who was on the advisory group, quit and called it a "masterclass in butt covering".

The report also says to increase funding, but doesn't suggest a number (unlike previous reports). This gives the Government wriggle room to not be held accountable. Obviously, they will increase funding but how will people know it is enough to make significant change?

There is the risk of being too focused on creating leadership roles - the report recommended a wellbeing commission and a suicide prevention office - and not being connected to the people truly touched by mental health and addiction.

The inquiry noted that the Health and Disability Sector Review will consider broader issues about the roles of DHBs. The establishment of a Māori health ministry or commission with broad functions also deserves further consideration, it said.There was a directive to "produce a cross-government investment strategy for mental health and addiction services", which may leave people wondering why this wasn't done during the year.

THE FUTURE

The panel had an incredibly short time-frame. Following the inquiry around to 15 meetings was exhausting for me - I can't imagine what it was like having 26 public meetings and 400 private ones. Let alone being the face of supposed change. The panel were only there to bear witness, but many cried and yelled and begged for help and direction.

Cynically, I can see the Government increasing mental health funding, but not by nearly enough, and adding a bunch of prevention and promotion campaigns. Perhaps the repeal of the Mental Health Act would become an election issue in 2020. But people have done enough waiting - in emergency departments, for rehab clinics, for specialist services or to get the coroner's findings of their loved one's death.

At the public meeting in Hamilton, Kaumātua Ron (not to be confused with panel chair Ron Paterson) closed the night.

"The panel has been tasked with change. Anything else is putting a plaster on the system already there."