Amicus: New Zealand’s abysmal mental health statistics

Emily Davidson

New Zealand has appalling mental health statistics. In 2017, 606 people died by suicide.[1] This is an all-time high. The previous record was set in 2016.[2] Within our broader suicide problem, it is evident that we have a child and adolescent mental health crisis. Our teen suicide rate (those 15-19) is the worst in the developed world and we have the second greatest number of self-inflicted deaths among those under 25.[3] Almost one in twenty secondary school students report trying to take their own lives each year.[4] 32,064 children and teenagers were referred to the Child and Adolescent Mental Health service last year,[5] which is about 90 young Kiwis a day. The total of referrals has grown by nearly 6000 since 2012.[6]

It is disturbing that our suicide rates are trending upwards, even when measured against an increasing population. Suicide rates dropped from the highs of the 1990s, but those reductions have halted since 2007.[7] Today, it is unusual for someone’s life to not have been touched by suicide or serious mental illness in some way. With this far-reaching impact has come increased public concern, which brought mental healthcare to the fore in the most recent election.

Our Current Mental Health Law

Government policy is a significant underlying factor in the mental health of a nation. Legislation can play a crucial role in framing policy to clarify an effective system of prevention and treatment.  It is abundantly clear from our suicide rates that New Zealand has a mental health crisis. Therefore, our current policy is not doing the work that is needed.

In New Zealand, our main mental health legislation is the Mental Health (Compulsory Assessment and Treatment) Act 1992.[8] The Act sets out the conditions under which a person can be made to receive treatment without their consent. A person can only be subject to a compulsory treatment order if they have a mental disorder as defined under the Act.[9] This means that they must have an abnormal state of mind shown by delusions or disorders of mood, perception, volition or cognition; and this abnormal state of mind must mean there is a serious danger to the person or other people, or that the person’s ability to care for themselves is seriously reduced.[10] Because compulsory treatment infringes on the patient’s freedom of choice, there is an exacting application and assessment process to ensure that the person does meet the criteria.[11]

The Mental Health Act is intended to provide treatment and protection in the most acute cases of mental illness. The definition of ‘mental disorder’ is deliberately strict because depriving a person of their right to refuse treatment is not something that should be taken lightly. However, this means that our primary mental health legislation is not designed or intended to support mentally ill people who fall short of an extreme standard.  The Act is not just an ambulance at the bottom of a hill, it is at the base of a mountain. By the time someone falls under the Act, they will be seriously unwell. There may have been multiple prior opportunities to intervene that have been neglected. Furthermore, the rigorous process means that the protections offered by the Act will only come into play when it is clear that someone is deeply mentally ill and dangerous to themselves or others. Often, the signs of someone being mentally ill, and even suicidal, are far subtler and would not meet the criteria. The Mental Health Act is clearly not enough. We need robust policy in place that provides for care before people are a danger to themselves.

Change on the horizon

There is currently a strong impetus for change in mental healthcare. The Labour Government has promised to expand the ‘nurses in schools’ programme, make visiting the GP for mental health issues free, and introduce ‘mental health co-ordinators’ into primary care.[12] The Government has also committed to free counselling for under-25s and the re-establishment of the Mental Health Commission.[13]

A Mental Health Inquiry is presently underway to assess what changes can be made to improve mental health outcomes in this country. The panel has held more than 200 meetings and received 5000 submissions.[14] The overwhelming message has been frustration at the reactionary approach of our current system. The existing focus on treatment rather than prevention is inefficient and leads to worse individual outcomes. Other common complaints were over-reliance on medication, and difficulty accessing help for people with moderate mental health needs. The panel will submit its recommendations by the end of October. The Government will decide which recommendations are accepted and resourced.[15]

What else should we do?

Mental health policy should be re-formulated to establish measures that serve a preventative and holistic approach to mental wellbeing. One such measure should be increasing counsellors in schools. In the 1990s, education reforms allowed schools to become self-governing.[16] As a result, many schools re-allocated funding that had previously been pegged to ensuring there was one counsellor for every 400 students. Today, some schools with over 600 pupils have no counsellors.[17] Access to counsellors at what is often a turbulent and emotional stage of life is a crucial preventative measure. Counselling would allow students to learn how to process their emotions in healthy ways, and give them the tools to support their mental wellbeing in the future.

There is a clear need for an increase in funding for youth specific mental health support services. The Child and Adolescent Mental Health Service (CAMHS) provides specialist consultation, assessment and treatment, but only to the most unwell. Last year alone, 1824 children and teenagers were turned away by the service.[18] Alternatives are often prohibitively expensive and wait times are a major obstacle to meaningful intervention. Those assessed as non-urgent by the service are forced to wait up to six months to get help.[19] Like any physical illness, a delay in treatment results in a worsening of the condition. A key reason why the service struggles to keep up with demand is that it is significantly underfunded. CAMHS receives 13% of total district health board mental health funding, but is tasked with caring for all patients aged 19 and under – that is a quarter of the population. [20] A reasonable allocation of funding should therefore be 25% of total district health board mental health funding.

A greater emphasis should be placed on talk therapies. Although having a GP prescribe an anti-depressant may be the quickest way to temporarily solve the issue, it does not address the underlying causes, or offer a healthy long-term solution. Our public mental health system operates on a ‘revolving door’ basis, patching up and pushing out patients.[21] Under this approach, talk therapies are difficult to access. Often, they are only available on a time-limited basis, which is unlikely to bring about lasting change for most patients. As a result, New Zealanders are relying on a privatised mental health system to provide access to what is often the most meaningful and effective long-term solution to mental illness. The consequence is that talk therapy is only available to those with the financial means, and not to our most at risk demographic. It is imperative that talk therapies are funded as part of a holistic and long-term approach to mental wellbeing.

Mental illness is a symptom of an unwell society. It sits at the intersection of many different socio-economic factors. It is a complex beast, and there is no silver bullet. However, our understanding of the causes and treatments has developed greatly over the last 20 years, and our mental health policy needs to move with it. New Zealand needs to invest in the mental wellbeing of its population, and provide for preventative measures and holistic treatment so that our future generations can be happier and healthier.

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[1] “Mental Health Inquiry says ‘there was some rage’ as it acknowledges public frustration but remains confident of delivering blueprint for change to Government” (17 July 2018) NZHerald https://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=12087239.

[2] “Mental Health Inquiry”, above n 1.

[3] “Break the Silence: New Health Minister pledges change on youth suicide” (13 November 2017) NZHerald https://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=11942866.

[4] “Break the Silence”, above n 3.

[5] “Editorial: We need to deal with our terrible statistics” (22 July 2017) NZHerald https://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=11893198.

[6] “Editorial”, above n 5.

[7] “Break the Silence”, above n 3.

[8] Mental Health (Compulsory Assessment and Treatment) Act 1992.

[9] “Mental Health and the Law” mentalhealth.org.nz <https://www.mentalhealth.org.nz/assets/Uploads/Ch-2-MH-the-Law-Mental-health-compulsory-assessment-treatment-act-2002.pdf> p 31.

[10] Mental Health (Compulsory Assessment and Treatment) Act 1992, s 2.

[11] At Part 1.

[12] “Break the Silence”, above n 3.

[13] Above n 3.

[14] “Mental Health Inquiry”, above n 1.

[15] Above n 1.

[16] “Break the Silence”, above n 3.

[17] “Mental Health Inquiry”, above n 1.

[18] “Editorial”, above n 5.

[19] “Break the Silence”, above n 3.

[20] Above n 3.

[21] Kyle MacDonald “Why is mental therapy in Auckland so expensive?” (19 July 2018) NZHerald <https://www.nzherald.co.nz/lifestyle/news/article.cfm?c_id=6&objectid=12091138>