Mike King: New Zealand's mental health was not ready for the John Kirwan effect
Campaigner Mike King took a stand this week about how the country is tackling suicide issues. Is the mental health system coping with the demands put on it? Talia Shadwell reports.
The national character, according to a well-trodden cliche: a milk-fed, farm-bred, rugby-mad silent stoic type. Its greatest ambassador: an All Black.
If Kiwis had problems – and they did – they were supposed to let them fester behind closed doors and sealed lips.
So when an All Black, of all people, told Kiwis he had suffered from depression as far back as 1992 it was the watershed moment New Zealand's mental health system has failed to adapt to, comedian Mike King believes.
Since the early 1990s Sir John Kirwan's has campaigned for mental health awareness, and continues to do so. Kirwan has fronted many advertisements pointing people towards depression.org.nz and other resources, all while being involved in numerous speaking engagements about the issue, all over the country.
His efforts in breaking stereotypes and reminding people that it was OK to ask for help have made a tremendous impact. But for campaigner and comedian Mike King, Kirwan could not do it alone.
"I don't think the Government were prepared for John Kirwan's message," King recalls.
"You used to be able to get face-to-face counselling within a few weeks.
"Then, suddenly, there was this overwhelming flood of people saying, 'I'm doing this. I'm going to [ask for help] ... I do believe they [the government] actually thought they had it covered."
King believes today's system has not kept pace with the contemporary New Zealander: who has grown up feeling encouraged to ask for help – but when he or she does: too often cannot find it.
"The worst part is people turning up to emergency departments around the country telling them that they are feeling suicidal, then they wait for hours in ED. Then... they're in front of an over-worked mental health worker, told they don't meet the threshold for care."
King raised the point in a damning letter this week announcing his high-profile resignation from the suicide prevention panel – saying the Government's draft plan was "deeply flawed," and claiming the panel's recommendation for 20 per cent suicide reduction targets was ignored.
THE PRESSURE ON SERVICES
At Wellington's Evolve Youth Clinic, a free community service, swamped staff were forced to turn away 500 teenagers for six months before the Capital & Coast District Health Board (CCDHB) this week agreed to fund them to hire another part-time GP.
In the year to November 2015, nationwide one in 10 youth waited longer than eight weeks to be seen by mental health services. In Wellington, that rose to almost one in five Maori youth.
CCDHB mental health director Nigel Fairley says the wait times during that period were because Wellington's Kaupapa Maori youth mental health team, which provided a higher proportion of services, had vacancies.
The service is now well-staffed, and current wait times had evened out, he says.
When asked to respond to King's letter, particularly the points about the struggle to access psychiatrists, nationwide director of mental health services Dr John Crawshaw reiterates the Government's message around its investment in mental health and the increased pressure on services.
"Primary mental health is a priority for both the Government and the Ministry of Health. There's now a $1.4 billion in mental health investment - that's an increase of 18 per cent since 2008/09.
"Over the last four years, the number of new clients seen across New Zealand in the 0-19 years age group in under three weeks has increased from 7866 to 10,471, and the number being seen in under eight weeks has increased from 10,933 to 13,924.
"During the same period, the total numbers of new clients 2016 increased from just under 13,000 to 15,411. These figures include over 3000 new clients annually who were seen on the same day because of urgent need."
These figures are regularly referred to in an effort to emphasise the increased demand for services. But it's clear the Government investment has not kept pace with demand.
A 2016 independent report on youth mental health commissioned by the Ministry of Health found Maori youth were disproportionately affected by mental health issues, and tended to respond better to treatment aligned with iwi, whanau, and holistic health care.
But King fears the health system's focus on Maori mental health is "polarising" New Zealanders.
"Suicide doesn't care whether you're Maori, or wealthy or poor, or black, white, yellow or orange - it takes everybody."
Greens MP Marama Davidson says while she agrees with King that suicide is a broad social issue, she thinks when young Maori are over-represented in suicide statistics, it is worth exploring whether there is something about the way the services for them don't fit.
"What we know is that young people are presenting to their GP ... they would like some help.
"What kids need is professionals – whether it is drugs, alcohol or depression: every day is a hard day."
CALLS FOR HELP
Even just a chat is hard to come by, according to Youthline.
Its volunteers took 334 individual crisis calls – the most serious among the thousands each year it receives – in the year ending March 2016. In the same period ending this March, those calls trebled: to 997.
The number of calls about suicide rose from 719 in February, to 1293 in March.
It was not yet known why there was such a significant spike in calls for help - but a survey Youthline commissioned last year found the number one issue young people called about was stress.
Youthline, which was hit by a Government funding-cut in late-2016, was only equipped by its funding to answer one in four calls that it received, national spokesman Stephen Bell says.
The calls they did receive - via phone, text or email - where someone self-harmed while the volunteer tried to talk them out of it, left workers feeling helpless to intervene - especially if they couldn't find their location to pass on to police.
"We can feel incredibly powerless when we're with someone and trying to find them, they are hurting themselves and we're trying to hang in there... so we can get close to a relationship where they are asking for help."
Crawshaw says Government officials are working hard "to understand and address the wider determinants of health and well-being".
"The ministry and DHBs are both concerned to ensure that patients are engaging with a responsive mental health system, which ensures better outcomes for New Zealanders. We work together to achieve this."
"All DHBs regularly report to the ministry on the ways they are managing the delivery of services in their areas and if they have specific issues, how these can be addressed."
He refers to the ring-fence around funding - imposed by the ministry – which means DHBs have control over how they budget for mental health services, but cannot spend less than the previous year.
"The ring-fence was put in place to protect specialist mental health and addiction service investment and development," Crawshaw says.
Crawshaw says mental health is strongly influenced by social factors: "low income, unemployment and a low standard of living all contribute to poorer outcomes for those with mental health and addiction issues".
WHERE TO GET HELP:
* Lifeline 0800 543354 (open 24/7)
* Suicide Crisis Helpline 0508 828865 (open 24/7)
* Youthline 0800 376633 (open 24/7) or text 234 from 8am – midnight
* Kidsline 0800 543754 (open 24/7)
* 0800 WHATSUP helpline, 0800 9428787 (1-10pm weekdays and 3-10pm weekends)