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Anderton: Phobic Trust International conference

Speech to Phobic Trust 4th International conference

Thank you for inviting me to open the 4th International Conference hosted by the Phobic Trust of New Zealand. Many of you have travelled a long way to be here, and I would particularly like to welcome speakers from Australia and England.

Here and around the world, mental health disorders are a significant public health issue. The range of illnesses includes depression, anxiety, nervous disorders and problems with drug and alcohol addiction. Recent studies show diseases like depression are becoming more common in developed countries.

They are also having a greater effect on the quality of life of New Zealanders. For example, people suffering from depression have worse general health, take more time off work and their work is restricted when they are present. They make more use of health services, and experience poorer health-related quality of life.

The impact of mental illness can be enormous. It imposes direct costs on health services. And more importantly it imposes indirect costs on individuals in the distress they experience from the disease itself or in those who care for them when they are ill.

We know from two major studies in New Zealand over three years that anxiety disorders start early and tend to continue for a long time. So I am pleased this conference will hear from speakers with expertise in working with children with anxiety disorders. Child and youth mental health is an important area for the health sector, and I would like to see real progress in this area.

This Labour-Progressive Government is committed to improving the mental health of all New Zealanders. It is committed minimising the harm caused by alcohol and other drug use and abuse. Progress doesn't come from good intentions, however, but from thoughtful strategies and action. The strategy is called Te Tahuhu - Improving Mental Health 2005-2015. Te Tahuhu broadened the Government's interest in mental health and addiction from people who are severely affected by mental illness and addiction to all New Zealanders.

Nevertheless, we continue to place emphasis on ensuring that people with the highest needs can access specialist services. The strategy works to build mental health services that work better and smarter and are more responsive to the needs of patients. These services should be based on evidence about what works.

Putting the strategy into action requires a strong workforce and a culture for recovery. It also requires us to recognise that some specific groups in New Zealand are more affected by the disease than others - Maori for example.
Kaupapa Maori services have been successful to date and the strategy plans to build on them.

The action plan to implement Te Tahuhu is called Te Kokiri. This action plan is the result of a partnership between the Ministry of Health, District Health Boards and people who have a stake in the sector. It went out for public consultation earlier this year and will be launched in August.

The action plans we make will put a strong emphasis on building a more responsive primary health care sector. This is our first line of assessment and treatment. The Government has recently funded a range of demonstration projects in primary care in 38 Primary Health Organisations.

These projects are trialling new ways of responding to people with mild to moderate mental health problems, including anxiety. The projects are being fully evaluated, and what we learn will help us to develop better ways of working. The evidence is that good primary health care has the potential to have the largest impact on reducing mental illness and increasing the health status of people who experience mental illness.

While anxiety is common, it often occurs together with other mental health problems. Significant among these are depression, substance use and dependence. The Government has put a considerable emphasis into improving the assessment and treatment of people with alcohol and other drug problems. There is a lot more work to be done in this area.

However, there are already many services in place and new activities under way.
These include:
A range of psychosocial and support interventions delivered to individuals or groups in a variety of settings,
A National Alcohol and Drug Helpline,
A National Addiction treatment workforce development plan for the next five years,
The development of a National Committee on Addiction Treatment, which is to be the voice of the treatment sector,
The Ministerial Committee on Drug Policy Alcohol and the Action Plan on Alcohol and Illicit Drugs, which encompasses a whole of government approach,
Clinicians working with people with anxiety disorders should be aware of these initiatives, and
Links with alcohol and other drug services mean that the broader needs of their patients can be better met.

Among the mental health issues we need to confront, suicide is especially wrenching. New Zealand's rate of suicide is high, especially among young New Zealanders. But, while suicide disproportionately affects young adults, approximately 80 percent of suicides now occur in the over-25s.

All suicidal behaviours, regardless of medical severity, are indications of severe emotional distress, unhappiness and/or mental illness. Every suicidal behaviour has an enormous impact on others. The evidence suggests most people dying by suicide or making suicide attempts have recognisable mental health problems - anxiety disorders, depression and/or substance use disorders.

Five hundred lives a year - nearly ten a week - more than the road toll - end in New Zealand through suicide. This tragedy reaps a devastating harvest among families and loved ones. It's a tragedy for our community as well as personally for the lives it touches.

We have a responsibility to make a difference because we know we can. A recent article in one of the business papers that likes to attack me every so often said health ministry activists - and me - have no idea of an appropriate policy response to suicide. The truth is, exactly the opposite. We know how to make a difference and in fact we have been making a difference.

Since the Youth Suicide Prevention Strategy was launched in 1998 the rate of male suicide is at its lowest point. We have more responsive services, new best practice guidelines and information resources and a greater community understanding about suicidal behaviour.

The body of research, both from New Zealand and internationally, has grown significantly. Because we know what makes a difference we are expanding our prevention efforts to address suicide and suicidal behaviours across all age groups.

I recently launched the New Zealand Suicide Prevention Strategy 2006-2016.
It sets out a policy framework to guide a range of suicide prevention activities over the next ten years. There is no quick fix. But there is a long-term fix - or at least a substantial improvement.

To ensure this strategy is transferred into measurable and tangible activities, action plans will be developed every five years to guide implementation. This Strategy is complementary to the goal in Te Tahuhu of improving mental health and well being and reducing mental health problems.

One issue that came through strongly in the development of the suicide strategy is the need to ensure our approach is evidence-based. Until recently, the evidence available for what works in relation to suicide prevention has been somewhat limited and primarily focused on clinical interventions at an individual level.

While we know socio-economic factors have an impact on mental wellbeing and vice versa, the links between these factors and suicidal behaviour are less well known.

The Ministry of Health commissioned a literature review and several reports from the University of Otago on the potential impact of socio-economic factors on suicide rates. This research has helped inform the Strategy. The evidence shows that mood disorders, including major depression, are the mental disorders most commonly linked to suicide.

The risk of suicide for people with major depression is 20 times greater than in the general population. Depression commonly occurs with other mental health and physical problems such as anxiety, diabetes and heart disease.

It's been estimated that by 2020, depression will be the leading cause of the disease burden in developed countries. Despite the many serious implications associated with depression, research shows a major reason people don't get help for depression is -- they don't think their symptoms are serious enough.

A public health campaign is needed to improve understanding of the symptoms of depression and explaining how to get help. As a result the Government is spending $6.7 million on a National Depression Initiative. It aims to strengthen individual, family and social factors that protect against depression.

It will improve community and professional responsiveness to depression. This initiative is an example of the Labour-Progressive Government's commitment to address suicide prevention as well as the mental health and well being of New Zealanders. These are serious issues and we are making considerable progress on them.

I am sure this conference will play a part too. Conferences such as this provide an opportunity to build their skills in working with the most common mental health problems that present to them -anxiety, depression and, addiction.

I appreciate this opportunity to highlight the Government's initiatives in promoting mental health and reducing addiction. I am sure you will all have much to learn and to discuss from the high calibre speakers due to address this conference. It's a privilege to be here to open the 4th International Conference, hosted by the Phobic Trust of New Zealand. And I wish you all the best for your deliberations.


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