Until 25 or so years back thousands of people resided, often involuntarily, in large custodial psychiatric hospitals. An official Ministry of Health report in 1986 referred to them as Dickensian, overly using drug therapies, seclusion and restraint. It concluded that most patients would not be there if community services and supports were available. A number of official inquiries and reviews conducted around that time reached similar conclusions and recommended major reforms in mental health care.
Today the Dickensian monstrosities have gone. Mental health is more out in the open. There is a wide spectrum of care and support is provided by general hospitals, clinics and community services. Many people are doing good things and making a positive difference – mental health service users/survivors, family members and workers in DHBs, primary care and other health and social services. I have no doubt that vastly more people are receiving appropriate care than in the past. I also see increasing gaps, if not chasms, in service provision. Ministry officials have, uncharacteristically, publicly noted marked increases in demand and heavy strain. Unions and staff have commented similarly. There are ongoing references by coroners and the media to serious service shortfalls and breakdowns. There are disconnects between primary and secondary care, with people experiencing severe mental health issues having major physical health problems and greatly reduced life expectancy. People with common anxiety, affective and substance use concerns are often unable to access appropriate and timely treatment and support. This is unacceptable.
Factors outside the health system – housing, poverty, unemployment, discrimination, erosion of human capital, isolation and loneliness – are also affecting health and wellbeing. These factors also require attention, in their own right and in relation to health and social services.
This report, the People’s Mental Health Review, collates direct accounts of the lives and experiences of a wide spectrum of New Zealanders. I commend those who initiated it and contributed. It adds weight to the call for a formal review or inquiry into our mental health services. The issues and concerns today seem similar to those that led to the Mason Inquiry a generation ago. It is again time to take stock, obtain an accurate overview of what we are doing well and where we are falling down, and chart a better way forward.
Professor Max Abbott CNZM
Pro Vice-Chancellor and Dean, Faculty of Health and Environmental Sciences, AUT
Co-director, National Institute for Public Health and Mental Health Research
Professor of Psychology and Public Health
Past President and Senior Consultant, World Federation for Mental Health