Psychologically distressed survivors of the Christchurch terror attacks can't get ACC help because the corporation doesn't cover mental injuries the way it covers physical ones. Can a government which says it's prioritising mental health continue with this ACC model?

Photo: RNZ / Claire Eastham-Farrelly

Yama Nabi's father had been killed, he had seen dead bodies, wounded children and a river of blood. He was traumatised and unable to work, with children to feed and a mortgage to pay. He contacted ACC for help.

The man told him he didn't qualify for support and offered him some advice; it stuck in Nabi's craw. "The gentleman told me, 'Join together, unite with your family'... He's sitting there telling me a little fairy tale."

Encouraging words wouldn't cover Nabi's lost wages. They wouldn't stop the flashbacks to the blood, the bullet wounds, or the footage of the last moments of his father's life, captured on video and live-streamed by his killer. They wouldn't give Nabi the support he needed to recover from arriving at Christchurch's Al Noor mosque on 15 March, minutes after a gunman killed 44 people with a semi-automatic (the man went on to shoot dead a further seven at the near-by Linwood mosque).

"I saw the bodies and everything like that, but they think I'm not a victim," Nabi says.

If it had been his body rather than his mind that was injured that day, right now crown entity ACC (Accident Compensation Corporation) could be offering him up to 80 percent of his normal wages, transport to medical and rehabilitation appointments, aids and equipment to help with his injury, and help at home.

But ACC won't cover 'mental injuries' unless they fit within a narrow set of boundaries: they must be sustained while a person is at work, as a result of a physical injury, or from sexual abuse.

Those boundaries leave Nabi in no man's land, suffering and unsupported. Others are in the same position. By the end of April, 85 claims involving mental injuries caused by the mosque attacks had been filed with ACC, and 35 of those had been declined because they didn't involve a physical or work-related injury (decisions are pending on another 25 of the claims).

The predicament of those turned down has turned a spotlight on a long-running discrepancy in the way ACC covers mental and physical injuries. But will it prompt change?

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Photo: RNZ / Ian Telfer

Since 15 March, lawyer Warren Forster's phone has rung more than usual; people who were in the Al Noor and Linwood mosques on 15 March keep asking for the ACC expert's help. They are distressed, wrestling with sleeplessness, flashbacks, nightmares and anger associated with post-traumatic stress disorder (PTSD), and have received letters from ACC rejecting their mental injury claims.

Forster has had to break it to each of them that there's nothing he can do - the corporation is simply following the law. The problem, he tells them, is with the law itself.

"If you break your leg ACC works really well, but if you develop a mental injury as a result of trauma, then the systems we have generally don't work."

He likens the ACC system to an incomplete transport network. "Some people have high speed trains and buses and accessible footpaths come to the house. Other people just have houses plunked in the bush, without any way of getting around."

With the support of a Law Foundation scholarship, Forster researched international support models and is now pushing for a new system that covers mental injury, but also all disabilities regardless of their cause. "What we know from evidence is that if we provide rehabilitation; [if] we provide social support, financial support and healthcare; and we actually focus on getting the person back to doing what - as much as possible - they were doing beforehand; and then rehabilitate them into doing new work, if they can't [do their previous job], ... that model works best."

Photo: RNZ / Rebekah Parsons-King

He has an uphill battle ahead. To see mental injury covered, let alone a system to cover illness, would be a victory many have dreamed of and failed to claim. Two decades ago, in an interview with RNZ's Kim Hill, former prime minister Sir Geoffrey Palmer said this about ACC and mental injury: "The question you have to ask is - is this sort of damage to someone worse than a motor accident that leaves them maimed and disabled as a result of physical injury? It is certainly palpable and clear and psychiatrists can recognise it. You can bring evidence about it… Why wouldn't you treat that the same as the sort of incapacity that arises from physical injury?"

It wasn't Sir Geoffrey's first critique of the ACC system and it wouldn't be his last; he's still battling for change. In September last year, backed by a group of leading ACC lawyers, he again called for an overhaul of the "unfair" and "discriminatory" ACC scheme. Like Forster, he wants a system like the one originally envisioned by ACC architect Sir Owen Woodhouse, that covers physical and mental injury but also illness.

In December, the OECD released a report on mental health and work in New Zealand, which said intervention for mental health comes too late, is "fragmented", and that health and employment barriers need to be addressed together. It recommended the expansion of ACC to cover mental illness.

ACC Minister Iain Lees-Galloway responded that would represent "a fundamental change to ACC's purpose" and "to date I have received very little correspondence that indicates that this is front of mind for most New Zealanders".

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It may not have been front of mind then, but it is now. Since the mosque attacks, social media has filled with messages from New Zealanders stunned to learn where the limits lie when it comes to ACC.

How, they ask, could people who saw friends shot in front of them, who were buried under bodies, who were smeared in others' blood, not qualify for ACC? "What? Extend the cover", "This needs to be changed now", "I don't see why a near-miss in a traumatic event shouldn't qualify for psychological services," some of the messages read.

They may not be asking for as radical a change as covering illness as well as accidents, but they certainly want to know why there is such a disparity between the cover for physical and mental injuries.

ACC points out it is doing what it can - explaining why it is rejecting claims and pointing people towards other agencies that may be able to help, but it simply can't approve claims for mental injuries unless they fall into those few narrow categories. "We are required to operate within the boundaries of the scheme, as set out in existing legislation," it told RNZ.

If ACC won't cover the uninjured but mentally distressed, then who will take responsibility for the traumatised people of Christchurch, those social media threads have asked. Eyes swivelled toward Victim Support, which collected $10.5 million in donations, but the charity was wrestling with the task of sorting out which victims and survivors should get what and struggled to quickly distribute the money. (It was only yesterday, almost two months on from the shootings, that the charity announced it would make a payment to uninjured people who were present at the mosque.)

Prime Minister Jacinda Ardern says survivors are able to seek help form Work and Income, but benefits don't match ACC's 80 percent income cover, and don't cover the outgoings of someone like Nabi, who faced losing his house.

Lees-Galloway seemed to acknowledge that mental injury limits needed attention when he said the government wanted to ensure there was help and support for those psychologically affected by the shootings, and was considering its options. But two months on from the attacks, he has made no further announcement.

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Photo: RNZ/ Stan McFerrier

As the days then weeks rolled by after the shootings, Yami Nabi became increasingly worried. He didn't feel up to going back to his job as a butcher at the meatworks and was afraid of how he would cope if he had to. After what he'd seen on 15 March, how would he handle the blood? How would he touch the carcusses?

Those fears competed with increasingly pressing financial worries, he says. "Who's going to pay the mortgage? Who's going to pay for food for the family?"

Similar worries settled over houses across Christchurch. Bianca Lindstrom joined the Christchurch Victims Organising Committee the day after the shootings and, clutching food parcels, has visited physically uninjured but psychologically distressed survivors. She says they've fallen through the cracks. "What we're finding is that they are traumatised. They can't go to work, and they're not getting paid."

"They're sitting at home scared, they're too scared to leave the house. They're too scared to go to the mosque and be around the community that they're used to being around. So a lot of them are isolating themselves, which is [making things] even worse."

She calls the lack of ACC cover for mental injury "insane" and says the government will end up paying the price. "It's going to get worse… It's going to be impact upon impact upon impact to the point where they're just going to be dealing with so much bad mental health."

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Photo: AFP

We've been here before - just ask Kirsty Cullen. The Christchurch designer was buying sushi at a shop in Christchurch's CBD when the 2011 magnitude 6.3 earthquake hit. She had her hand on the shop's door handle when the the facade of the building collapsed, sending bricks crashing down into the doorway and clouds of dust rising into the air.

When she eventually scrambled out over the debris, she saw crushed buses, totalled cars, fallen masonry, and smoke rising from the CTV building, where 115 were killed - one of them a friend.

Photo: Supplied

For a year, flashbacks - full of that brown dust - frequently gripped her, making her dry retch. She avoided the CBD, had nightmares, and couldn't turn on the TV for fear there would be a news show plug mentioning the quake, an ad from an insurer referring to that catastrophic day or, worse, an image of the Sumner cliffs collapsing amidst a plume of that same brown dust.

Cullen was diagnosed with PTSD and prescribed medication, but she needed more help and couldn't access it. She couldn't afford a private psychologist and wasn't unwell enough to get treatment through the public mental health system, which clogged with people struggling following the disaster (five years on, the service was still seeing 500 more adults a month than before the quakes).

At one point, Cullen was called into a meeting room at work and told she didn't seem to be coping and should take time off. But she had used all her sick and annual leave caring for her daughter, who was traumatised by the first quake, and didn't qualify for ACC. How would she support her family?

She hears about mosque survivors facing the same dilemmas and feels history is repeating. "I think it's tragic because it's only just beginning... These people will keep having flashbacks and issues for a long time yet. And some of them may just keep going, 'Oh, gosh, I've got to get on with my life, I've got to keep earning money. I can't have a problem with this - I'm fine, I'm fine, I'm fine, I'm fine.' And then it'll be the tiniest little thing that will set them off."

Ask her what she thinks of ACC covering physical injuries but not mental ones, and there is exasperation in her voice. "An injury is an injury," she says.

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Photo: Supplied.

Last year, ACC accepted 2,024,675 new claims for physical injuries, and 2410 for mental injuries. Can a government which came to power peddling the message that mental health is one of its priorities continue with this ACC model?

ACC Minister Iain Lees-Galloway declined RNZ's interview request, saying there was little he could comment on, but in a statement his office said this about ACC covering mental injury: "There are no plans to do this at present but mental health is a priority for the upcoming Wellbeing Budget."

Will those New Zealanders raging on social media threads accept that? Forster says while individual traumas suffered every day, like watching a spouse die in front of you in a car crash, usually don't capture ongoing public attention, the Christchurch mosque attacks is a seminal event that could put pressure on the government.

"What we see in Christchurch is a whole group of people who experienced really traumatic and really terrible experiences for humans to go through, and we treat some of them as though they have human rights, and some of them as though they don't," he says.

"Some people [qualify for ACC] if they meet particular categories, so for example, if I broke my fingers running from the mosque, I would receive cover for trauma, as a result of the physical injury. If I was a cleaner, who didn't actually see anything going on, but I heard it going on behind the door, then I would receive cover, because it's work-related ... But if it's a volunteer on the street that came running and to help immediately witnessed at all, I would have no cover whatsoever."

There's no point, he says, repeating the experience of the Christchurch earthquakes, which saw lawyers go to court to challenge ACC, largely unsuccessfully. "What we need to do is actually change the law to overcome these boundary disputes.

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Four weeks after the mosque attacks, Nabi went back to work. He wasn't ready - he wanted to be at home to let his mind heal - but he felt he had no option. "I don't want to lose the house, you know?"

He didn't expect a year off work - "Nothing like that!" - but he thought he might be supported through the worst of his trauma. "I thought at least give someone a month, two months, [say] 'Okay, we'll support you.' ACC should have turned around to the families, the victims and said, "Don't go to work for months. Just relax and heal up."

He's back in the slaughter area of the meatworks. "How am I coping? I'm just putting my head down, just going to work, doing my job. What else can a human being do?"