Hurt & Hope: Is Canterbury in the grips of a mental health crisis?
One in six Cantabrians has received mental health support since the earthquakes. Is our region in crisis?
Eve Jones* is raising three children largely on her own after alcohol "took control" of their earthquake-stressed father.
Ella Armstrong, 3, suffers severe anxiety after being pinned to her bed by a toppled bookshelf in her Waiau home during the November 2016 earthquake. Greg Smith* lived in a tent in the red zone after quake-triggered mental health issues lost him his job, home and relationship.
Cantabrians have been through a series of challenging events in the last seven years – earthquakes, floods and fires. Demand for mental health, addiction and domestic violence services has skyrocketed and the suicide rate has increased.
These trends, and what to do about them, have become politically-charged issues. Leading up to last week's election, the Government and Canterbury District Health Board (CDHB) were said to be "at war" over funding.
Is Canterbury in the midst of a crisis? The Press has spent two months answering that question by investigating mental health in the region.
We found "crisis" was not the right word. Rather, Canterbury is in the grip of a chronic mental health problem and the solutions are more complex than money.
Mental health demand is on the increase nationwide and in countries across the globe. Over the past decade demand for specialist mental health and addiction services in New Zealand has risen from 2.3 per cent of the population to 3.6 per cent.
The true number of Kiwis who make contact with the wider mental health sector is estimated to be one in five each year. In Canterbury, natural disasters and a stressful recovery added a layer of hurt to existing issues.
While about 80 per cent of the population is doing well, surveys found those renting, on low incomes, with health conditions or disabilities, or unresolved insurance or Earthquake Commission (EQC) claims rated their quality of life much lower than the rest.
Nearly 17 per cent of Canterbury's population have received mental health support since 2011. To quote one public health worker: "A good recovery leaves no one behind."
During this investigation The Press spoke to scores of people on the frontline, including mental health workers, officials, police and non-government groups. They agreed services were strained and under-resourced and people's issues were more severe than they were pre-quake.
Most said Government funding – an extra $106 million since 2011 on top of normal funding to help post-quake pressures – had not kept up with demand.
We spoke to survivors and strugglers, those suffering the ravages of addiction, domestic violence and anxious children.
People like 13-year-old Maia Wilson*, who did not tell anyone she wanted to die for a year after she was sexually assaulted.
Or community mental health nurse Denise Coots, who was terrified of working on Christchurch Hospital's fourth floor after the February 2011 earthquake, but still showed up to help the region's most vulnerable.
And Sandra Brown*, who thought she could manage her partner's violence until he punched her in the face and stood over her with an axe.
International research shows disasters can have a long-term mental health impact and suggests policymakers allocate resources towards the most vulnerable in the five to 10 years post disaster.
Immediately after the February 2011 quake, mental health presentations, much like crime, lulled. Communities rallied, neighbours talked to each other and support was easily accessible.
But latest data from police, health authorities and not-for-profits show that, in the last three years, mental health, domestic violence and addiction issues have plateaued at unprecedented levels.
Mental health inpatient services have been close to, or over, capacity since 2012. Some nights, there are more adult patients than beds.
Children wait up to six months for mental health treatment. Suicide attempts in the region have increased 60 per cent over the last five years compared to 52 per cent nationwide.
Minister of Health Jonathan Coleman says the CDHB is well supported with the extra funding.
To put the extra $106m it received since 2011 into context, it represents about 1 per cent of the board's funding over that period (this year its budget was $1.5 billion).
'WE ARE AND WILL BE STRONGER'
Psychiatrist and University of Otago, Christchurch, associate professor Dr Caroline Bell says international research has found 10 to 20 per cent of people have difficulties for several years post-disaster.
CDHB data showed the proportion of Cantabrians who needed mental health support between April 2011 and March 2016 was within that range.
Canterbury's population is 546,300, according to Statistics New Zealand estimates.
About 16 per cent of the population (90,451 people) accessed mental health help in the first five years after the February 2011 quake. More than half of those people needed to see a specialist or be admitted as an inpatient. The rest were treated in the community through their GPs, not-for-profits or community mental health and social workers.
Bell says the post-quake environment – homes still being fixed and fought over, broken streets, road cones, construction noise – is stressful for everyone.
"It's not to the level of post traumatic stress disorder (PTSD) or anxiety, but it's like a constant state of hyper arousal. You get used to a lot, but you wonder how you'd be without that."
Disasters can have a positive impact – it's called post-traumatic growth, she says.
"Seeing the city coming back to life, we value it more than before when we took everything for granted … I'm hopeful that we are and we will be stronger."
'A GOOD RECOVERY LEAVES NO ONE BEHIND'
All Right? Campaign manager Sue Turner and public health specialist Dr Lucy D'Aeth says most Cantabrians are doing well.
The campaign's latest survey shows 82 per cent of respondents rate their quality of life as good. But 64 ill grieving for what was lost in the quakes and Cantabrians' life satisfaction and sense of purpose is marginally lower than the rest of the country.
"There are still some people left behind. It's almost like a lottery. A good recovery leaves no-one behind," Turner says.
"We have people who are right back at stage one with re-repairs. That's horrible. It keeps them in that space."
On the bright side, Cantabrians are more aware of their mental health and more likely to ask for help now than they were seven years ago, she says.
This series looked for hope and found it in spades. People are working harder than ever to help the most vulnerable.
The post-quake mental health recovery did not get everything right, but the lessons could help New Zealand prepare for the next disaster.
* Names have been changed to protect identities.
WHERE TO GET HELP
Lifeline: 0800 543 354 - Provides 24 hour telephone counselling.
Youthline: 0800 376 633 or free text 234 - Provides 24 hour telephone and text counselling services for young people.
Samaritans: 0800 726 666 - Provides 24 hour telephone counselling.
Tautoko: 0508 828 865 - provides support, information and resources to people at risk of suicide, and their family, whānau and friends.
Whatsup: 0800 942 8787 (noon to 11pm).
Kidsline: 0800 543 754 (4pm - 6pm weekdays).
The Lowdown: thelowdown.co.nz - website for young people aged 12 to 19.
National Depression Initiative - depression.org.nz (for adults), 0800 111 757 - 24 hour service.
If it is an emergency or you, or someone you know, is at risk call 111.
For information about suicide prevention, see www.mentalhealth.org.nz/suicideprevention.