Covid-19 has added to an already worrying mental health situation, but some groups are feeling the psychological impact more intensely than others. One Auckland mother shares her family's experience.

When the coronavirus hit New Zealand two years ago, Stacey*, a 12-year-old Auckland girl, seemed to cope with the upheaval to daily life as well as any of the children around her.

Stacey lives on the North Shore with her parents, both successful professionals, and two older brothers. Before the pandemic, her mother Emma says, Stacey was a confident, energetic child who liked netball, water polo, and Girl Guides. She'd never displayed signs of major emotional or psychological problems.

But in June 2020, after returning to school after the city's first lockdown – Stacey was in the first year of intermediate school at the time – Stacey's parents began noticing alarming changes in her behaviour.

She started obsessing over small things. Flicking a light switch on and off when leaving a room. Opening and closing her wardrobe multiple times when getting dressed. Pressing the power button on her tablet repeatedly when trying to turn it on.

Suddenly, Emma says, Stacey was incapable of doing everyday tasks that had been second nature. Her mind seized up when she had to walk over lines or cracks, which meant she couldn't climb stairs or cross the road. She struggled to write certain letters and numbers. She couldn't put on a seatbelt.

"Almost overnight, we lost our daughter and instead had one terrorised by mental illness," says Emma.

It now took hours just to get Stacey to school. Teachers tried to accommodate her; friends rallied to help. But some of the kids teased her for acting weirdly. Stacey's hands and arms were raw because she couldn't stop washing and sanitising them.

She was only too aware that her behaviour didn't make sense, and it was highly distressing.

"Day after day was spent in tears," Emma says.

One night, Stacey was so upset she locked herself in a bathroom for three hours, crying. Emma sat outside, reading stories and singing quietly through the door, doing everything she could think of to soothe her daughter. But it got worse.

"I can't take this anymore!" Stacey screamed at other times.

For Emma and her husband, who'd never been through an episode of mental illness with their older children, Stacey's sudden deterioration was terrifying.

At night, they searched the Internet for information. They quickly concluded Stacey must have obsessive-compulsive disorder (OCD) – nothing else they found seemed to explain her behaviour – but there was little useful guidance, Emma says, on what parents should expect, what to do about it, or where to go to get help.

Was this their life now? Emma worried. Would Stacey keep getting sicker? They'd heard horror stories about the poor state of mental health care, about parents' desperate attempts to get help for their distressed kids, the terrible outcomes for so many young people.

"It's hard to know what to do," Emma says.

Stacey is one of a growing number of Kiwis whose mental wellbeing has declined since the coronavirus outbreak, escalating an already worrying situation.

The state of mental health was already worsening steadily before Covid.

Between 2011 and 2020, the number of adults who took part in the annual New Zealand Health Survey who'd been diagnosed with depression or anxiety rose from 16 per cent to more than 20 per cent.

Rates of people reporting psychological distress within the past four weeks rose by two-thirds over that period.

Concerns about these trends led in 2018 to the landmark He Ara Oranga report, which called for a transformation in the nation's approach to mental health. A year later, Labour made "taking mental health seriously" a top policy priority in its Wellbeing Budget, committing $1.9 billion to initiatives including a new counselling service for people with mild psychological conditions.

Covid poured petrol on the fire.

As part of a major ongoing investigation, the Herald spoke to dozens of people with experience of mental illness, their carers, clinicians, and health officials, and reviewed thousands of pages of documents and data from public bodies, much of which has not previously been disclosed.

Taken together, the reporting shows the pandemic has magnified an already urgent problem, causing misery for thousands of Kiwis and adding additional strain to a health system that was already overburdened.

New research commissioned by the Mental Health Foundation, published for the first time today by the Herald, has found that 36 per cent of people surveyed had poor emotional wellbeing, up from 25 per cent in December 2020. The polling, conducted by Ipsos, used a questionnaire devised by the World Health Organisation.

"A very large percentage of the population are actually really struggling with their mental wellbeing," says Shaun Robinson, chief executive of the Mental Health Foundation.

"That's really concerning."

The foundation's survey mirrors the findings of studies by academics here and overseas.

Dr Susanna Every-Palmer, an associate professor at the University of Otago and chair of the New Zealand branch of the Royal Australian and New Zealand College of Psychiatrists, co-authored a November 2020 study that looked at psychological wellbeing after the first lockdown. Thirty per cent of respondents reported "moderate to severe" distress, much higher than normal, 16 per cent had high levels of anxiety, and 6 per cent had contemplated suicide.

Those elevated rates have continued through the pandemic, Every-Palmer says.

It's worth emphasising that the vast majority of Kiwis say they're still doing okay, even after two years of extraordinary stress and turmoil. Some people experienced good psychological outcomes during the pandemic, enjoying getting to spend more time with family and less time at work and using Covid as a catalyst to re-evaluate their lives.

And not everyone with a poor emotional state will develop a life-altering mental condition that requires professional help. But the research shows that a growing number of people are at risk of doing so, Robinson says, at a time when the system's capacity to help them is severely constrained.

Our mental health system was already overtaxed after years of underinvestment and rising demand, resulting in high barriers to access, inconsistent treatment, and crippling staff shortages. Now services are being inundated by a surge of new cases from people who'd never had a mental illness before Covid, according to Government data, District Health Board documents and interviews with frontline staff.

Covid has added "a crisis on top of a crisis", Robinson says.

Emma took Stacey to see a clinical psychologist in August 2020, a few weeks after noticing her sudden change in behaviour.

Within minutes of meeting Stacey, Emma says, the psychologist identified her as having obsessive-compulsive disorder.

Often misrepresented in everyday conversation, OCD is a serious anxiety disorder that compels people to repeat certain actions so often that they cause significant distress and disruption to their lives. For some people, it is debilitating.

While the causes of mental illness are complex and sometimes hard to pinpoint, Emma is convinced that Stacey's condition was triggered by the pandemic.

She puts it down to the stress of being abruptly thrust into an unsettling, anxiety-provoking new existence of mask-wearing, handwashing, and enforced isolation at the same time as being cut off from routines, relationships and activities that gave her purpose, self-confidence, and an outlet for her busy brain.

"Auckland kids endured such a long time of restrictions," Emma says.

"Effectively everything that kids would normally do to have fun and relieve stress was gone."

Most handled the disruption remarkably well, but some were overwhelmed by it. Stacey was one of those who were overwhelmed.

Emma and her husband didn't bother seeking help from the public mental health service in their area. Everything they'd read and heard about the public system led them to believe that, even if there was treatment available for Stacey's OCD, they'd have to wait months to get in, she says.

They didn't want to wait, so they found a private therapist who charged nearly $600 for the assessment and more than $200 an hour after that. The family's health insurer didn't cover psychological treatment, "so you either pay it or you get no therapy", Emma says.
"The cost adds up fast."

Later, Emma would count the family as fortunate to have even found a psychologist to treat Stacey. Such has been the explosion in demand for mental health treatment that many private therapists now have a waiting list that is months long and some have stopped taking new patients.

Treating OCD typically involves psychological therapy that confronts the person's compulsions and tries to lessen the anxiety they provoke. Stacey, still so young, found this hard at first, but it helped somewhat over time, Emma says. At home, the family did everything it could to help Stacey break her repetitive thinking.

There were moments, Emma says, when they could see glimpses of their happy, carefree child – like when Stacey was in the pool playing water polo, where there were no lines to trap her. But those moments never lasted long. Her illness was always lurking.

Stacey's condition grew worse when Auckland went back into lockdowns.

"She was beside herself," Emma says. "She couldn't sleep or calm down."

At higher Covid alert levels, Stacey's therapist suspended face-to-face sessions. They tried doing the treatment by video instead, but it confounded Stacey.

"We were basically back to fending for ourselves again," Emma says," as well as trying to continue our work and supporting the rest of the family."

"It was a living nightmare."

Emma tried to find creative ways to stop her daughter's state of mind deteriorating.

In August, when the arrival of the Delta variant put Auckland into its longest lockdown, Stacey's teacher gave her class an assignment to keep them occupied at home.

Find as many green letterboxes in your neighbourhood as you can, the teacher instructed. The student who found the most by Friday would get a prize.

Stacey's OCD made it hard for her just to walk to the end of the street without stopping. Stepping over the cracks in the footpath, crossing a drain cover – her brain resisted. But Emma figured the assignment would allow Stacey to work on those mental barriers, and give her a reason to leave the house every day.

Together, they found all the green letterboxes in their neighbourhood, and then kept going. For five months, Emma says, she and Stacey walked street after street on the east side of the motorway from Long Bay to Devonport, taking photographs of every green letterbox they came across.

"It was hundreds of kilometres of walking," Emma says. "Our shoes were worn out by the end of it."

Some people are experiencing the psychological pressure of the pandemic more intensely than others.

While all of us have been exposed to higher amounts of stress in the past two years, and it's perfectly normal to feel worn out and downbeat because of that, in most cases those feelings will pass without causing major disruption or professional help. "Most people are resilient," says Every-Palmer.

For some vulnerable groups, however, rates of poor wellbeing, anxiety and distress have been persistently high since the start of the pandemic, researchers here and overseas have found, putting those people at greater risk of a serious mental illness.

One group causing a lot of concern among mental health experts right now is the thousands of New Zealanders who've had Covid-19.

The consequences of long Covid are not entirely clear, but evidence is emerging that it can have a lasting adverse effect on the brain.

In February, a study in the British Medical Journal found that people who'd been infected with Covid-19 were at higher risk of mental health problems including depression, anxiety, addiction, and sleep disorders. Those findings are "pretty disturbing" when you consider how many Kiwis have been infected by the coronavirus, says Robinson of the Mental Health Foundation.

Also at risk are the health professionals and essential workers who've been at the forefront of the Covid response.

New Zealand's health workforce was already depleted before Covid, with high levels of burnout, according to medical unions and researchers. Since the Omicron outbreak, their resilience has been tested like never before. Overseas experience suggests that the increased workloads, emotional strain, and professional compromises brought by Covid could have a lasting psychological effect on medical staff.

More broadly, there are several groups that seem to have been more distressed by the pandemic's wider social and economic disruption than the general population. They include women, the young, some ethnic minorities, people who lost their jobs, people who live alone, people in the poorest neighbourhoods, and people with existing mental health conditions.

The Herald spoke to numerous people with mental illness or their carers who said Covid had worsened their conditions, bringing new stressors and interrupting treatment and support they rely on to manage their lives.

Some, like Stacey, were unable to have face-to-face contact with their doctors, therapists or support workers for long periods.

Several were distressed by the Covid vaccines.

One woman in her 30s who has experienced mental illness linked to childhood abuse says she grew so anxious when researching the vaccine's long-term effects that she couldn't go through with the jab. She then felt so socially isolated because she wasn't vaccinated that it brought back traumatic feelings from her past.

"I make excuses when invited out," she says. "I feel like I am carrying this terrible dirty secret."

And then there are kids like Stacey.

Children and teenagers were already in the grip of a long-simmering mental health catastrophe before Covid.

Rates of psychological problems among young people rose alarmingly in the past decade. According to the latest national Youth2000 survey, which tracks the health and wellbeing of secondary school students, the proportion of students reporting symptoms of depression rose from 13 per cent in 2012 to 23 per cent in 2019. Six per cent in the latest survey said they'd attempted suicide in the past year.

It is a trend that is happening globally, experts say, for reasons that are not well understood. Some of the increase may be because there's greater awareness now of the importance of mental wellbeing, which means people are more willing to ask for help when they need it. But it also appears that young people are genuinely more distressed than they used to be, experts say.

For some people, an episode of mental illness may be triggered by traumatic events. Social factors such as poverty, racism and inequality can also have an impact. So can social media, alcohol, drugs, bullying, academic expectations, parental stress, and anxiety about the future.

All of those factors have been compounded by Covid.

"The impacts of Covid-19 on youth mental wellbeing is likely to be extensive and enduring," health officials told the Minister of Health, Andrew Little, in a confidential briefing in September.

"Covid has made it a lot worse," agrees a mother in Wellington whose teenage child has attempted suicide several times.

For Stacey and her family, the past two years have been hell, Emma says.

"It hasn't just been hard on Stacey, but the entire family."

Stacey's older brothers had to support their little sister while adapting to the loss of so many of the things that were protective of their own mental health: contact with friends, sports, life milestones. Stacey's parents were under constant stress while they tried to hold it all together.

"I'd be lucky if I got four hours sleep a night for days and weeks on end," Emma says.

Looking back, Emma is angry there wasn't more attention paid to Covid's psychological consequences, particularly on young people.

She wasn't opposed to the public health response, Emma says. The family complied with all the expert guidance. But she wonders whether more could've been done to lessen the disruption for people like Stacey, who couldn't cope with it.

"There are so many things that Stacey has looked forward to that have been cancelled due to Covid restrictions, things that would've helped her mental health," Emma says.

She worries about the long-term impact on this generation of children of the lost school camps, sports tournaments, GirlGuide jamborees and other life events, and thinks it could've been avoided. Some of the restrictions, in her view, were unnecessary.

Asked about her views on the state of mental health generally, Emma says the family's experience left her despairing.

"The mental health system in New Zealand is poor," she says.

For all the public talk about the importance of reaching out to talk about mental health problems, she says there was far too little information when Stacey's condition emerged about what to expect, what to do, and where to go for help.

"There's just this complete lack of information, full stop," she says.

While Stacey did get treatment, Emma says the family was lucky to be able to afford to go private and many others in a similar situation are unable to get help. And there's virtually no support for parents and carers, she says. "They pretty much have to grin and bear it."

Earlier this year, Stacey started secondary school. It hasn't been an easy transition given her OCD.

After two years at intermediate being treated as different, Emma says, Stacey is determined to be "normal" at high school. The family is better at managing her condition, but it's slow progress. Stacey still struggles sometimes. There is a long road ahead.

"It's hard to look back and remember how easy life was before OCD," Emma says. "And yet despite all of this, we know there are others worse, waiting in those hospital emergency centres desperate for help for their kids. We just hope that one day we aren't the ones waiting there."

* The Weekend Herald has agreed to change the family's names to protect Stacey's privacy.

HELP US INVESTIGATE

The Herald will continue reporting on the nation's mental health and the way that services help people who experience difficulties. And we need your help.

We want to hear from as many people as possible who have experienced mental health problems, those who care for them, and people who work in the mental health system. The more people we can speak to, the more thorough and accurate our reporting will be. We will not publish your name or identify you as a source unless you want us to.

• Please share your experience by contacting Investigations Editor Alex Spence: alex.spence@nzme.co.nz

WHERE TO GET HELP

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

For counselling and support

Lifeline: Call 0800 543 354 or text 4357 (HELP)
Suicide Crisis Helpline: Call 0508 828 865 (0508 TAUTOKO)
Need to talk? Call or text 1737
Depression helpline: Call 0800 111 757 or text 4202

For children and young people

Youthline: Call 0800 376 633 or text 234
What's Up: Call 0800 942 8787 (11am to 11pm) or webchat (11am to 10.30pm)
The Lowdown: Text 5626 or webchat

For help with specific issues

Alcohol and Drug Helpline: Call 0800 787 797
Anxiety Helpline: Call 0800 269 4389 (0800 ANXIETY)
OutLine: Call 0800 688 5463 (0800 OUTLINE) (6pm-9pm)
Safe to talk (sexual harm): Call 0800 044 334 or text 4334

All services are free and available 24/7 unless otherwise specified.

For more information and support, talk to your local doctor, hauora, community mental health team, or counselling service. The Mental Health Foundation has more helplines and service contacts on its website.