Simon Shepherd interviews mental health experts
On Newshub Nation Simon Shepherd interviews Mental Health
experts Shaun Robinson and Maria Baker:
I’m joined now by Shaun Robinson, CEO of The Mental Health
Foundation, and Dr Maria Baker, CEO of Maori healthcare
organisation Te Rau Ora. Welcome to you both this morning.
Let’s start with the budget’s funding for mental health.
Shaun, rate it out of ten. What’s the best bit and the
Shaun Robinson: I’d give it a seven out of ten. The best bit for me is actually a tiny little detail, which is resiliency building for primary school children – there’s a couple of million in there, and that’s going to be about building up kids’ skills to be able to manage their own mental health as they grow through life, and that, sort of, is where we need to be going in the next phase of mental health. I think the worst bit for me is probably the need to do even more around addressing issues around alcohol sale and some of that impact of mental health and wellbeing. But I wouldn’t say that’s bad. Overall, this is a really great response to mental health, and I’m feeling more optimistic than I’ve been for years.
Maria, are you feeling more optimistic? And how would you rate it?
Maria Baker: Kia ora, Simon. I would rate it an eight. It’s the biggest investment I’ve ever seen in my lifetime specifically to mental health and addiction. There have been proportions of the money being targeted right across the continuum if we’re thinking about mental health and addiction and wellbeing in its broader sense. I do think that there is also some room for opportunity for Maori to have the fair share right across the components of that budget, in addition to some of the other components overall with the Wellbeing Budget, because we know that for our people, given our issues in terms of being at the bottom of the ladder – the economic and social ladder – that we do experience some of the worst mental health and addiction issues, and self-harm and suicide issues.
Right. Now that’s something that we need to talk about. Okay, so the government accepted or are considering 38 out of the 40 recommendations from the mental health review. One not adopted was the suicide reduction target. Shaun, should that have been adopted?
Robinson: Well, we certainly advocated that there should be a target, but really, just as one tool within an overall action plan to reduce suicide. So I think what’s most important is that Government has committed to coming up with that action plan. We haven’t had a plan in New Zealand for several years. We haven’t had co-ordination, we haven’t had a direction about how we’re going to tackle this.
But would a target not give us some urgency, or something to strive towards?
Robinson: Well, I do think it would give us some urgency. It can be interpreted as kind of saying, “Well, we get to that target and then we stop.” I don’t think that was ever the intention. So I guess my question is how do we now measure success? You know, how do we know if we’re making progress? But, again, I do feel optimistic that the government is committed to actually doing something about this.
Okay. It’s also allocated $40 million to suicide prevention, Maria. So that’s $10 million a year. Is that enough?
Baker: There’s never enough. Suicides and self-harm and mental distress is complex anyway. When we have a look at the contribution that is occurring across sector, actually, health is the leader. We need more investment at grassroots. There are a number of different innovations and programs that are working well that are demonstrating, particularly, building capacity and capability in Maori and Pasifika families and communities, that are focusing on leadership, that are focusing on the type of training and interventions that are supportive of our communities. There’s lots of evidence to demonstrate that these things work, but they need upscaling and they need more investment.
Did the budget deliver enough in terms of Maori mental health?
Baker: Not specifically yet. I think, overall, if I consider the Wellbeing Budget, it really resonates. The philosophy around wellbeing from this government resonates with us.
Yep, but do you want more targeted funding for Maori mental health?
Baker: We would love more targeted funding for Maori mental health.
Do you want the Maori Mental Health Commission to do that?
Baker: Yes, we would. Across the board, Maori, be it in health, be it in education, and corrections, are saying “We want our own entity. We want our own authority to be able to make the decisions that we need to make.” We want to self-determine the solutions that work for us. We know that these things work for us.
So why is it important to address it outside the mainstream?
Baker: It’s important for us because the current authoritative approach, it dictates to us. It filters through the type of money. It doesn’t have the ability to be able to give the money, or the decisions, or the ability to have an understanding of what wellbeing means to us. We’re talking about infrastructures and decision making that come from a Western society that restrict us.
Baker: It’s oppressive. It doesn’t empower Maori. But there are numbers of different, really awesome commissioning agencies and procurement models that are already underway.
Yeah, but should it be evidence-based? I mean, you’re talking about kaupapa Maori.
Baker: It is evidence-based.
It is evidence-based?
Baker: There is proven evidence and formed practice from this country and research that is informed by kaupapa Maori – solid pedagogy and methodologies that are valid here. There’s a 30-year record. The issue is that who is saying that that is evidence that’s valid, and who is saying that it isn’t? This is the issue here in New Zealand.
Okay. I just want to move on then, to alcohol, which you mentioned earlier, Shaun. So it’s been considered, stricter rules around selling alcohol. Should that happen?
Robinson: Absolutely that should happen.
Why should it happen?
Robinson: Well, because alcohol is a key social ill that impacts on so many other of the social determinants of poor mental health and other poor health outcomes, and the industry targets vulnerable communities with multiple outlets. People who are desperate self-medicate with alcohol. I myself live with bipolar disorder. Before I was diagnosed, before I had support and proper medication, you know, I abused alcohol as my way of coping. Now, I’ve always been, you know, I’ve had a good job, a good place to live. You know, I have a lot of the social advantages of our society. Had I also had a whole lot of other things going wrong in my life, turning to alcohol would have been a very easy solution.
So there needs to be some movement on that?
Robinson: There needs to be a lot of control.
Okay. Let’s talk about the big spend - $212 million allocated for health workforce training in the budget. Where are the workers, to both of you, who are going to fill these roles?
Baker: We have a workforce. The dilemma is who determines what a workforce is? We have Maori with lived experience. We have whanau with the ability to be a whanau workforce. We have grassroots and community. We have NGO capability. We have kaupapa Maori mental health and addiction. We have a workforce.
Shaun, do we have a workforce out there?
Robinson: Well, yeah. I totally agree with Maria, and I think it’s been great to see in the budget documents an acknowledgement of peer support. There are really good models of kaupapa Maori peer-led services, of other peer-led services. We need teamwork in addressing mental health and addiction issues. We need to get away from this notion that doctors and nurses and pills and prescriptions are the answer, to the notion that people who have been through it, walking alongside other people, understanding where they come from, being of their culture, looking like them, can do far more, often, to coach people in their wellbeing. It will take time. We’re looking at a massive scale-up of earlier support for people, and that will take time, but it’s good that that sort of diversity of workforce has been acknowledged.
Baker: Can I just add to that? There is this workforce. What we will need is the organisations conducive enough to know how to employ and support this workforce. This is where the change needs to also happen.
So we’ve got the Minister here next. Is that something that you would say to him? What would you say to the Minister, if you had the chance, about this? What’s the next step?
Baker: Well, we don’t want to see all the contribution going in to clinical services only. We want to see the whole aspect around building a mental health and addiction workforce that is all in sundry that is wellbeing oriented, that is not just at the serious end. And I do believe that there has been conversations about the models, and they still term the clinical elements around mild to moderate, and that kind of terminology, but we’re looking about people within communities and families to actually have the understanding of how to care for themselves and to have good resilience to cope, that kind of thing. But we need people in communities. So we need places for those people to be employed.
All right. Shaun, quickly, what would you say to the Minster?
Robinson: Well, I’d say, “Look, the World Health Organisation says depression and anxiety will outstrip heart disease by next year. We will never have enough services to address this growing demand. How are we going to get really ahead of this? Not just have more ambulances at the bottom of the cliff, or even a bit further up the cliff, but have fences at the top of the cliff to empower people to manage their own wellbeing?”
Okay. Shaun, thank you very much for your time. Maria, thank you for your time.
Transcript provided by Able. www.able.co.nz