Earthquake stress triggers mental health issues

There are ordinary people who coped well in the aftermath of the earthquakes for whom the stress has now become to much, write Drs Alistair Humphrey and Peri Renison.

Mental health issues could affect anyone.
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Mental health issues could affect anyone.

Tony is a 32-year-old man who had hoped to get a job in the rebuild after his marriage broke up in Ashburton but couldn't get a job. He became depressed and suicidal and was admitted to HIllmorton where he was treated and recovered well.

When ready for discharge he had still not secured accommodation and was placed in crisis respite before being sent to the City Mission, where he started using alcohol. Within two weeks he was back in Hillmorton with another depressive episode.  

It's Friday afternoon  - Tony has been successfully treated again and could go home – if he had a home to go to. Instead he is on an emergency housing waitlist and paces around the ward taking up a space needed for somebody else. 

The phones keep ringing and staff remain calm despite the enormous pressure for more beds – but they know that mental health demand is vastly exceeding supply and most feel that they are close to breaking point.

This is a typical story any day of the week in Canterbury mental health services, which have been stretched to their limit in the four years since the earthquakes.  The mental health statistics of Canterbury are alarming. 

Prior to the earthquakes, Canterbury's mental health was on a par or better than most other health districts.  At a board meeting in April the changes since the earthquakes were outlined in graphic detail:

- 43 per cent increase in adult community mental health presentations.
- 37 per cent increase in emergency presentations.
- 69 per cent increase in child and youth mental health service presentations, which would be higher without CDHB's schools programme.
- 65 per cent increase in rural mental health presentations.

Canterbury now has the highest proportion of elderly accessing mental health services and the highest proportion of Maori accessing mental health services in New Zealand.  Overall, the difference between Canterbury and the next worst affected metropolitan DHB is equivalent to nearly 8000 more people in Canterbury accessing mental health services.

Despite this, the Ministry of Health has refused to recognise this pressing need, and will not even fund Canterbury to the appropriate level for its population.  hey appear happy to sit and watch one of the best performing DHBs in the country struggle under the weight of an overwhelming mental health burden brought on by the earthquakes.

Minister Gerry Brownlee led a delegation to Japan in March and signed the Sendai Framework agreement on behalf of the NZ government. One of the four priorities for action in, was "Recovery, Rehabilitation and Reconstruction".  

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In the lead-up to this historic UN agreement, there was much discussion about psychosocial recovery – Japanese people were not the only ones to empathise with Canterbury's long hard road through recovery.  There is good scientific evidence from the 2004 Indian Ocean tsunami and earthquake, from hurricane Katrina, and from the Victorian fires that mental health issues persist in communities who have suffered a disaster for many years. 

Although post-traumatic stress is an important issue for some people, it is other conditions, such as anxiety, depression and substance abuse which constitute the bulk of disorders several years on – moreover, the prevalence of these conditions increases in the years after a disaster. 

These conditions are compounded by the "everyday" issues with which all of us in Canterbury are familiar – Survivors of the Australian fires have described relocation issues, loss of employment, pain, physical injury, legal procedures, and financial loss as some of the ongoing stressors which persist for many years.  How familiar is this to Cantabrians in 2015, who would also add insurance woes to the list?

Christchurch Mayor Lianne Dalziel was invited by the World Health Organisation to speak at Sendai, and she highlighted Canterbury's challenges and successes in this area: 

Four years on we are in the early days of recovery, and the anxiety about aftershocks has given way to stresses about insurance, repairs and relocating offices, schools and homes. 

This in turn has led to increased presentations to general practice for anxiety and depression, accompanied by marriage break-ups, drug abuse and school difficulties for young people - ordinary families facing extraordinary difficulties.

At the more serious end of the scale, our mental health services have struggled to meet an un-relenting demand from people with new mental health problems, as well those with known problems which have relapsed in the wake of the earthquakes.

As highlighted by the chair of Canterbury District Health Board, the Canterbury Health system has responded to New Zealand's largest ever natural disaster with less than 1 per cent of extra funding over the past four years.  However, this tiny increase in funding did not take account of the 30,000 increase in Canterbury's population in response to the rebuild. 

Under such circumstances, many DHBs would have collapsed, but the continued high performance of Canterbury DHB is testament to the dedication of clinical and support teams in Canterbury, along with the adaptive leadership of Canterbury DHB which has facilitated innovation. The UK King's Fund and the British Medical Journal have recognised Canterbury's integrated health services as an example to the world. 

Ironically, the excellent overall performance of Canterbury disguises areas of particular difficulty, particularly mental health.  Data provided by CDHB to the Ministry of Health about the need for more investment to deal with long term psychosocial problems caused by the earthquake has been ignored. 

So have the traumatic accounts of staff who work in Canterbury's mental health services - politicians ignore clinicians' warnings at their peril. 

Some of the burden on mental health services is undoubtedly caused by the lack of housing in Christchurch.  This has been widely reported by The Press, by the Salvation Army and other NGOs caring for the homeless.

More than 98 per cent of CCC social housing was reported damaged by the earthquakes, and demolition of red zone property has led to an increased demand.  Low unemployment and relatively high pay packets mean that for many people the hikes in rent are not a problem. 

However, for those who have difficulty finding high paid employment, the double whammy of rent hikes and lack of social housing is adding to their mental health problems and at times literally driving people onto the streets.

In recent weeks the number of lower cost bond registrations has increased, which in turn suggests that low cost rentals are being freed up as people move back into earthquake-repaired houses.  This is good news for the YWCA, the City Mission and other providers of emergency accommodation which have waiting lists for the small number of beds they can provide. 

It is also good news for mental health services who are likely to face increased levels of mental illness for many years to come, much of which could be cared for in homes in the community – if only such homes existed. In any case, there is a housing deficit of almost 10,000 homes and supply is not projected to meet demand for at least another two years.

The challenge facing Canterbury's mental health services is likely to persist for many years.  Without sustainable investment, in recognition of the genuine disparity Christchurch faces in the long slow recovery from the earthquakes, many experienced staff believe the mental health services will fail to meet the ongoing needs of Canterbury. 

Canterbury DHB's adaptive leadership, innovative approach to prevention such as the "All Right?" Campaign, and integrated approach to healthcare (including mental health services) have influenced the Sendai Framework – a blueprint for disaster management for the world. 

But even the most innovative and determined health service requires adequate resourcing.  As Churchill said "Give us the tools, and we will finish the job". 

It's 4pm on Friday and Tony is fortunate - a unit is found for him to go to. Within thirty minutes of his departure another patient arrives – Vivienne – a 54-year-old woman who ran her own business for 20 years before the earthquake forced it to close. 

Her son has gone to university in Auckland because, in his words "there is more social life there" and she had been supporting her husband who had lost his job and now works for a much lower income. Vivienne never thought she would need mental health services, but she is typical of many people for whom the stresses of post-disaster Christchurch have been too much. 

Such cases are commonplace now in post-earthquake Canterbury. These are ordinary people, who coped well in the immediate aftermath of the earthquakes, but for whom the stress has become too much and now face mental health problems that are easily treated with appropriate resources. 

Next week it might be you, or me, or our children or spouses who need support for a mental health problem.  As the last Minister of Health said, we all deserve the right care in right place at the right time. It's high time that Canterbury's mental health services are resourced to meet the demands they are facing.

Drs Alistair Humphrey (Medical Officer of Health for Canterbury) and Peri Renison (Psychiatrist) write on behalf of the Christchurch Hospital Medical Staff Association (CHMSA).

* Lifeline's telephone counselling service provides 24 hours a day, 7 days a week counselling and support on 0800 543 354.

 - The Press

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