The stigma of mental illness
Longstanding but misleading stereotypes that associate mental illness with bizarre or dangerous behaviour perpetuate fear, misunderstanding and a reluctance to seek help. In 1998 the Mental Health Commission reported, ‘One of the biggest barriers to recovery is discrimination. That is why stopping discrimination and championing respect, rights and equality for people with mental illness is just as important as providing the best treatments and therapies.’1 The commission advocated empowering and protecting the rights of people with mental illness, enabling them to participate fully in society and preventing discrimination against them.
Mental illness at work
People who have experienced mental illness may be treated unfairly in the workforce. The Like Minds, Like Mine programme aims to reduce such misunderstanding and discrimination. One person told the campaign:
‘Disclosing my history of mental illness … was a pretty natural process … When I've had to have time off work or needed a bit of extra support because I’ve hit a rough patch, it’s barely raised an eyebrow ... When you weigh up what people with mental illness have to offer a mental health workforce, any time off is seemingly inconsequential.’2
Like Minds, Like Mine
In 1998 a national public education programme, Like Minds, Like Mine, was launched with the aim of creating ‘a nation that truly values and includes people with mental illness’.3 The programme worked to reduce traditional misunderstandings and discrimination. Many high-profile New Zealanders, including former All Black Sir John Kirwan, and musicians Mahinaarangi Tocker and Mike Chunn, spoke openly about their own experience of mental illness and related problems.
Māori mental health
The proportion of Māori who are consumers of mental health services is much higher than their proportion of New Zealand’s total population. To respond effectively to their mental health issues, health providers have aimed since the late 1980s to involve Māori with mental illness (tangata whaiora) and incorporate traditional Māori healing practices into mental health services. The Mason Clinic in Auckland, built on part of the site of the former Carrington Hospital, includes Te Papakainga o Tane Whakapiripiri. This unit, opened in 2006, is designed like a Māori village with a meeting house, dining hall, accommodation area and courtyard with traditional symbols of healing and cleansing.
Pacific Islanders’ mental health
People from other Pacific countries are also over-represented as consumers of mental health services. Pacific peoples traditionally may have viewed mental disorder as spiritual possession, usually caused by breaches of sacred customs. In contemporary New Zealand, mental illness among people who identify as Pasifika may also be linked to a wide range of social, economic and behavioural factors. Pacific peoples have generally approached mental health services for treatment at a much later stage of mental illness than other New Zealanders. Often those services were contacted because the patient was referred by an official agency such as the police or a hospital emergency department.
Contemporary policy issues
In 2018 the government announced a ministerial inquiry into mental health and addiction as part of its first 100 days agenda. The government is also entering into industrial negotiations to extend pay equity to those working in the mental health sector. Fairer pay for mental health support and addiction workers has been identified as necessary to recruit staff to provide quality services.
This followed unprecedented electoral interest in mental health, including the stresses caused by rising demand for mental health and addiction services, continued workforce and funding shortages, access issues and widespread public and political concern about the high rates of suicide. Mental health care and support workers were also aggrieved because they were not included in the $2 billion pay equity settlement for aged care workers announced in 2017.
The inquiry’s brief is wide and includes mental health challenges faced by people across the full spectrum from mental distress to enduring psychiatric illness; mental health and addiction needs from the perspective of both preventing mental health and addiction challenges and promoting mental well-being, and identifying and responding to people with mental health and addiction challenges; and the prevention of suicide, as well as support for those close to someone who has taken their own life. The novel focus on strategies to promote mental health and prevent mental illness and addiction as well as treatment service development, provides the opportunity for an holistic and in-depth review. The inquiry wants to generate hope and set a clear direction for the next five to ten years that the government, the mental health and addiction sectors, and the broader community can pick up and implement – to make real, positive change.
After this inquiry has reported in October 2018, the government plans to re-establish the Mental Health Commission. The inquiry’s findings will help inform the terms of reference, role and mandate for the Commission.