Great Minds is a major NZME project exploring the growing impact of mental health and anxiety on Kiwis and how we can improve our wellbeing. Here, John Weekes asks political leaders about the extent of the problem and how they plan to tackle it.
It is beyond dispute the Covid-19 pandemic has amplified New Zealand's mental health challenges.
Many Kiwis have personal stories emerging from lockdowns, layoffs, isolation, bankruptcies, or fractious arguments about mandates and vaccines. And now, data confirms the rising levels of stress and self-harm since the pandemic arrived.
How these challenges can be addressed remains a matter of some dispute between political parties, even though politicians have been working on cross-party mental health discussions for years.
Health Minister Andrew Little says although some overseas experts describe rising levels of mental illness as a "shadow pandemic", he'd characterise the pandemic more as an event having a major impact on people's general sense of wellbeing.
"I'm the first to say there is still more for us to do," Little tells the Herald.
One area for improvement is in specialist or acute services, where he says the need is not necessarily for more beds.
"What I routinely get told by the people running mental health wards is, there are people in those wards who almost certainly don't need to be there but there's nowhere else for them to go - because we're not good at getting people back out into the community with appropriate support."
Little says the Government has already started addressing workforce development issues, including some long-term challenges. He says New Zealand needs many clinical psychologists and psychiatrists, and that will mean training more people locally but also hiring from overseas.
"Even during the time of the border closures we had exceptions for health workers, including mental health workers, but it has certainly become a lot easier now to get folks across the border."
Little says New Zealand needs to better address the needs of people with mild to moderate anxiety issues and what some clinicians call low-level depression. He says more work could be done on making psychotherapy or "talk therapy" options available.
"They're the issues that can often compound into much more serious bouts of depression and other episodes. So it's about getting to grips with some of those problems early on, helping people through that, so further down the track you're keeping the pressure off some of those more acute services. And we need those acute services to be there for the people with really serious clinical problems."
There's a justifiable criticism about parts of the mental health system where waiting times are long because of services under huge pressure, he says.
"Under the reforms with Health NZ, it'll get a lot easier. One of the principal objectives of that is you remove these artificial boundaries between DHBs. And if the best help you can get is at Hillmorton [the psychiatric hospital] or at Waikato or at Dunedin then we'll get you down to where you have to go to get that help."
Little says the National Party's proposal for a dedicated mental health and suicide prevention minister is window-dressing.
"The reason I give it absolutely no credibility is their past track record. We invest a lot in health ... We did a major review of mental health as soon as we took office because we had to, because it was in dire straits. And we've made a big $1.9 billion investment."
The Government announced that investment in 2019 and said it would fulfil many recommendations from mental health and addiction inquiry He Ara Oranga. It pledged to roll out new universal mental health services nationwide over five years, and highlighted the need to train more qualified mental health workers.
Little says He Ara Oranga is still relevant and the centrepiece of the huge investment involved new frontline roles addressing gaps in mild to moderate mental health issues.
But that $1.9b spend faced sharp criticism after a Mental Health and Wellbeing Commission report in late March said more was needed to address pressures on specialist services, especially for young people.
National's mental health and suicide prevention spokesman Matt Doocey has asked the Auditor-General to investigate the $1.9b investment and claimed the Government had stopped the Opposition from speaking to officials about relevant issues.
Doocey says having a dedicated mental health and suicide prevention minister would improve planning and accountability in the sector.
"You've got Australian mental health professionals quite openly talking now about a shadow pandemic," he said. "We're starting to see early warning signs here."
Doocey says National doesn't want a new ministry or extra bureaucracy, just someone focused every day on the specific challenges of the mental health crisis.
"When we talk about mental health, it's not only about treating mental illness. It's about promotion of mental wellbeing. At all times we should be focusing on these parallel workstreams."
He says it'd be great to see policy settings that outlast the three-year parliamentary cycle.
"In the perfect world it would be fantastic if political parties turned up with pretty similar mental health and addiction policies."
Like Little, Doocey says early intervention and helping people build mental health resilience early on will have long-term benefits.
"If people learn these skills early ... they will go on to have better mental health over their lives. That doesn't mean we can't be doing things today ... There's no reason why New Zealand has to have one of the worst suicide rates in the world. There's no reason why we should have high rates of mental distress."
Doocey says changing attitudes and greater awareness of mental health in the public arena is heartening.
"Having the likes of John Kirwan and Mike King being so open about their mental health challenges raises awareness and frees people up to talk about their own issues. You've got a younger generation that's driving this as well. They face their stigmas and they're open about talking about their mental health needs."
He says National recognises the need for different government agencies to be part of the solution to current mental health problems.
"There would be a whole breadth of targets. Corrections could be about the number of people engaging in mental health treatment that could be supporting their reintegration once they leave prison."
He says whatever the policy settings, there are no quick fixes.
"We are facing something I think could take up to 10 years to address."
Chlöe Swarbrick says the dedicated minister is not National's idea at all, but one she had at the last election and in 2017.
The Green Party's mental health spokeswoman says her party's key point of difference is taking into account the many social and economic determinants of poor health, including poor mental health.
In practice, that means recognising the terrible impacts poor housing, low wages and social alienation can have on mental health. And she says for a long time, the destructive effects of addiction weren't widely recognised enough in official responses.
"If we look at the basis of He Ara Oranga, that effectively summarises the majority of contemporary research. The thing that differentiates this mental health inquiry is the addition of addiction as a mental health focus. That is the first time that a government-commissioned inquiry made that explicit. It is also the first one not to seek to pathologise people who are already inside the system."
On Health NZ reforms which will abolish the 20 District Health Boards (DHBs), Swarbrick says reducing barriers around DHB information-sharing will be important.
"There are massive issues in the incongruence and lack of communication," she says of the current system.
She works on the cross-party mental health and addictions wellbeing group, along with Doocey and representatives from other parties. The group's first publication was the Zero Suicide Aotearoa report in mid-2020.
The report took some guidance from He Ara Oranga. The MPs all acknowledged a need to think beyond a health-only response to mental health and addiction support to a broader social model.
Although the Greens diverge from Labour on the need for a dedicated minister, they agree on the need to bolster the specialist workforce.
"I've been very vocal about the fact that we need a far bigger clinical psychiatry workforce," Swarbrick says.
And she says much of the strident criticism of the Government's $1.9b investment has been valid.
"It's incredibly fair to be incredibly frustrated at the slow movement of the bureaucracy."
Te Pāti Māori is currently reviewing all its priority policies, including mental health, and is likely to have an updated policy released later this year.
"Covid-19 and the mental health crisis have highlighted just how important it is that we have Māori leadership at the most senior levels of our health system," party co-leader and health spokeswoman Debbie Ngarewa-Packer said earlier this month.
"We need a system that understands us and is responsive to our needs, not a system that refuses to share power and resources," she added.
The party has said it will invest $100m into innovative community, Māori and iwi-led initiatives with a specific focus on oranga hinengaro, or mental wellbeing.
In an opinion piece for the Herald last year, Ngarewa-Packer wrote of the Te Whare Tapa Whā model developed to describe Māori health and wellbeing. The model has four dimensions of wellbeing, inspired by the four walls of a wharenui (meeting house), each in turn built upon the foundation of the whenua.
These dimensions are taha tinana or physical wellbeing, taha wairua or spiritual wellbeing, taha whānau or family and social wellbeing, and taha hingengaro or mental wellbeing.
Act's health spokeswoman Brooke van Velden does not support the idea of a dedicated mental health portfolio minister, and says a lack of choice for the public is among the biggest challenges.
"We acknowledge that we can do better for mental health for New Zealanders," she says. "The He Ara Oranga report showed that we do have a real lack of access and choice."
Act says it would form a separate mental health and addiction agency on a national scale.
"Currently we have a mess of a system where people don't know where to go to get help," van Velden says. "Act doesn't believe that creating a new minister will solve the problem of mental health in New Zealand."
Van Velden says the standalone agency would allow people more freedom in deciding where to go for help.
"The central interface can help in that the money would be attached to the person," she says.
"I spoke to a young man who said the service he was given was like a flea on an elephant's back. This person really deserves the chance to go to a different provider. I meet countless people who have mental health conditions who are not happy with the care and service provision they get now," van Velden adds.
"We have to be better."
