The Mental Health and Addiction Inquiry's public meetings showed a divide in opinion between family members and people who live with mental illness. Now, JESSICA MCALLEN dives into the specifics of the system and what needs fixing.

The large majority of people who take their own lives have never come to the attention of our mental health services.

That's what Prime Minister Jacinda Ardern said during mental health awareness week. She said the first step is seeking help and encouraging people to be much more open, particularly males in our community.

The statement was backed by a line from several Ministry of Health briefings - that only about 46 per cent of those between 10 and 64 years old who died by suicide or undetermined intent had used mental health services. But the numbers the prime minister's team used to demonstrate her point come with serious caveats.

They only include the 3.6 per cent of New Zealanders who come into contact with specialist mental health and addiction services - and only if they did so in the 12 months prior to their death. According to the most recent statistics, specialist services - generally aimed at those with more severe or long-term illnesses - engaged with 169,454 New Zealanders in 2016.

Read part one: The story of New Zealand's Mental Health Inquiry

The numbers Ardern used don't include people who got help through their GP or private counselling and then went on to kill themselves. They don't include people who have been rejected from DHB services. Many more people may have reached out for help - only to find there was none.

That's the problem with the 'mental health system' - no-one seems to really understand how it works, or how the numbers add up. Not even our prime minister. But the people who are in it do.

They are the ones who told the Mental Health and Addiction Inquiry that they've looked for help, only to find that they go straight to the bottom of a waiting list if they move suburbs. They're the ones who look for help only to be told to call back during office hours.

The ones who say that emergency service workers don't really believe you're suicidal unless you have scars. The ones who sit in the grey space between specialist care and seeing a GP. The single parents, the sexual violence survivors, the ones who know counselling isn't for everyone. They're at the mercy of acronyms - CYFS (now Oranga Tamariki), WINZ, Compulsory Treatment Orders (CTO). The ones who want to die.

IAIN MCGREGOR Nick Stoneman has autism and needs to be alone sometimes. The Mental Health and Addiction Inquiry's public meetings showed a divide in opinion between family members and people who live with mental illness.

THE FACES OF THE INQUIRY

Katie*, 25, was at the Dunedin youth meeting of the inquiry. She lives with Post Traumatic Stress Disorder (PTSD) which developed after she was sexually abused.

With mental illness, there isn't always a miraculous recovery, she said. "PTSD isn't necessarily this catastrophic thing in the way that might look good in TV shows … it's that time bomb for how you handle a crisis in particular.

"It's a very similar thing to shellshock where a person's perception of the world - how safe they are and what their place is in it - is shaken so drastically."

Certain situations can test her coping skills - like arguments and discussions that remind her of an abusive situation.

"Being in sexual situations while sober is one that I've had quite a lot of difficulty with … but you feel like so many people have had abusive situations it feels illegitimate, or too long ago, or like it wasn't scary enough if it was sexual abuse rather than someone literally beating you up."

She goes through the ACC special claims service - where people who have been sexually abused can get free private therapy. She heard about it from her GP. She was on a waiting list for three months before she could see a psychologist - it could have taken even longer, but she was okay with her psychologist being a man.

"It's a lot harder to feel that you can turn down a care person when you finally get to the top of the six month waiting list because they're culturally insensitive or transphobic."

Every few months she has to do an assessment to make sure she still needs help. The onus is still on her to call around to find which private services accept ACC and she has missed out on treatment while applying for more time.

"It was still hard even with the assistance and … I don't want to say luck, but having had enough of the right bad things happen in terms of having a chronic illness and being sexually abused, that I was eligible."

When Ian Finn starts finishing other people's sentences, that's when he knows he's heading into a hypomanic episode.

He was the last person to speak at the Tauranga meeting, held at the historic village south of the city centre. There were a lot of hurt people, he said, and Finn felt sorry for the panel.

"I wanted to thank the panel for listening and say I acknowledge that you've had a big slamming tonight, we appreciate that you're here, listening, and want to make a difference. I was quite annoyed with myself for not doing that because it felt like the panel really took a slamming."

Finn is diagnosed with type 2 Bipolar. He has a hypomanic episode about twice a year. A short one is four or five days, and a long one is three to four weeks.

"I become highly creative [when manic] so I think about things I would not normally think about, I'll learn a new song on my saxophone … it's awesome, I wish I could stay in that state all the time but I can't - and however long I stay manic, or as high as I go, that's exactly how low I'm going to crash as well."

When he needs to feel centred, he takes out his canoe: "No matter what state of mind you're in, mate, you'll always come back feeling better."

His employers were smart enough to realise that when he's hypomanic, he's super productive.

IAIN MCGREGOR/STUFF Nick Stoneman has autism and needs to be alone sometimes. The Mental Health and Addiction Inquiry's public meetings showed a divide in opinion between family members and people who live with mental illness.

"I was building new cow sheds, new calf farms, they couldn't believe they had me working for them! But I wasn't like that all the time, I was only like that for a season. Then I would be depressed again and struggle to do my normal daily work. I did a helluva lot for them when I was manic and used to save up jobs …"

Finn said it's hard to actually get a job if you're open about mental health. But it's such an important element to getting out of your own head.

"You end up having to lie to get the job, and disclose that later - when they know that you can do what you're supposed to do. How can people have normal mental wellbeing if they can never get out of the bottom of the economy mental health can put you in?"

People with mental illness can still work, and even though some might need the occasional time off, employers should be there for them.

"There has to be something in place so that if they have an episode and they have to leave work, their job is there for them when they come back, and that's a difficult one."

As with all things to do with mental health, Finn's experience with mania is not universal. He has a friend with type 1 Bipolar who hates being manic because type 1 mania often gets more intense - at times, people can become delusional.

Finn wants the inquiry to look into the lack of follow up care when people are discharged from a mental health inpatient unit. For example, a person with Bipolar might be manic to the point of being out of touch with reality and admitted into a mental health unit. Once they stabilise they will be released.

"They drop below stable into a depression … they're actually just transitioning because they always crash afterwards. Then, they are most at risk of harming themselves."

When a woman approaches him after the meeting and talks about how she doesn't want her daughter on medication, Finn told her that medication actually has a place for some people.

Later, he explained: "If someone is diagnosed with bipolar today, it could be up to two years until they are really on the right stuff. It takes eight weeks for it to take full effect and you have to wean off one before you can start another one.

"Sometimes people become unwell in that time and then you can't really measure the side effects of the medication because they might have just been having a typical episode - whether they were on medication or not. You've got to wait for them to stabilise to monitor what they're on and a lot of people, as soon as they have an episode, think they're not working so change to something else.

"If you don't have the right people around you, it can be an extremely difficult time."

Jessica Kahukura, 31, didn't want to chicken out at the Whanganui meeting, held at the racetrack in a room next door to the Eulogy Lounge. So, she stood up first to speak. She said crisis response teams tell you to ring the police, and then the police tell you to ring the crisis line. In the end, you don't end up speaking to anybody.

About 12 years ago, after she gave birth, she was admitted to the Whanganui mental health inpatient unit with "post-natal mania". In a rare move, her son could spend time in the unit with her. It was a big part of her recovery.

"It was pretty hardout, I don't really remember a lot of it. It was a bit hazy".

She was diagnosed with type 1 Bipolar but when she was released she struggled with her case workers.

"One of them just wanted to have cups of tea and cigarettes and chat. Another just walked in and wanted to tick her boxes. The questions were formal: "Have you showered? Have you eaten". It was uncomfortable.

She found a good case worker through the Whanganui district health board who helped her realise going back to basics is a good thing. "Food, medication, exercise, and a bit of mindfulness."

Kahukura was on Olanzapine for 12 years and has recently started weaning off it.

"It's like being in a deep sleep and then waking up and being tired for your whole life."

She now takes mood stabiliser Epilim and antipsychotic Quetiapine, which can be used to help with insomnia. Healthy sleep is important for people with bipolar and Kahukura said the Quetiapine has been "pretty miraculous".

"I was scared to take it the first time and I took it, had a really good night's sleep, and woke up refreshed. I couldn't remember ever feeling like that.

"I've fought medication since I've been on this boat, and all it really took for me was a change of medication, a lower dose, and great communication between me, my key worker, and my doctor."

She'd like to see more focus on the mental health of children, starting at birth.

"People are being more open about it since like 12 years ago when it all started for me, but times that by 10 again."

She says she wants an emphasis on mental health care that connects her to her culture. The number of suspected suicides by Māori in the 2017/18 year was 142.

"If men felt that their tears were as godly and full of love like Ranginui's tears for Papatūānuku, they may not be as hard on themselves. Maybe we could prepare our youth by not only reminding them of Māui's great achievements but the events of his demise, reminding them to slow down and reassess," Kahukura said.

"If we told the story of Māui and the sun from the sun's point of view, maybe we could look at bullying in a different light also. The transformation of Hine-tītama to Hine-nui-te-pō. When I am most unwell take me to my gods. Let me see Ranginui the sky father, feel the earth beneath my feet and Tāwhirimātea, the wind on my face."

MATT SHAND Ian Finn was the last person to speak at the Tauranga Mental Health Inquiry meeting.

Nick Stoneman, who attended a Christchurch session, needs to be alone when he's having a bad day.

"A lot of autistics aren't in the community, they don't want to be seen, they don't want that engagement. A lot of them will sit home and just stay home in their little world. Facebook is our friend. That's our social connection to the world. You can control it and if you don't want contact with anybody you just shut yourself off."

Stoneman didn't speak at the inquiry meeting he attended, but he is concerned about autism's position in the health system. He wants to one day work in public transport but he struggles to find a full time job.

The process around getting an autism diagnosis through the DHB needs to improve, he says.

Like Ian, he wants more focus on supported employment. He uses a programme called Workbridge which helps him find work. But every 12 months, he has to change agencies to get a new round of funding.

"Unless you get an employer that really wants to understand how to deal with it, most employers just aren't interested."

But he said people with autism have a lot to offer.

"We're very focused on what we do and how we do it, we're very persistent, we won't step away and take a break, we'll just keep going until the job is done". The flip side, he says, is that sometimes people with autism can come across as having a lack of social skills.

Holding a cup of hot chocolate from the donut cart next door, Minnie Ratima sits under a magnolia tree in central Napier. She's there every Friday, part of a support group set up by her friend Polly.

This Friday's magnolia tree meeting was the first since Polly died, a week earlier. Polly would talk about her depression but "sometimes you just don't know it has gotten that bad", Ratima says.

Polly liked the magnolia tree because her twin daughters were buried underneath one. They had died in a house fire as children. The day before, Ratima, a Māori warden, had attended the June 7 inquiry meeting in Hastings. She was frustrated by the tone of some speakers.

"A lot of people last night talked about 'it's not the money, it's about the love' - f... off! It is about money and it is about love," she says. "But you have to have common sense as well as dollars and cents."

There's Pat Magill and Rob Temple meeting at the spot today. Polly was the glue, Minnie says. They are hoping to have her unveiling here. Minnie takes out a baby seat from her car for me to sit on because the concrete is cold in the middle of winter.

She's angry about what happened with synthetic drugs. Workplaces testing for Marijuana "forced people to go to an alternative high which became more damaging." Then there was the Housing New Zealand mess. Tenants kicked out of their state homes if there were traces of meth under the impression it contaminated houses. This was debunked by the Prime Minister's science advisor this year.

"There's a couple of people awake enough that want to go for compensation now but there's a lot of them that are too far gone. Why should they care? The fantasy world they've created when they smoke the stuff is still a better place to live in."

We've gotten more punitive and role models are out of touch, she says.

"Those who've made it are still wanting to get down and preach to those who haven't made it. It's stupid, that's why we're in the s...."

Pat Magill, 92, has a long history of advocacy in the Hawke's Bay. He can't believe New Zealanders embraced the "lock the bastards up and throw away the key" mantra. We don't know our own history, he says.

"That's what Minnie is talking about. We lost our hope. Greed took over, sense of community went out.

"We're punishing the problem, not looking at the cause of the problem...we've become a nasty little nation."

JESSICA MCALLEN Minnie Ratima sits under a magnolia tree in central Napier. She's there every Friday, part of a support group set up by her friend Polly. L-R Pat Magill, Minnie Ratima and Rob Temple.

THE WORKERS

A mental health nurse in Tauranga addresses the room: "If I see you on my ward, I'll give you a cuddle...Unfortunately we tick boxes...what does he look like?....I don't have time for that." In Hastings, an addiction worker says: "we have a shortage around residential treatment centres. Even the current ones, there's so much criteria that our whānau are going to prison".

A Whangarei mental health worker says little has changed since the many inquiries of the past: "same story, some complaints, same heart break". Kaitaia chemist Atif Malkonyan says doctors and psychiatrists aren't working together. People will get one prescription from mental health services but then their GP will say "I haven't seen this". Prescriptions can be lost in fax.

A man comes into his pharmacy everyday because he is lonely. "Pharmacies are more approachable than GPs and can often be the first port of call. There needs to be better communication."

Workers faced problems with assault, clients killing themselves, double shifts. Bosses - such as Nigel Loughton at Odyssey house - told me about the need for decriminalisation of weed but also how the pay equity settlements had made life difficult for NGOs: "[we're] effectively behind the eight ball and lose staff, have difficulty retaining staff and are not able to properly remunerate staff".

When the inquiry meetings got to Invercargill, it was -3C. The Workingmen's club the room vibrated with anger. The town is familiar with working groups and reports that never translate to action. The people there bristled: "Will you just go back to Wellington? Sit around, make a couple of changes, never see us again."

This is the town that had a big role in the 1996 Mason Inquiry into mental health services, when Eric Galletly was shot dead by police in a sports store after holing up there for 21 hours.

Cathy Strong has been working as a manager at Number 10 youth one stop shop for five years. It is a place where those aged 10-24 can get free health and social services. Number 10 has had an increase in mental health problems over the past two years, and staff burnout can be a big problem.

She added that there is a lack of services - and the ones that do exist are stretched to capacity and have to "turn people away". But there's also limited collaboration, a lack of support and follow up with young people exiting mental health, and not enough support for families.

"Southland as a whole is bottlenecking, in every service … we pull in every favour we can in trying to help young people," she told the panel.

Strong has been here before. The whole town has. They had meeting after meeting about improving services. But then, "they all went back to Wellington".

The inquiry's meetings moved up the country after that. And when they did, the inquiry's chair Ron Paterson made it clear: "We are not from Wellington."

WHERE TO GET HELP:

1737, Need to talk? Free call or text 1737 to talk to a trained counsellor

Depression.org.nz - 0800 111 757 or text 4202

Lifeline – 0800 543 354

Suicide Crisis Helpline – 0508 828 865 (0508 TAUTOKO)

Kidsline – 0800 54 37 54 for people up to 18 years old. Open 24/7.

Youthline – 0800 376 633, free text 234, email talk@youthline.co.nz or chat to someone online.

Rural Support Trust - 0800 787 254

Samaritans – 0800 726 666

What's Up – 0800 942 8787 (for 5–18 year olds). Phone counselling available Monday-Friday, noon–11pm and weekends, 3pm–11pm. Online chat is available 7pm–10pm daily.

thelowdown.co.nz – Web chat, email chat or free text 5626

Anxiety New Zealand - 0800 ANXIETY (0800 269 4389)

Supporting Families in Mental Illness - 0800 732 825.