Mental health targets that stop at the front door risk widening the gap and growing the "missing middle".
Mental health targets that stop at the front door risk widening the gap and growing the "missing middle".
Editorial
EDITORIAL
Whenever we talk about mental health, most conversations circle around the types of issues that can be solved with better sleep and some time in nature, or issues that people need to be hospitalised for.
There is an “in between” we often forget – and that’s where a lotof us fall. These are the “missing middle” in mental health: people whose condition is neither mild nor severe but somewhere in between. That gap doesn’t exist just in conversation. It is very real with regard to access to diagnosis and treatment of mental health issues in New Zealand.
In a feature about OCD treatment in New Zealand published a few days ago, the Herald highlighted the issues with access to diagnosis and treatment for the condition across the country, and the disparities and inequities that still exist in that access.
One of the people who opened up about living with this mental health disorder was Laura Butler, from Hastings, who told the Herald about her difficulties accessing treatment in the past and how, because of the cost of accessing specialised treatment in New Zealand, she’d often had to let herself get “more and more unwell” in order to be able to access support through the public system.
“Now, because I’ve been so unwell in the past, I get seen with more urgency. There’s a sense of having to get so unwell to qualify for public treatment,” she said.
According to Dr Paul Skirrow, a clinical psychologist and senior lecturer at the University of Otago, “successive governments have consistently failed to meet the needs of what has been described as the ‘missing middle’ in mental healthcare”.
“The focus of specialist mental health services has tended to be on people with high acuity (highly unwell, highly suicidal or violent – sometimes described as having ‘severe’ mental health issues). More recently, there has been a focus on primary mental healthcare, with short-term (one to six sessions) generic counselling and educational interventions (typically aimed at people described as having ‘mild’ mental health issues). However, there are thousands of people who have more chronic conditions like OCD (often described as having ‘moderate’ mental health issues) [who] could be helped by having access to evidence-based psychological therapies,” Skirrow said.
The options for those people, with conditions that aren’t just mild but are also not “severe enough”, usually lie within the private sector – which comes with its own set of constraints. This often means for that “missing middle”, accessing treatment is a financial decision, and one many cannot afford to make.
Dougal Sutherland, clinical psychologist at Te Herenga Waka – Victoria University of Wellington, recently wrote a piece for The Conversation about how the Government’s latest mental health targets are not enough.
The new targets announced by Mental Health Minister Matt Doocey include 80% of people accessing specialist services being seen within three weeks, and 95% of people presenting for mental health needs at an emergency department being seen and discharged or transferred within six hours.
Mental Health Minister Matt Doocey. Photo / Alex Cairns
As Sutherland points out, “despite a number of high-quality reviews, there is a lack of data on the total costs required to have a mental health system that meets the needs of New Zealanders”.
“Targets can be helpful in motivating and focusing efforts. But to be truly effective, they need to include the whole system, not just the front door,” he said.
“Appropriately staffing mental health services is a key underlying factor in helping the Government reach its new targets. To this end, the new goal is to train 500 mental health professionals a year, an increase of 17% on the present 428 a year. However, to date there are no details on which professional groups within the sector are to be trained. The shortage of psychologists and psychiatrists within New Zealand is widely acknowledged,” he added.
“Failure to increase numbers of psychiatrists and psychologists will severely limit the effectiveness of specialist services and could effectively nullify any benefit gained from faster access.”
No one in New Zealand should feel like Butler and all the others who have a sense they need to get worse before they can get our attention and qualify for treatment within the public system.
We must ensure our healthcare system is robust across the board, not just “at the front door”.
