The stigma of mental illness
Long-standing 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 workplace. The Like Minds, Like Mine programme aims to reduce 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 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, following unprecedented public interest in mental health and rising demand for mental health and addiction services, the government established an inquiry into mental health and addiction. The inquiry looked at mental health and addiction challenges from mild mental distress to acute mental illness. It also considered mental health and addiction needs, with the goals of meeting mental health and addiction challenges, promoting mental well-being, and preventing suicide. The findings were published in He ara oranga: report of the government inquiry into mental health and addiction.
The government’s response to the report was a commitment to improve mental health and addiction support across a range of initiatives delivered by many government agencies. It took a ‘population health’ approach, emphasising the need to build the social, cultural, environmental and economic foundations of mental well-being and to support the whole population to stay well. It envisaged increased investment in specialist mental health and addiction services, and the physical facilities they are delivered in.
The government also committed itself to expanding the primary mental health and addiction system for those in what He ara oranga called the ‘missing middle’ – those individuals and whānau who have mental health and addiction needs, but do not meet the threshold for accessing publicly-funded specialist services. This will involve the provision of services through general practices, as well as tailored kaupapa Māori, Pacific and youth-specific services.