Trauma and social and economic stress
Mental health and wellbeing in New Zealand is undermined by many social and economic factors that operate outside the mental health system. This includes the ongoing impacts of colonisation, and the damaging effects of all forms of discrimination and violence, including the high levels of domestic and sexual violence in our country. Mental wellbeing is also negatively affected by financial stressors including job insecurity, low-wage work and the lack of affordable housing.
Trauma was a feature of 102 (21%) of the stories, with traumatic experiences often being described as a factor that contributed to mental distress and the need for mental health services. Some stories described trauma experienced in the process of accessing mental health services. Sexual violence was specifically mentioned in 30 stories, but many people used more general terms like ‘violent’ or ‘abusive’ childhood, which could cover a range of different forms of trauma.
“I grew up in an unsafe, and unsupported family that thrived on adults drinking heavily, verbal abuse, neglect and an inability to love. Sadly I would say, a typical NZ story.”
“I grew up in an abusive family where I endured sexual, physical & emotional abuse for 18 years.”
Other forms of trauma that appeared in several stories include having a parent or other family member die by suicide or violent crime, being the victim of a violent crime, and having a head injury or other injury.
“I was in my first year of University when depression hit me like a truck after a traumatic brain injury. My life changed forever.”
A recurring theme in these stories was the sense that people’s traumatic experiences were not properly taken into account in the process of diagnosing or treating their mental distress.
Sexual and family violence
New Zealand has high rates of sexual and family violence, so it comes as no surprise that we received many stories describing the mental distress experienced by people who have survived sexual or family violence.
Other stories suggest that even when women explicitly describe their mental distress as stemming from an experience of trauma, including sexual assault, they may not find the support and understanding they need to heal and recover.
“Nearly 12 years ago I was a volunteer firefighter. I was assaulted and raped by one of the officers who was in charge of my crew and training most of us young members. I demanded help and support for myself and crew mates. They phoned the CAT team and I was taken by the police, locked in a police cell and transferred up to the hospital psychological ward. I did what I was told, I was compliant but heartbroken to be treated so badly for having nightmares and flashbacks because of the community service I had done. Then having nurses wake me all night caused me to become anxious and have panic attacks and insomnia. I felt like was unsafe there had no privacy or autonomy. Support and being believed and listened too would have helped me. I was diagnosed with PTSD and have been treating myself to stop having flashbacks and panic attacks.”
One of the most alarming stories in the review was from a woman who was raped while in a psychiatric ward, supposedly receiving treatment for mental distress which had at least partly been caused by an earlier rape.
“I went through a rape case this year after a patient raped me. Even though two senior staff came to my aid it was brushed under the rug. However four years later I was supported to formally lay a complaint with police who took it very seriously and after a thorough investigation charged him and put him before the courts.
I was raped when I was 12. I never told anyone until I was broken at 18 in a psych unit. Then years later for it to happen again in a hospital receiving treatment stemming from the first incident, witnessed but not believed by the staff working with me. Nothing done it was dealt with in such an appalling way and has been so detrimental.”
Given the high rates of sexual violence in New Zealand, our mental health services must be resourced and designed to provide safe and appropriate support to people who have experienced sexual violence.
Lou’s story illustrates how we are currently failing to deliver that, and suggests how we could do better.
“When I finally found the courage to ask for help as an adult woman to address childhood sexual abuse I thought I was walking into a stage in my life where my hope would be restored and I would be provided with the skills to regain control over my life.
What I discovered was a journey into never ending diagnoses, medications, symptoms, behaviours and treatment approaches which never addressed what the root cause was in my life, trauma. At the request of my doctor, I was sent to a psychiatrist. The symptoms of my "breakdown" were discussed and my inability to sleep, never was I questioned about my history of sexual assault. I was placed on a common antidepressant and sent on my way. Adult psychiatry does not inquire into, see signs of or understand sexual trauma.
The last 10 years of my life has seen me on a never ending merry-go-round. To be pushed from pillar to post, treated as someone who had some sort of "brain disease", not as someone who was profoundly hurt and traumatized by defining incidents in my childhood.
Healing people doesn't come from a pill out of a bottle, it comes from deep individual healing work, dealing to unique individual trauma and intergenerational trauma. Healing comes from being in a protected environment which nurtures and provides the means and opportunities to thrive and flourish and lead lives of wholeness, experiencing true happiness and joy with those treasured around you.”
When we talk about trauma in Aotearoa New Zealand, we can’t overlook the violence and trauma of our colonial history. Whilst very few of the stories submitted to the review referred to our colonial history explicitly, the traces of that history show up in many of the stories. This could, and should, be a topic of it’s own review. For now it’s important to note that the roots of much of the trauma and violence described in these stories can be traced to the violence perpetrated against tangata whenua in Aotearoa, and that healing those historical wounds will require an ongoing willingness to face painful truths and account for harm done.
"Ehara taku toa i te toa takitahi—engari he toa takitini ke!
Essentially I never stand alone. The person you see, or support, or uplift, or judge, or diminish is never just me. Never just one. What you do to me, you do to my entire ancestry. For I am just one of the most recent physical embodiments of them. A singular link in a timeless chain. The countless warriors, chiefs, healers and helpers, cooks and cleaners, everyone.”
WhAnau and family
One critical aspect of social context for many people who submitted their stories was the support, or lack of support, which they had from their families. Sarah Gordon’s story shows how powerful family support can be, and what a positive impact it can have on someone’s life.
“I was diagnosed when I was 17, and put in a mental health hospital. I was there six months before I was discharged back into the care of my family, with the advice that a return to university would not be wise and that independent living would not be an option for me. My parents were not compliant with that advice, and they facilitated and paid for mental health support to enable me to go back to university.
I managed to complete a bachelor of science, a law degree, a masters of bioethics and health law and a PhD in psychological medicine. But more important than any of that, I don’t live independently, I live with my husband and two children. And I work for the department of psychological medicine, University of Otago. I use my personal experience of mental illness to inform mental health research and teaching.
My positive outcomes are about the support that I received right from when I was first diagnosed. My family's expectations about who I was and what I was capable of never changed. Their perspective was that given the impact of my illness I'd just need a bit more support to realise my dreams and aspirations. People need to know that recovery is not only possible, it is probable but it is dependent on the right attitudes and the right support.”
Many stories described much less supportive family relationships, and some illustrated how easy it can be for people who are going through a crisis on their own to either be dismissed or simply fall through the cracks.
Post Natal Depression
Research indicates around 15 percent of mothers will suffer from postnatal depression – up to 9,000 cases a year in New Zealand alone – making it a serious public health issue that affects mothers, children, partners and wider whānau. So it is not surprising that many of the stories submitted to the review were from women who had experience severe mental distress during pregnancy or after the birth of their babies.
“After having my first baby I visited my doctor for help with depression. With no family in NZ I was experiencing extreme lows and I needed help. My baby was 9 months old and I was told by a doctor that there was no help for mums with kids over 9 months old. Other than alerting an acute mental health team (which would take weeks to engage and which sounded both scary and serious), there was no help for me. With no income and feelings of despair, I had no-one to help me.”
The recurring theme of these stories, as with many other stories, was of the struggle to access timely, accessible and appropriate mental health services. Barriers included long wait times, geographic isolation, or a lack of options that were suitable for mother and baby.
"My only choice was to commit myself into a psychiatric hospital and my son could be placed into care. That was not what I needed, when I felt as though I was failing the one job I had, failing the small person who I loved more than anything else, I did not need to be locked up. … It blows me away that when doing everything you are told to do when you are not coping, talking to someone, seeing a GP, asking for help - only to be told there is no help, or that help is four weeks away. We need to put more resources into supporting people towards wellness, not removing them."
94 stories (20%) were about children or young people, this includes stories submitted by adults about their experiences with mental health services when they were children or young people and stories submitted by parents about their children. These stories echoed the themes of the rest of the submissions. Parents expressed fear and sadness at the deteriorating health of their children while they waited to access mental health services.
"My story is about my 12 yr old son, who is still waiting to be seen by a CAF Rural Counsellor after the process started 5 months ago. I want my son to be happy and enjoy his childhood. The services available are just not there when you really need them due to the huge waiting lists, lack of funding, lack of services in general. We are very lucky that my son can talk to us about how he's feeling as I am sure if he couldn't talk to us, we would be in a much more serious place. He has said on more than one occasion that ""I don’t want to be here anymore mum"". My heart aches every time he says this."
Some parents wrote with gratitude about the wonderful care their children received from some mental health professionals, and frustration at being ignored or dismissed by others. Many stories came from young people whose first contact with mental health services happened while they were still children, and some of them explained the challenges they experienced when they needed to transition from specialist services for children and youth, to the adult mental health services, some feeling they got lost between those two services along the way.
Another theme in the stories from and about children was the potential role of schools as a place for more education about mental health, and mental health services. Many of the children whose stories were submitted to this review were in school when they first experienced mental distress, and they think they would have benefited from more education on the topic at school.