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Category Archives: News

Stuff article puts spotlight on psychologist shortage

On Tuesday, Stuff published an article by Helen Harvey highlighting the ongoing issue of access to psychologists in New Zealand. You can read the whole article here if you missed it.

In a nutshell, there still aren’t enough of us to go around, wait-times are too long, and we have far too few funded options. Dr Malcolm Stewart of the NZ College of Clinical Psychologists hits the nail on the head when he says, “The whole mental health system needs an overhaul. I don’t know if the system has ever really met the need.’’

We went on strike for a whole year trying to advocate for an increase in our workforce numbers so we could create the conditions we need to meet demand, but all we got was a pay-rise and a working group. No real change. None of us are in it for the money of course, so we keep leaving. The official story is always one of moving on to greener pastures, and we usually are. But that’s not usually the whole story. We aren’t allowed to talk in public about what happens in the pastures of DHB-land. It’s a bit like joining Fight Club that way. So it is good to see a journalist taking this up in the media again.

Harvey writes, “Following on from Like Minds Like Mine, a Government funded public awareness campaign, there has been a lot more acceptance of mental health issues and more people seeking out psychological assistance, Stewart says. “And more and more people are seeking non-pharmacological ways of dealing with issues. Good therapy, amongst other things, often helps people to hold onto hope and to believe that change is possible. This can be very protective of life and helps people believe that they can be part of changing their own lives. It is often harder for people to feel this optimism and agency if their treatment is mostly just medication.’’ One in five New Zealanders live with mental illness and/or addiction each year, Health and Disability Commissioner figures reveal. And it is estimated that nearly half of the population will live with mental distress and/or addiction at some point during their lifetime. The system is creaking under the weight and many are blaming years of inaction in the area of mental health.”

Read the full article here:
New Zealand’s Psychological Crisis Putting Lives at Risk
Helen Harvey, Stuff, 26 Jan 2021. https://www.stuff.co.nz/national/health/122695066/new-zealands-psychological-crisis-putting-lives-at-risk

British Psychological Society releases position statement on psychologists with lived experience

The British Psychological Society’s Division of Clinical Psychology released a position statement on clinical psychologists with lived experience of mental health difficulties on the 19th of August.

The document opens by stating, “The Division of Clinical Psychology publicly recognises and supports the unique and valued contribution that lived experience of mental health difficulties brings to individuals working within clinical psychology.”

It goes on to recognise how many therapists with lived experience there are among the profession, the diversity of these experiences, the complexity involved in making decisions to disclose these experiences, the impact of stigma, and the value these experiences bring to the work and the field as a whole.

They close by writing, “Overall, this statement wishes to make clear that lived experience of mental health difficulties does not have to be a barrier to training or practising as a clinical psychologist. On the contrary, people with lived experience are an asset to the profession and make a significant contribution to it”.

As a therapist with lived experience myself, it is a wonderful thing to see these points written down by such a well respected group. I look forward to the day that the professional bodies here in New Zealand take similar steps. I am incredibly grateful to the good folks at In2Gr8 Mental Health for the hand they had in making this a reality.

Read the full position statement here www.bps.org.uk/news-and-policy/statement-clinical-psychologists-lived-experience-mental-health-difficulties


The Latest from the British Psychological Society

In case you missed it, on the 1st of February the Division of Clinical Psychology at the British Psychological Society published a new report that presents a different way of looking at mental-health problems,  The Power Threat Meaning Framework.

The announcement explains, “A group of senior psychologists (Lucy Johnstone, Mary Boyle, John Cromby, David Harper, Peter Kinderman, David Pilgrim and John Read) and high profile service user campaigners (Jacqui Dillon and Eleanor Longden) spent five years developing the Power Threat Meaning Framework as an alternative to more traditional models based on psychiatric diagnosis. They were supported by researcher Kate Allsopp, by a consultancy group of service users/carers, and by many people who supplied examples of good practice that is not based on diagnosis.”

You can read the full Power Threat Meaning Framework or a shorter overview.

Find the original announcement here.

People’s Review of the Mental Health System

Share your story and help create a better mental-health system.

The people at Action Station have teamed up with Kyle MacDonald to create a People’s Review of the Mental-Health System. They want to gather together as many personal stories as possible, to convince our politicians of the need for improvements.

Their question to you is simple: what has your experience of the public mental health system been?

The public invitation goes on to say “Everyone has a story about mental health in New Zealand. Whether you work as a mental health professional, have experienced the mental health system directly yourself or someone in your family has, your story matters. We don’t need more statistics, the numbers already add up to make it clear that we have a crisis and need urgent action, and still nothing has been done. But personal stories can do what numbers cannot – they can move Ministers to action. Stories create empathy, and empathy creates change.

Find out more here.

Research Evidence on Peer Support Work

In light of the recent media attention on Peer Support Work, the team at Engage Aotearoa thought it timely to share some research on peer support, should members of the community want to get some more information on the topic.

In a review published last year researchers cite a meta-analysis of 11 studies evaluating peer support against case management and clinical professionals in support roles, which concluded “No significant differences in symptoms, hospital admissions, service use, psychosocial functioning or client satisfaction were found. In a second category, six trials compared usual care with services with PSWs in adjunct roles, four with PSWs in mentoring or advocacy roles. There were no significant differences in quality of life, social relations, client satisfaction, hospital admissions, but a small reduction in emergency service use and a larger number of met needs. With these small benefits and no adverse effects found for PSW, Pitt et al. conclude in their review that PSW’s support was noninferior to support by mental health professionals” (emphasis added).

Reference: Mahlke C, Krämer UM, Becker T, Bock T, (2014). Peer support in mental health services. Current Opinion in Psychiatry, 27/4, 276-81. doi: 10.1097/YCO.0000000000000074

In a 2011 review researchers noted that “it seems prudent to mention that a result of no difference demonstrates that people in recovery are able to offer support that maintains admission rates (relapse rates) at a comparable level to professionally trained staff” (emphasis added). They also point to several studies that reported improvements in empowerment, sense of independence,  self-esteem,  hope and community integration along with reduced internalised stigma.  Authors outline several challenges that face peer support workers in the execution of their roles, which require training and organisational support and go on to conclude that peer support workers “have the potential to drive through recovery-focused changes in mental-health services.”

Reference: Repper, J., & Carter, C., (2011). A review of the literature on peer support in mental health services. Journal of Mental Health, 20/4, 392-411.

A 2012 study of peer support worker perspectives of their work, showed that peer support workers are aware of the many challenges they face and highlight the value of their training in enabling them to deal with such challenging issues as self-disclosure and managing boundaries.

Reference: Kemp, V., & Henderson, A.R., (2012). Challenges faced by mental health peer support workers: peer support from the peer supporter’s point of view. Psychiatric rehabilitation journal, 35/4, 337-40.

There is a notable lack of evidence to suggest that peer support work carries risks that are not inherent to any work in the mental-health field and which cannot be overcome without adequate training and supervision. In 2014, Te Pou launched a set of core competencies for peer support workers in New Zealand, to help define the role and help regulate who is able to practice as a peer support worker in mental-health and addictions services. Importantly, in Mary O’Hagan’s 2010 paper, we hear service-users’ own answers to the question “What are the benefits of peer support to you?
  • Knowing you are not alone. Seeing that you are able to live with a mental health diagnosis and still go to school, get degrees, have a job, have a relationship and family. Feeling you are more ‘normal’ or ‘okay’.
  • If it were not for peer support, I wouldn’t be alive.
  • My life was turned around.
  • It was my passage way to getting better, pretty much the only one.
Reference: O’Hagan, M., Cyr, C., McKee, H., & Priest, R. (2010). Making the Case for Peer Support. Mental Health Commission of Canada. Cited in O’Hagan (2011). Peer Support in Mental Health and Addictions: A Background Paper Prepared for Kites Trust.

Find out more about Peer Support in NZ at Kites Trust, the Peer Workers Association or Mind and Body Learning and Development.

Guest Blog: Robert Miller on the Social Bonds Pilot for NZ Mental-Health Services

Commentary on Latest Move of New Zealand Government Over Mental Health Care

UntitledLike many Kiwi’s, Robert Miller from the NZ Schizophrenia Research Group recently received a message from Annette King, health spokesperson for the Labour Party, asking him to sign a petition against the government proposal to trial funding mental-health services with Social Bonds. Here, Robert shares a few of his thoughts on this controversial new move to fund mental-healthcare. Social Bonds involves using a private investment model where companies put up their own funds and are reimbursed (with interest) only if certain outcomes are met. The process of ‘procurement’ is now well under way. By March 2015, seven potential partnerships were being assessed, with a view to ‘moving to implementation in the second half of 2015.’ The Government document mentions ‘NGOs, retail banks, and specially created partnerships’, but provides no details of which organisations are to be involved. The first four Social Bonds contracts have been announced and they all have work targets as the defined outcomes.

Greetings from Masterton!

Yesterday, I received two messages on the same topic – the government’s latest initiative for funding mental health care in New Zealand by what it calls ‘Social Bonds.’ One came from Annette King asking me to sign a petition, which I did. The other came from my good friend Julie Leibrich (former Mental Health Commissioner) expressing her serious concern about the government move. Here is her message –

‘National is planning to use Social bonds to fund mental health services.  Social bonds allow Government to contract out services and funding to non-government or private organisations, with agreed targets and timeframes. If the targets are met, Government pays back the investors, and also pays a return on their investment. The return depended on the level of results, up to an agreed maximum. Labour says that the risks of the policy are huge, because in order to meet targets providers are likely to focus on “easier-to-help” clients and not difficult and expensive ones. The Department of Internal Affairs warned that New Zealand should not “engage in trials or implementation of a social impact bond”. There is a good article about the dangers. I think that people with mental illness struggle enough as it is to get good care, and the idea of them becoming Guinea pigs in a social experiment is appalling. So I would be grateful if you would consider the petition, and if you want to, then sign it.’
~ Julie Leibrich, former Mental Health Commissioner

Since the pilot was announced, there has been much comment on the Social Bond scheme for mental health funding, in newspapers, generally highly critical. Let me make a few of my own comments, briefly, because there is urgency here.

(i) Mental health is probably one of the hardest areas of health policy to get right, and this government seems to think it is just about money. It IS about money, of course, but just as important (perhaps more important), it is about organisational culture, sensitive responsiveness to needs of clients, and morale in mental health services. It is quite possible for dedicated, highly trained and skilled staff to deliver a first class service when physical aspects of the service (buildings etc,) are distinctly below par. It is the ‘human capital’ as much as the funding available which matters. These aspects of a good service cannot be measured in the usual way in which profit and loss are computed.

Nowhere, it seems, does one sense that actual persons with their own hopes and dreams are involved. Collectively, they are just ‘a problem’ to be reduced

(ii) The nature of funding streams IS an important factor in delivery of mental health care. In something as complex as setting up an effective mental health service, with its community outreach, it would help if funding (especially of NGOs for mental health care) were not administered in such a way that different agencies who should collaborate, are forced to compete for funds.

(iii) Earlier this year I learned of someone writing a report about mental health for Treasury, found her e-mail address, wrote to her, but never received a reply. Maybe this government move is related to that report, although it has clearly been under development already for some years. In this case the government seems to be moving to get this inconvenient burden off its shoulders. The un-named banks and financial institutions are likely to have their bases outside New Zealand, have no responsibility to the New Zealand electorate, only to their shareholders. Apart from maximizing profits, mental health is an area which is not a money-making business, is not, and never has been capable of really generating a profit, except in a highly distorted sense of market discipline. In addition, I ask: What would be the ‘quid pro quo’ demanded by those private investors? If it seems that targets are not being met, and the return on investment therefore not likely to be forthcoming, what pressures will be put on services to meet the targets? What corners will be cut on ethical aspects of service delivery? What style of healthcare delivery would they require? Would delivery of mental health services become hostage to multinational enterprises, with agenda quite out of line with our own philosophy of healthcare?

(iv) There may be some merits in the social bond scheme as a way to bring about public/private partnership. However, if so, it would be better to test this particular model of such partnership in an easier area than mental health care. It seems as if this is being tried out in the mental health area first because ‘no one really cares too much about this anyway’. Government policy makers should reconsider the choice of mental health as the first place to try out this approach.

(v) In terms of ‘meeting targets’, the devil is in the detail. The main target appears to be getting people with mental health problems into paid employment; but this depends on many factors beyond control of any mental health service. In addition, for many service users, obtaining employment is the end of a long journey. It might be better to emphasize earlier stages of that journey, namely helping to rebuild personal resources of people whose normal development has been undermined by mental disorders. This might include entering and succeeding in higher education. Entry into paid employment would be a natural flow-on from this, which is a more fundamental form of assistance.

Immense flexibility is needed to cope with the individuality and idiosyncrasies of each client… Target-driven systems are unlikely to achieve this

(vi) In any case, this appears to be setting up a ‘pseudo-market’, possibly a subterfuge for covert administrative and government control. It also seems to imply that the government admits that devising a good mental health system is beyond its capability; and somehow, by offering financial incentives, the market in mental health care will somehow magic up a level of intelligence in this area, which is superior to the government’s own. This stretches credibility.

(vii) Administrators do like to set targets, as if the matter of concern is one where commands can be given, and outcomes/outputs delivered according to plan (but, in today’s world, using the ‘invisible hand’ of market forces as an intermediary). Those at the front line of any human services, especially mental health services, know better. In their practice, immense flexibility is needed to cope with the individuality and idiosyncrasies of each client, for instance in matching each client to the most suitable practitioner of counselor. Target-driven systems are unlikely to achieve this. Such flexibility is one of the features that make for a good organizational culture and good morale in those services.

(viii) The government’s plan is one more move – perhaps more dangerous than others so far – to move small aspects of our social services to enterprises based offshore. Others we know about include setting up private prisons, or catering services in hospitals, to name a couple. Who are the movers of this international trend? What are their real objectives? Early in 2014, as part of a resignation document I wrote, when I left committees of RANZCP, I shared a paragraph expressing my concerns, which contained hints of answers to those questions:

“…that entrusting mental health issues to untrained community people has encouraged re-uniting two policy areas which had been painfully separated in the second half of last century. The two areas are mental health and justice. In the nineteenth century in Western countries (and in many other countries still today), the two were not separated. Authorities who could put you away in an asylum were either medical people or JPs. Since 1950, there has been steady progress in prizing these two apart, so that the area where, inevitably, the two overlap, becomes a difficult and highly specialized discipline of its own – forensic psychiatry. I fear there are now accelerating moves to bring these two back together again. With international consortiums now running both private prisons in many countries, and some mental health NGOs, I fear that merging of the two policy areas is gaining momentum internationally, led by those whose ethical perceptions are quite different from most of those who will be reading this document.”

(ix) I have just sent in an abstract to the New Zealand branch of RANZCP for their forthcoming meeting in Hamilton in September. Basically this is about the history of psychiatry. Sadly I conclude that, over the last century a specialty, which, in the 1890s, had the promise to become a respected branch of personal health care, at least on the continent of Europe, was largely taken over by those who sought the most efficient way to administer a ‘social problem’. This emphasis is quite explicit in the Government document: Under the section titled “What is the Government looking for the Pilot to do? we read in its first bullet point “test the concept within the New Zealand context to see whether this is an effective and efficient way for government to reduce social problems” [emphasis added]. Nowhere, it seems, does one sense that actual persons with their own hopes and dreams are involved. Collectively, they are just ‘a problem’ to be reduced. Mental health care has insidiously become linked in the public mind to other ‘nasties’ of social policy, including (from 1834), workhouses and asylums, and then prisons, together with legal sanctions on prostitution, suicide, sexual orientation, street drugs, ‘welfare dependents’ and so on, all those areas that ‘nice people’ do not want to know about. The battle between these two has been raging for the last century, and more. I fear that parts of that battle are now being waged by international corporations, unaccountable to any electorate, probably in denial about the personal aspects of healthcare, or the person-centred ethical precepts, which should guide healthcare.

(x) Now is the time to challenge this outrageous government move.

Robert Miller

Learn More

About the author: Robert Miller was educated in Britain, originally a medical student, until he was overwhelmed by a psychotic disorder. Later he retrained as a neuroscientist and came to New Zealand in 1977 to a position in the Department of Anatomy at Otago Medical School. His research objectives have been to explore the theory of brain function and its relation to mental disorders. He founded and continues to lead the NZ Schizophrenia Research Group in 1994. From 2009-2014 he served as community representative on committees of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) where he learned that one of the biggest problems in mental health is to get different players to listen to one another. Robert tries to stay independent of all organisations, so as best to encourage them to work together. He is not a member of the Labour Party.

Toi Ora Performing Arts Group Wins Awards for Short Films

After some years of working their craft the Toi Ora Live Art Trust’s Performing Arts group have come up trumps with two out of their four entries winning awards at the 48th Annual WorldFest International Film Festival in Houston.

With over 4700 entries and just 15% of entries receiving awards, they entered in the Dark Comedy category and won a Silver Remi Award for “Walter out of the Blue” and a Bronze Remi Award for “Walter Satyricon”

Congratulations to the Performing Arts group for this brilliant success and a big thanks to the support from our tutors Stephen Ure, Mick Innes and Greg Callinan,” says Toi Ora director Erwin van Asbeck, “The team kept working away at their ideas and kept it light with obvious humour and fun. Well done, onwards and upwards, you never know what lies round the corner.”

IIMHL New Zealand Special Update

The following links are a summary of the IIMHL AND IIDL UPDATE – 15 NOVEMBER 2014

If you want further information on the IIMHL organisation go here. To sign up for their mailing list go here.

For general enquiries about these links or for other IIMHL information please contact Erin Geaney at erin@iimhl.com.

  1. The Physical Health of People with a Serious Mental Illness and/or Addiction: An evidence review
  2. Stories of Success
  3. Tihei Mauri Ora: Supporting whānau through suicidal distress
  4. New ‘wellbeing bank’ for baby boomers
  5. “There is always someone worse off…” (regarding the earthquakes in Christchurch)
  6. Debriefing following seclusion and restraint: A summary of relevant literature
  7. Families and whānau status report 2014: Towards measuring the wellbeing of families and whānau
  8. Growing Up in New Zealand: Vulnerability Report 1: Exploring the Definition of Vulnerability for Children in their First 1000 Days (July 2014)
  9. Parents or caregivers of children with a disability have a voice in New Zealand (video playlist)

Also recommended in the update are:

Effective parenting programmes: A review of the effectiveness of parenting programmes for parents of vulnerable children
(2014, April 14). Wellington: Families Commission

New Zealand practice guidelines for opioid substitution treatment
(2014, April). Wellington: Ministry of Health

 

 

Dominion Post reports NZ police handling 12,000 suicide calls a year

“Police are receiving 12,000 attempted or threatened suicide calls a year, increasing the strain on their resources.

The national figure of 11,939 calls last year amounts to an average of nearly 33 a day – and the figures have been rising steadily in the past five years.

But police say they have little expertise in the area of mental health, and the increasing time spent on callouts takes officers away from other duties.

They are now working with the Ministry of Health in an effort to understand why people in distress – or their friends and family – appear to be ringing police rather than mental health crisis services.

One possibility they are looking at is that people may feel the police are now more likely to respond quickly to calls than clinical services…”

Read the rest of this article from The Dominion Post (30 Sep 2014) online here. 

Updates from the Engage Facebook Page

Here are some highlights from Engage Aotearoa’s Facebook page:

Advice From Our Tribe: What positives/lessons can you draw from your mental health experiences? 

Helplines to merge into single service – National – NZ Herald News

Anti-gambling body to get chop – National – NZ Herald News