Brighter Future? The faces of mental health

06:00 am on 26 June 2017
Lois Williams, Northland reporter
Karen Brown, Health Correspondent
Mei Heron, Political Reporter

In her dark times, Freya Sadgrove finds comfort in poetry.

English writer Philip Larkin's ability to beautifully articulate feeling and emotions especially resonates with her, when her own feelings are in turmoil.

Freya, 24, has depression, anxiety and bipolar disorder.

She first started feeling depressed when she was still in high school, but it got much worse in her first year of university.

Worried about where things were headed, she saw a GP, who put her on an emergency list to see a psychiatrist - but there was a fortnight-long wait for an appointment.

"I was suicidal, I was in a lot of danger [and] two weeks was a very long time. I couldn't imagine getting through."

Unfortunately, Freya didn't get through - she ended up in emergency psychiatric care.

After that, her doctor warned her to stay away from the public health system.

"She said you should go private if you can, because the system is overcrowded and you'll have to wait a very long time."

In Freya's view, her experience is symptomatic of a mental health system that is not coping.

Freya Sadgrove ended up in emergency psychiatric care after the wait to see a psychiatrist proved too long Photo: RNZ / Rebekah Parsons-King

Last year more than 161,000 clients were seen by mental health and addiction services - 40,000 more than 8 years ago.

An additional 200,000 people have been diagnosed with depression since 2007, and nearly 300,000 more people have been diagnosed with a mood or anxiety disorder.

The number of Māori seeking help is rising more rapidly than for any other other ethnic group.

And every year about 500 people die by suicide in New Zealand - a statistic that has remained stubbornly high over the last decade.

Since it took office in 2008, the National Party has given $300 million extra to mental health services and pledged another $224 million over four years in May's budget.

But is that enough for a system that is creaking under the pressure of rapidly growing demand?

Freya doesn't think so.

"People give up on the system all the time.

"There are too many people needing to use a system that doesn't have enough people to deal with the volume of trouble it's faced with. It's not coping."

It boggles her mind that key initiatives are not being given money.

Currently Lifeline's 24/7 helpline receives no government funding after losing a contract in 2015.

"That's a lifeline," Freya says. "Why would you - ugh. That was a bad decision. I have occasionally called helplines and if I hadn't called them it'd be bad news for me."

Huge effort has been put in to make society aware about mental health and it's great that people feel more comfortable speaking out, Freya says.

What is needed now is more resources, more front-line workers and more funding to cope, she says.

The system is under such stress that she and her friends turn to each other instead.

"My family have really helped me, and my friends have really helped me. And there should be ways that this doesn't have to be the be-all and end-all. 

"It shouldn't have to crush you."

"We have this real thing in New Zealand where it's like, let's go down to the pub, have a drink, and harden up."

Camerin Jago says it's become harder to access mental health services after the Christchurch earthquakes, because of the demand Photo: RNZ / Rebecca O'Sullivan

When Camerin Jago first told his mates he thought he was an alcoholic, they laughed and said, "No you're not, you just drink like we drink."

Camerin believes he's been dealing with mental health issues most of his life, but it wasn't until 10 years ago, in his twenties, that they became more real.

"It wasn't until I was basically diagnosed with alcoholism and severe addiction issues [that] I was made aware of some of my mental health issues that were quite prominent."

Camerin sought help with CareNZ, which supports people with addiction problems and also works alongside the Department of Corrections in prisons.

Living in Christchurch, Camerin says it's been good to see people more open about their mental health since the first 2010 earthquake.

"Basically the whole city was dealing with post-traumatic stress in some shape or form."

The government has funded the 'All Right?' wellbeing campaign since February 2013, which conducts research to track the mental health of Cantabrians as well as offering support.

A recent campaign study shows about a third of Cantabrians think their health is worse than before the quakes, and one in 10 reported drinking more.

International evidence shows psycho-social recovery following a major disaster can take five to 10 years, the Health Ministry says.

For Camerin, the earthquakes came at a time where things in his life were difficult, his relationship was in a bad place, and as a result he was again struggling with his drinking.

He ended up seeking help from Relationship Services, which was offering free counselling to anyone who had been through the quakes.

But he says with so many people needing help, the services are stretched.

"I feel like resources are getting strangled more and more, it's harder to get help, it's harder to get free counselling, there's more [hurdles] being put up for people before they can actually see that person or get some help."

Figures released by the Ministry of Social Development in early 2016 showed funding for psychological services through community groups in Canterbury had been cut from $1.6 million to $200,000, and funding for trauma counselling had halved to just over $400,000.

Following criticism, the government announced an extra $20 million in mental health funding for Canterbury.

Then earlier this year, the government announced it would give $6 million to the Community Resilience Partnership Fund, which helps support community-led wellbeing projects in Canterbury.

Camerin says that's good news.

"I think that's the real strength, is people talking about it on a ground level and taking the stigmatism out of it.

"We have this real thing in New Zealand where it's like, let's go down to the pub, have a drink, and harden up."

"I fell through the cracks"

 Lisa Ng says there have been times where the mental health system has left her to her own devices Photo: RNZ / Rebekah Parsons-King

When Lisa Ng suffered a manic episode three years ago, she was thrust head-first into the mental health system.

The keen mountain biker and photographer was immediately diagnosed as bi-polar, but the treatment she's had since then has been patchy.

Early on, she missed an appointment with a psychologist and no one checked up on her. She became depressed and tried to take her own life.

Recently, a UNICEF report ranked New Zealand 34th out of 41 in a study on the health and well-being of children in the OECD. It singled out the country's high suicide rate as the main contributing factor.

In 2014 - the latest year statistics are available for - 504 people committed suicide. More than half of them were males.

Lisa Ng worries the lack of improvement in those figures is due to an overcrowded, under-pressure health system.

"They've been instances [when] I've just dropped off the radar, and if I hadn't pursued it myself, I would have been left to my own devices. I fell through the cracks."

A recent report by the Office of the Auditor-General found some hospital inpatient mental health units had high occupancy rates - sometimes beyond capacity - and pressure on services meant some people were discharged from hospital too early, and sometimes without a proper plan.

Lisa recalls a similar experience where she was admitted to a psychiatric ward for three weeks, but was released with nowhere to go. She ended up staying at various friends' houses.

Not long ago, Lisa felt herself entering another manic phase. Her medication has been increased but there's such a backlog of patients that she is still waiting, more than three months later, to see a psychologist.

"I needed help early on but I haven't been able to receive it... It scares me that I might end up in the dark narrow spaces [where] I go, 'I want to end my life' - that scares me a lot.

"If you're heading towards a manic episode, you want to address that earlier, rather than wait for me to enter a psych ward where I'm full-blown manic."

Lisa feels supported by her friends and her family. Without them, she knows life would be a lot harder. She just wishes the mental health system could give her help too.

"I'm not blaming the team that I see, but if you're underfunded, you can't see everyone."

"I was forever fighting to be acknowledged as a person"

Delena Ru says Māori people feel marginalised by the current mental health system Photo: RNZ / Rebekah Parsons-King

Delena Ru was the solo mother of three teenagers - two of whom were very sick - when she went to the doctor seeking help.

The GP said she was fatigued, depressed, and needed to take a drug called Prozac.

Looking back at the visit, which took place over a decade ago, Delena Ru recalls being alarmed at the impersonal nature of her visit.

"I was being treated more like a statistic... This is wrong with you, so that step is what we're going to do. And that's it."

"They had categories of where you fitted, or didn't," she says. "And if you fell outside of those categories or boundaries, then the service that was provided was minimal."

There was a gap in the system for people like her, she says - people who weren't acutely unwell, but did need help.

"[The system] dehumanised me. It made me feel like I was forever fighting to be acknowledged as a person."

The rate of Māori seen for mental health problems has risen by nearly 60 percent since 2002, compared to a 33 percent rise in the general population over the same period.

Delena Ru Photo: RNZ / Rebekah Parsons-King

Delena believes Māori still feel labelled by society as "failures" and "uneducated" and because of this, struggle with their mental health more.

However she says many friends and family come to her for mental health advice, because they're experiencing a system they feel treats them differently because of their race.

"They felt marginalised all the time."

The Office of the Director of Mental Health raised concerns in its 2016 annual report about the high proportion of Māori in the mental health system.

An important question for the sector to consider was whether Māori were receiving differential treatment, the report said.

A study published in the New Zealand Medical Journal in May found under-diagnosis of depression and anxiety was more likely in Pasifika, Māori and Asian New Zealanders.

Delena wants a system that helps people stand on their two feet rather than continuing to be dependent on that system.

"The system is way overdue for a make over or a facelift. [We need] more support towards resources - social workers, front-line staff.

"You can't keep applying the same application when things are not working. It's almost like being stuck. What's actually being delivered?"

"If we just poured money into the same things that we're already doing, that would be a disaster."

Shaun Robinson Photo: RNZ / Cole Eastham-Farrelly

Shaun Robinson remembers being in rooms, with doctors behind glass windows looking in.

The mental health system has come a long way since the 1990s, he says.

"Looking back, had I not been a white, well-educated, fairly confident male, I think negotiating through that system would have been pretty difficult. It was pretty impersonal."

The system now is much more empowering and he's finally a partner in decisions for his own care, he says.

Now chief executive of the Mental Health Foundation, Shaun is bi-polar, but says it took him a long time to finally accept he could have a mental illness.

"Like a lot of Kiwi blokes - and women as well - the idea of having a mental illness was scary and a noted weakness.

"We've done a really good job over the last 20 years at reducing stigma. People are more prepared to ask for help."

Because of that, though, there's been a growing demand for services - resulting in difficulty accessing those services, inconsistent quality, and staff under immense pressure, Shaun says.

While the government has given millions more dollars to the sector, there needs to be a re-think about how that money is spent, he says.

"If we just poured money into the same things that we're already doing, that would be a disaster."

The 1988 and 1996 Mason Reports created a blueprint for mental health services "that took us a long way in the last 20 years", Shaun says.

"But since about 2008, with the global economic crisis that pulled the plug on a lot of resourcing, we've kind of run out of steam and we need to have a new strategy, a new blueprint that says what we're going to do."

"We do the best we can with what we have."

Community mental health nurse Rebecca Win Photo: RNZ / Rebekah Parsons-King

Rebecca Win helps people every day.

She's been a nurse for 11 years - two of those as a community mental health worker.

Her team is fully staffed, but they are busy and referrals are increasing, she says.

"I think it's really clear that we can't meet the demands that there are for our services. It often feels there aren't enough hours in the day and you need to prioritise your workload - we do the best we can with what we have."

It can be overwhelming and stressful being unable to provide the care that people need, Rebecca says.

"The acute work is increasing, there is quite high demand [for] our services, but we are only funded for the top three percent ... of people that may need mental health contact."

Like others who spoke to RNZ, she too worries that even the increases in funding there have been since 2008 are insufficient.

"The stresses in society [have] really increased the demand and really affected people's ability to feel resilient and to cope with the day-to-day things," she says.

"I think that has increased over many years to a point where it feels like it's a crisis.

"Where I see investment needing to be is in primary health care and in that mild to moderate spectrum that we as a service don't cover."

Where to get help

If it is an emergency and you feel like you or someone else is at risk, call 111.

RNZ's election series Is this the Brighter Future? examines the government's record since it was elected in 2008. Read more here.