1/200 Episode 107 - Mental Health Service
We speak with Ross and Mikey about Mental Health Services in NZ, Government rhetoric and systemic issues over the preceding decades.
Transcript
(Editor’s note: Huge thank you to Mikey for prompting this and doing the work of formatting it down to something readable from about 50 pages- we don’t have the time at the moment to make this happen for our casts so we really value the work he’s done for us here to make this one more accessible)
Kyle: Welcome to one of 200 the New Zealand and International Politics podcast. Today I have two guests joining me: A friend of the cast Ross, who has previously joined us to talk trans rights and the nurse strikes and a new guest potential friend of the cast Mikey, a youth health nurse specialist and nurse educator. Welcome to cast both of you.
Ross: Kia ora it’s Nice to be back.
Mikey: Thank you for having me.
Kyle: So I was saying before we started recording that mental health is something that we've been wanting to do coverage of for a while now, especially with some of the rhetoric out there, some of the misinformation, the obvious political pitfalls of it, and the kind of political games that get played with it as well. You know it fits right in the space of media and political analysis that we do, but the time hasn't really felt right to do it and I don't personally have the expertise to cover it. So thank you both for coming on to have the discussion with me because I think it's a really important one and one that often gets lost in, you know, for better and for worse in click bait stories about personal tragedy or point scoring between political rivals or just huge amounts of data which is very difficult for the public to pass in any way that makes it useful. Then you have celebrities that and the like kind of weighing in and here and there through the last decade I guess who will get some spotlight shown on the issues for a while, or maybe about some specific issues. But the policy hasn't really shifted in quite some time, at least in terms of the outcomes. Now, at the previous election, Labour made some promises are around mental health and mental health funding, in light of some of the pretty horrific statistics that New Zealand faces in that space. Just in the last couple of weeks that's been brought up again because we're not really seeing that funding have any effect anywhere, if we're seeing that funding appear or materialize at all. And I think the latest from was Andrew Little was to say, oh, he's very worried to hear about that, and he will look into it.
Ross: Is there is there anything more this Labour government than earmarking hundreds of millions of dollars for mental health and then not letting us have it, but helping us feel better about having it by keeping it for it safe for us? But it's just, yeah it. It feels very feels very emblematic of those stuff.
Kyle: Yeah, I feel like there's a review coming on in the very near future.
Ross: Oh good.
Mikey: Do you mean like a review of how the money has been spent do you mean or services.
Kyle: Or what’s happened to it.
Mikey: Hmmm.
Kyle: Or yeah, how it's going to be spent or where the money that was ear marked for it has gone. Whether the DHBs are the issue. And I'm kind of worried that it it might be used as some form of pressure to push the centralization, as opposed to just getting on with that.
Mikey: It's like my sense that being like tightly connected with mental health services from a professional side of things is that the, uh, assumption that, I think everyone in those services has been holding is that the government undergoing this mental health review process that was a review of all the services and there was a sense that nothing was going to be done until there was a plan forward. The downside of that being we've got business as usual, plus no increased funding when we have increased needs of the community and that we're kind of seeing the result of services that are have expanding wait lists that are having to actually increase the acuity of the people out of, uh, you know the, they're only seeing people at higher acuity levels than they used to, and that sort of thing. So yeah, that's kind of like, that's how I see it on the ground is I don't think anyone expected an immediate funding of stuff because we don't actually, we don't actually know what would be beneficial yet is my…yeah, if that makes sense? … I mean, we kind of do, we've got, we've got years of research and data into what is beneficial for community mental health services or what's beneficial within our community, to foster, you know, mental health. And we know all of that, but yeah. Yeah, it's a bit complicated.
Ross: I think that's, I think that's the thing, isn't it? Michael…Mikey 'cause we talked about this on Twitter, which I think started this whole thing, which was the thing that seems to get missed out from this conversation over and over and over again is what's the cause of poor mental health and well-being in the first place and that just seems to be like the big part of the discussion that government certainly don't want to discuss and it because it's icky and 'cause it comes back to capitalism and deep seated in equity and certainly in the work that I do in the counseling space like so often you get people who are struggling with depression and anxiety because of poor housing because they're overworked and they're being underpaid or they're underworked, or they are, uhm, they've got poor physical health outcomes, or all of these other things which input which we know uhm, as you said, we know what works, we know it impacts on people. But you can't say we have poor mental health because we have a society that makes you mentally unwell, because then we'd have to do things like house people and make sure people were fed and and that doesn't go down well with our ute driving friends in Remuera. So they're not going to do it, and it just it always seems to come back to this sort of personal responsibility, this sort of weird mixture of you can fix mental health by having a cup of tea and a biscuit with someone, or you have to go into, you know, into like crisis care and I just I…it infuriates me how much of the conversation gets missed and how much it gets pushed back to personal responsibility.
Mikey: Like one of the things I find real hilarious is a lot of the mental health programs we have out in my, like, where I work, they're almost all titled with the word choice in the name for their program. Like the CAPA model, which is the choices and partnership, you know, model for mental health which you know just choice and partnership just hints immediately at that personal responsibility, that your mental health issues are your choice. In fact, there's a counseling program called Your Choice. And yeah, it's just kind of like it's so embedded that, that neoliberal individualistic responsibility stuff in our responses to mental health issues that its present so clearly in the names of the programs.
Kyle: I didn't realize that our mental health programs were just employee well-being programs.
Ross: Yeah…
Mikey: Yeah, I know yeah, like on a broad broad yeah…And like although, like 100% are mental health services are underfunded at the same time because of our mental health epidemic or so called, you know, the increasing mental health issues in our communities, they're not caused by a lack of counseling availability. They're caused by all these other, you know, other factors of life, you know, and the fact that we only ever look at the service side and not the cause side. It's just yeah. It's a bit ridiculous.
Ross: Yeah, like it's just, it's wild to me how there's this idea that you can somehow cognitive behavioral therapy your way out of not being able to make the rent every week? Like you can't DBT yourself into a house that doesn't have mold in it. And I it just…as someone who like say, who…who works in this space and who works in South Auckland and sees a lot of this stuff all the time, like it's as you said, it's this idea that it's choice like you can just somehow talk yourself into a better mental health outcome. And it's just this complete divorcing of mental well being from social well being from physical well being, from, you know, like a cultural disengagement, like there's so many factors to it, but all we look at is, you know, have you tried like have you? Have you tried yoga? Have you tried some mindfulness that we've got an app now? Fuck your app. I don’t want your fucking app.
Mikey: Right?
Ross: People want houses they want to be fed, like it's it's not hard.
Kyle: Yeah, is there a sense in which mental health services are treated, both by the health system and the government policymakers as the proverbial ambulance?
Mikey: I'm not, I'm not sure about ambulance. Yeah, like I, I almost wonder whether it's more like my sense is actually that it's probably about reducing the burden on the capitalist system, if that makes sense. Making sure that you do have a lot of happy consumers who are ready to consume products and continue working in shit places you know.
Ross: Like amazons well being cube.
Mikey: *laughs* Yeah. Uh, because like I don't, I don't think that…Uhm. :ike we've got our crisis team, which I would say would be the ambulance at the bottom of the Cliff, but they're not even that to be honest, the ambulance is literally gonna still be the ambulance at the bottom like, yeah yeah, I'm not sure like 'cause, like if I think about the way that our, most of our mental health services work, which they don't really to be honest. Like they don't really work for anybody. I don't see them actually addressing any of like the where the shit hits the fan kind of ambulance at the bottom of the cliff thing. Does that make sense. I feel like I just said a bunch of words, but…
Kyle: You definitely said a bunch of words that they made sense as well.
Ross: I think it's that tlike so…I'm, I’m registered with the New Zealand Association of Counselors and Counseling is a weird sort of aspect of mental health whereby, like, you can, anyone can say that they’re a counselor and the same way that anyone can say that they're a mechanic, but that doesn't necessarily mean that you've had any training. But, to become a registered counsellor is, uh, it's either a masters or it's a full bachelor…bachelor applied counseling, so it's good you know, so it's, it's a proper profession, but counseling is not part, uh, the government doesn't see you as part of the sort of more clinical side of mental health like we’re not, you know, I'll have to triple check the wording on this, but we're not actually privy to like some of the same standards and same expectations as other health professions. And it's just like, so we've got this whole group of people who are quite, very highly qualified and like able to deal with trauma and grief counseling and everything else who have to fight really hard for any kind of share of any kind of funding or any kind of you know stuff that comes our way. And like the lack of, sort of oversight, the lack of joined up, you know, having come from education, which is, you know, slightly different, like to come into this and you're like, OK, so we're part of this, this group that does this kind of thing in mental health, but we're not viewed as being like proper according to this group and we, it's just it, it seems very unserious to me like it, it seems odd to me that that's how things are are laid out.
Mikey: Yeah, not like I find that uhm disconnect uh like real obvious when like counselors aren't part of specialist mental health services in the DHB, they don't, they don't factor in, but every time the the DHB says oh look we're at capacity we can't see this person, can't you just get them to see a counselor like the, the way that we're actually dealing with the overflow from mental health services is to utilize counseling wherever we can access it, whether that's through some other funded programs or having people self access it. But the fact is like the DHB, mental health services rely on counselors to actually reduce the the work that they do without ever actually viewing counselors with that same level of like respect as clinicians, if that makes sense.
Ross: Hmm, Yeah, yeah.
Kyle: That makes a lot of sense about some of the disconnects across the health system in his space as well. Yeah, but I guess you don't really see it if you are on the ground because the the way these things connect is so often left out of the conversation and it go, going, you know, even into the way that our economy or peoples’ actual living conditions affect these things as well. Again, they’re left out of the conversation for the most part. This government, though, right, under under Labor, they they made similar claims, or, you know, promises, and in the last government as well. Uhm. So, so said similarly they're gonna, they're gonna do more funding for mental health. And we’re to our second term now without the the brakes being on from New Zealand First or like you know, whatever you want to say, and, yeah, you got the Minister basically saying I don't know what's happening. Well so where? Where is where do you think that comes from? Like is that just that the ministry is absolutely cooked, or is it a a lack of actual will? Is this something that Labour is happy to use as a vote winner? As opposed to something that they're actually serious?
Ross: Mikey?
Mikey: Haha, Thanks thanks, I like, I I get the idea that some people would say that that what Labour do is put aspirational stuff there so you know where their values are and then what the delivery of it ends up being a little bit more complicated at. 100% I think. Well, not 100%. That that definitely not that much percentage *laugher*, but like I think part of the issue is the, like focusing just on the services, the mental health services - What actually needs to happen within those services is revolutionary stuff in terms of like we need a complete overhaul of how we have that disconnect between the primary mental health services, which I consider counselors to be a big part of it, but who operate within this like, this unconnected kind of like, you know community based kind of system stuff. A huge disconnect from that and from the secondary, tertiary mental health services and within those tertiary and secondary mental health services there's a lack of funding that’s still there, there's a lack of actual workforce. One of the locals child and adolescent mental health services has been pretty much operating with a 30% vacancy for the past two years, thereabouts with thir uh… I remember at one point they had about 13 FTE positions unfilled. And it had been that way for over a year. And so like to fix that, that's uh…it's not even just a throw money at it problem because you don't have the workforce. And then you also have a culture that's been set up within these systems that nobody wants to work with because of like the the nature of it, if that makes sense. Uhm, you have high turnover and then you you have like even the psychiatric dominated nature of it, which kind of, although we have the all these different professional paradigms that are pretty decent from a mental health clinician perspective at providing appropriate and evidence based mental health support still gets kind of overpowered by the psychiatric paradigm. Rather than, you know, an occupational therapist, holistic kind of approach to mental health and all and uh. And then you've even got, you know, what do you do when like this so… uhh, like that you know you've got that level for the moderate end of the mental health care. But then you look at the more severe mental health presentations and the lack of actual services that we have that do that well without reproducing some really negative stuff that's been uhm historically within those psychiatric services. That's a that's a huge. That is a huge monster. And like I don't think uh 6 years of our government is going to suss that out, especially without the political wi- well but I wouldn't say it's even political will because the will, it's not about necessarily at that point about the politics. It's actually from the health side itself. They would have to go to war against people who have invested interests in the system as it currently is within the healthcare kind of structures and hierarchies and managers and all of that like though you know you, yeah.
Ross: And yeah, I think we make a really a really good point there around the psychiatric model and I I wrote I wrote a blog post on this the other week where I tried to access after - after being assaulted at work couple of years ago, I was unable to return to my work place - who'd have thought - and ended up trying to access support through ACC and they said they needed evidence of mental injury. Fine. I ended up getting a GP’s diagnosis, a psychologist diagnosis and neuropsychologists diagnosis of post traumatic stress disorder and ACC said that that was was insufficient. So you've got I, I would say that's quite a hefty amount of evidence, but they said no, I needed to see a psychiatrist. Which they paid for, but that was still, it took over a year from the initial assault and over, I think it was about nine months from when I made the claim for mental injury to actually get any kind of payout. And it's I I'm I'm very lucky that I have a partner who's employed that we were able to negotiate something around living arrangements and stuff, but if I had been I, I can't imagine trying to advocate for myself and get a fourth like psychiatric opinion without that kind of safety net and the answer is there's gonna be a lot of people who will not have made it that far.
Mikey: 100%. Yeah. And like that's part of that disconnect as well, as just like all the rest of our health services, we have the Primary Health care end of things which is, operates mostly under for profit and and from mental health side of things is almost entirely unfunded. It needs to be almost essentially funded by the people accessing it unless there's some ACC funding, which specifically, they pretty much only use it for sexual harm situations. And you know what that means is that there will be, you know, a privileged few from wealthy backgrounds who can afford to pay for counseling, which is a hundred, hundred and twenty dollars for a session, you know, that can find a counsellor that they can connect with culturally and personally, because if you look at the demographics of counseling it, it's not particularly diverse.
Ross: *laughter*
Kyle: And a hundred to a hundred and 20 is like a minimum, right like?
Ross and Mikey both talking, difficult to determine who said which: Yeah, yeah, there it goes, it goes high.
Mikey: It goes high. Yeah, if you're seeing Psychotherapists or psychologists gets higher.
Ross: Yeah. Yeah, and it's that that's just that as it's, it's a user pays model, and really expensive and that's something that as someone who's accessed counseling as a client before I've gone God, you know that's an awful lot of money for an hour sitting opposite from someone. But when you would start looking at it from the the counseling perspective, especially if you're in private practice, you know you're you're not seeing like 8 clients a day, you know it's not $800 a day. You're actually, counselors I know who work for NGO's on a contract basis still being lucky if they make, if they, you know they may, think about client cancellations and such like, they're, they're lucky if they're going to get 100 bucks per day in some cases. And it's, and it's not, it's not a steady income like it's very, very tough out there. And it's it's not, there's no financial support if you want to go into this, this, if you want to go into this profession and what you're saying about diversity in the workforce. One of the things that I've found really interesting about going back to, to study this is you have a very diverse pool of students, but you have a very traditionally white Western form of study to become a counselor that for all it pays the usual sort of lip service to Maori and Pacific Island modalities, it sees them as a modality and, which is not the case, and you are automatically, like the number of people in my cohort from the first to the second year dropped by 50%. And when I think about the people who are, who did not come back for that second year like that's, that that seems very telling to me, and it's that, there's this lip service about how they want a diverse workforce and the support that they will give and how they're making sure that counselors coming through our understanding of te tiriti and various other things. But it's not actually born out in how we are educating that workforce and how we are supporting that workforce in order to get them out there where they need to be.
Mikey: And then even then, like they're they're utilizing, you know frameworks like CBT, which are not grown from Aotearoa, it's imported models that have been tried on, you know, kind of like a European target audience, that's how it's been framed and structured, and the evidence is all from European or American based studies, not on a New Zealand context. So it's you know, yeah.
Ross: And again that that very individualistic modality of I am in control of, you know, like I'm in control of this and if I just think about it in a different way. And it's like, yeah, it's fine. It works in some situations, but it's not, it's not really authentic to a lot of people who live in this country who need responsive mental health services. Uhm. Yeah, it's, it's a huge. It's a huge gap. You know, it’s, I, I've, I've heard of people were trying to access services and basically just being given like a CBT worksheet or have you tried an app and that's not that's not appropriate. It's not respectful.
Mikey: No. And like where funding is available for counseling, you get three to four sessions and that's it. And the funders are always trying to squeeze it into a smaller and smaller. Can't you be productive for less? Can't you get more done for less?
Kyle: Yeah, it's really..you, you talk about this individual framework, right? But, it's not only being applied to the people who are seeking support while seeking services, but also to the people working in the industry. There's this whole framework that it sounds as if it’s, it’s missing for counselors for other mental health workers that exists only very barely, if at all, for a lot of people. So in terms of administration, in terms of even this booking clientele, you know linking out with community providers, linking up with the health services, the wider health services. It sounds just like none of it’s there.
Mikey: No, but there is no, like when we talk about the mental health system, when it comes to the Primary Health care end of it, there is no system. There's not in any definition of the term. There's no, there's no like structures. There's no, you know unified funding there's there's essent…most of the time there there's individual practitioners. Sometimes they'll be gathered around some NGO and that's kind of the extent of it. Which is why like 6-uhm, some of the research in New Zealand around where people access primary mental health services, over 66% of it is just GPs. And that's kind of like the only thing that a lot of people have access to you. And I don't know if you've ever tried to talk to your GP about mental health issues, it’s not particularly the ideal person that you want to talk to you.
Kyle: I think you can get lucky.
*laughter*
Mikey: Yeah, yeah yeah you can get lucky, but it's, even then, you've tried...you have to fit within this Primary Health care model of like 15 minute appointments. If you say it's mental health, you get 30, but you still pay a bit, you know, and at best you get like even more watered down CBT thing and some medication which you know not to. Medication has value, 100%, but when it's the only thing that people have access to, uhm, is a GP for mental health support we then end up using medication in place of an actual supportive system and in place of actually supportive transformational stuff in the communities that would make life better for people to live anyway.
Kyle: I think even with medication, you know if you're generally going to as you say, but at nearly 80-60-70% of people accessing adult health services through their GP, the number of I guess anecdotes, but stories I've seen of people having to be coached about how to access that medication by saying the right things for their GPs is just obscene because you know, you have to, you have to have the right kind of GP. You need to be able to say the right things. You have to have already tried particular things and if you haven't, the chances that they're going to sign off on a pharmaceutical product are just cut in half at a minimum.
Ross: I think also it's it's, it's very easy to if someone is presenting with anxiety to get a script for Sertraline or something and they say that they met as like you said medication is a useful and important part of mental health provision, but it's like if you've got lots of clients turning up with headaches and you're prescribing Panadol its not actually fixing the cause of the headaches like someone can come on go on Sertraline or example for three months come off Sertraline, if you're not identified, the source of the anxiety which couldn't be, as I said, it can be housing. It can be money. It can be all of these other things. If you have not made a dent in those or you have not started to address that, they they come off the medication problem still there.
Mikey: Yeah, and like, even with, you know, even if you do get access to medication like, I think that we've kind of made a mistake in over promising how effective medication is, and I think the medical system is at fault for that. Because if you look at the research of the efficacy of most mental health medication for mild to moderate presentations of the anxiety, depression you're looking at, kind of like a 30% efficacy rate, which is pretty piss poor especially when you combine it with the negative side effects that people have, which can be kind of broad and stuff and like, although like 100% like there is a value in it, it's it's often overstated. And like unless you do address those, the drivers of the causes, or if the cause isn't an immediate material thing, but historic trauma, or you know, like learn learned kind of like coping mechanisms that got us through our childhood real good but are no longer useful to us as adult. Without that additional kind of support, you're not really kind of going to change anything for anybody. You know?
Ross: Yeah, and then then you have this gap. As you said, it's not really a system so much as individuals and small groups trying to make things work and finding time to talk to each other, if they're lucky and that sort of creates these gaps where individuals can come in making some very strong claims about what they can do within that space, and I'm thinking I'm thinking Mike King and the whole the whole gumboot initiative and. There's something that just raises some red flags with me. I think there's something quite dangerous around individuals promising lots and making lots of noise, but not actually working with the people who are doing this everyday. Certainly I've I've heard some stories about people working with with gumboot, not getting paid there being issues around, you know around the people who are able to access that kind of support, what that looks like and it's just. Yeah, in the absence of a decent plan, in the absence of evidence based process and a proper system, you just create these these vacuums with very interesting situations arising.
Mikey: Yeah. Some, some of the problem that we had was suddenly the gumboot money was available and so NGOs started to feel that the pressure was off them a little bit to be providing some of what they were providing, so they actually started turning down people that they would have otherwise accepted because they're having to still do what they can with the crumbs that they've been given. And actually, I think in the end we didn't, at least in some of the areas that I'm aware of, what actually ended up happening was people were promised support that they didn't actually end up receiving, and then providers being promised payment that they didn't get paid as well. Which I mean, one of the things that I find because, you know, in my my clinical practice 'cause we I work in a nurse-led youth clinic. So we are, I'd say 60% of what I do is mental health support, but, but I’m nowhere near as skilled as a counselor, but just kind of been the assessment brief intervention in like supporting towards the best kind of things, but then implementing some positive youth development in the frameworks of that. But I often find young people come to me saying, oh, I've been told that I need to seek help when I experience these things, but so far there is no help, so what's what's the reason that I'm even speaking out? 'cause I'm, you know they they come to see me and I even try and connect them up for things and I'm limited in what I can do and they suddenly realized that there's been promise of the system that will support them. But there is no system that's supporting.
Kyle: That’s that gap between the rhetoric and the outcome again, right? Yeah, where there's very much a set of messaging around what you can do if you are struggling with mental health. And you’ll, you know you’ll see them around town and posters uhm, or in your workplace, just speak to a mate or like call this number you know, don't be silent, but as you say, you know there's something like one of the main workplace ones I think is EAP and you can access it and like for one to three sessions and then you might be able to organize to get more paid for by the work that doesn't really cut it.
Ross: Yeah, and it's but it's it's degrees in its degrees, it's you know, you you will have clients for whom just being able to sit and get out how they're feeling and have someone affirm that might be all they need, and that's great, in which case that talked to a mate and trying to improve people habits around talking about how they really feel is as valid. I'm not going to say that's not valid course, it's, you know, we all feel better then be able to sit and share and be listened to but it's, that's that's one part of it. That's the you've got a headache go for a walk and get some fresh air, like that's going to be fine for a lot of people. For people who's you know who have something that's a bit more wrong with them, you know it's it seems like you either have have that advice or we go all the way down to the mental health equivalent of you being rushed into surgery with a brain tumor, you know, like there's very little of that sort of interim care. And yeah, just Mikey what you said, you know, I've also worked with young people for a long time and it's, there there's school counselors and they do not have to be trained counselors. Anyone can be a a school guidance counselor. And…outside of that, there is very little for young people that is genuinely affirming and validating. And yeah, I've I've had young people I've worked with and they've had some horrendous stories about trying to get help and trying to be heard and listened to and having primary care just turn them away. Or not really, uh, believe them. I think this is one of the issues that come up with a lot. It's just not being believed when they say that they're in distress, and that especially for Māori and Pacific youth, you know you've got so many issues around around access there, or the best of times and it's just it's so hard to move the needle on this stuff.
Mikey: Yeah. Like part of it is like what I hear, like people talk about as the missing middle where you know like specialist mental health services at the DHB are funded for the top 3% of mental health presentations and you know, three sessions of counseling might be suitable for the people on like the more you know, 3% moderate end. But then you have everybody else who you know who are presenting with mental health issues for whom they need ongoing support of some description, but they don't need, you know, that they don't need that surgery level of care, you know, using that that model they don't need an inpatient mental health service or or that sort of thing. And those are that, that's kind of the category where a huge chunk of the suicides are kind of uh, are occurring within, you know where counselling’s not quite sufficient, but what's being offered by the mental health services isn't going to be that valuable or is too out of reach, and that any or not being offered you know.
Ross: Yeah. I think again, it's that it's that. It's those barriers to access. It's that we have a very Pākehā system of access, and as you said, Kyle has examples of people being coached into how to, how to answer questions in the right way to get what you need. But again going back to, you know you're trying to access ACC for something like that's, as someone who has worked in government and has a good idea of how red tape works and how to advocate for yourself in a language that I am proficient in, although I am Scottish like this, you know it was still a struggle, it was still extremely hard to get the help that I needed and there will be thousands of people for whom the system is rigged against and it will be Oh no, you need to go and call this number and you have to go through the whole thing again, oh no you need to talk to this person and to go through this whole thing again only to be told that you don't qualify for something and. It just it's not, uh, it's not a system that allows, it's a system that that gate keeps really really hard, and then you have a government and people going, but look at, they could look at these terrible statistics. It's just very sad. Probably no reason for, it's just. It's just natural law or something. But like that's sad.
Kyle: A really stark example of that just came back up in the last couple of weeks, which was the inability of the system to even allow itself to work in the favor of people suffering mental distress, in the case of the Christchurch shootings, where you know, originally and in the weeks after that, I think was Ian Lee Galloway was minister for ACC and he brought a paper to cabinet which was essentially saying we can ensure that people have support via an ACC mechanism that wouldn't set a precedent as just a really useful way to do this right now. And cabinet said fuck off, basically. Uhm, we we can't do that because then it might open it up up a challenge for all mental health to be covered under ACC. Uh. So we can't make an exception in this case. So even there where you know you're you're saying Ross, you're proficient in the language you had the support system there to try and get it was still hard. Yeah, even the minister at this time he had backing for I think from Treasury had backing over an investigation saying that, you know they could use this mechanism and make it work and the system, and the system and the individuals making the decision said no.
Ross: Yeah. It’s something deeply wrong where you are denying critical mental care to an extremely traumatized group of people because you don't want to set a precedent like that this, I I was so upset when I read that I had to like get up and walk around the room. You know, like I said, that was going to throw my phone across the, you know, into the wall. It's just this idea. Like, that's spite. Like, I, I can't think of any other word to describe that like that's spiteful. There's uh, ACC is almost self funding, like it's we've got a almost unique system that has all these long term investments in petro-chemicals or whatever the fuck it is. And it, you know, it can pretty much fund itself. And I remember back when a National were in government and they dropped the ACC levies. There was there was an expert on it who said if we just kept these ladies up for about five years, the system could be free like it actually run itself and we could provide all of this stuff. And National went for the quick vote, and went no we're going to, you know, it's going to cost you $5 less a year to have the registration in your car whatever the hell it was and just the money is there, the need is there. But. You can't have it and I I just. I can't, I can't parse it in any way other than fuck you.
Mikey: Especially when like, they're like we don't want to set this precedence of supporting people who need support, like how fucked is that like.
Ross: It's just it's yeah exactly but they. It's just. They really are though. Just it, it? It really is like proper conservative tourism with a hashtag be kind rainbow pride flag sticker on the arse of it like it's just. It disgusts like it actually disgusts me. I really can't…as when you think about the cost of y’know, 'cause these people will have post traumatic stress disorder, for people who don't know what post traumatic stress disorder is. It's not just I saw something and it made me feel sad. It's a real, physiological, psychological, ongoing like set of symptoms, which is massively debilitating, debilitating, like people who have post traumatic stress disorder, you know, like suffer from a wide range of symptoms which can stop them from working. It can affect their relationships, it can, it can have and just it's ongoing. And it's not something that you just like have a cup of tea in a chat with your friend over. It's like your brain has failed to deal with what it is seen, what it is experienced in a way that it can understand. So it basically it's it's like a corrupt file in your system and it just fucks everything else up and it actually needs support in order to become unfucked. And if you have seen something like the people in the mosques on those days, saw you, there is no numbers of gumboot fucking morning teas that can fix that and these people will be dealing with this for the rest of their lives. Their partners will be dealing with it for the rest of their lives. Their kids are going to be dealing with it for the rest of their lives, and we know that we can fix this. We know how to fix post traumatic stress disorder. Like it's we've we've got the tools we've got the people who can do it everything is in place to keep these to help these people through this not just like in terms of psychological well being, but also if we want to be bastards about it in terms of their productivity. In terms of like the cost benefit, you know people who cannot work need support in other ways, people who've got negative physical health outcomes because they've got post traumatic stress disorder needs to be paid for. So instead of fronting up the money to help these people get on with their lives and deal with what they have experienced, we're going to withhold that from them and cost everybody more. And I can't think of a reason why he would do that, unless it's just to be spiteful prick. It's it. Just I'm I'm so mad. Yes, set the precedent.
Mikey: Right, yeah, exactly. And and like the other thing that frustrates me about this specific situation is like ACC is not the only funding body we have that could be brought into place to provide this support, like the fact that we even kind of like have only, you know, like the government looked at it for ACC, but didn't think about actually using Ministry of Health money for this just kind of shows some of the problems inherent in our, in the system at this level of it at that Primary Health care level. And like if you, specially if you look back historically at the changes, you know, at ACC as an entity, and some of the changes that it went through during like those more big transformative Neoliberal years in the late 80s, early 90s, which is kind of where we got this ACC public insurance kind of system. If you actually look at mental health rates at that same time, that was when we had a gigantic 50% increase in suicides and we had a massive spike in anxiety, depression as well during that whole neoliberal like transformation stage when we withdrew all other support services, social services, cut benefits. Just kind of like fucked people over and then set up a system where they can't even access mental health services and we haven't, we've never actually clawed back from that point even you know, like we've never had suicide rates go back down till they were, to what they were pre that neoliberal shift that spawned ACC in the 1st place. And now we just kind of see that structure and the impact it's had carrying.
Ross: Yeah, but you know you can't. But this is just that, like if if the government wants to admit that that was what was sitting at the heart of it, then you opened up lots of other unpleasant questions which they are not, and I say they, THEY are not, and we as a whole are not willing to to accept or discuss, you know, like we're not willing to have discussions around how we've got to a point where two people working full time cannot afford to buy a house, or you know, like.
Kyle: Or rent a house sometimes, right?
Ross: Or rent a house.
Mikey: 100% yeah.
Ross: Yeah, yeah, you know. Like I, I remember five years ago went Te Po Marae in Mangere opened its doors to the homeless that that problem has not gone away, there are still families in this area living in cars. Well, there's still kids going to school with no breakfast, like it's and that trauma, you know, speaking of post trauma like that, trauma, intergenerational trauma, the personal trauma, like that feeds addiction levels, it feeds, you know, uh, intimate partner and domestic violence like it feeds all of these other things and, and we can again we can fix this stuff. But we won't, because Labour have got this desire to be seen as being fiscally responsible, which seems to just translate to being sociopathic and as a larger society, we're not willing to discuss the concept of collective responsibility and taking care of people because we're still stuck in this neo liberal mental health is just something that you choose to have.
Kyle: I didn't, well, maybe I half expected to come into this conversation with the result that a benefit raise and rent caps, are maybe the best direct solution to fixing our mental health issues. But I mean clearly the the factors on the ground are a really large indicator of how mental health is going to develop. But alongside that, it does seem to be this, I don't know if it's ideological or just personal belief or or whatever from from our leadership, or there's some kind of institutional inertia. Or maybe you know all of the above where where things are put on a platter for them and those decisions aren't taken, is that? In terms of their reviews that have been happening over the last number of years, Mikey uhm and some of that promise funding and trying to figure out where it goes. Which of those feels like is having the most impact.
Mikey: OK, like I 'cause I guess you've got the two different things. One is you have the the you know history of decaying of our social services which has led to increased inequality and that's had a major impact, and there's one way that we can address mental health. But we've also had the decay of our mental health services through a whole bunch of different things. And you know, like I, I don't think that the cause of the increased mental health problems is the decay of our mental health services as such. But I I kind of think both of those things are happening in Labour is just like, like like you know we've got both both of those things are kind of processes and both of those things need radical change and I don't see Labour wanting to do much radical change with either of those things. I think that when it comes time to the mental health report being enacted, we're just going to see some tinkering around the edge. And then that's it. You know Labour are still talking about, you know, putting school nurses in in every school, but have had not much movement on that and have said that's going to be one way that they’ll address mental health. But where are those highly skilled school nurse is going to come from. Like my job is training school nurses and it's not, we're not really going to get there. You know what I mean? So it just feels like they're tinkering around the edges of both of those things without any, like whether it is that political, the lack of political will to do something radical, transformative combined with that, you know, structural within the healthcare system, inertia, that we just can't shift these hegemonic powers, it it's kind of both and…
Kyle: No! Fuck!
Mikey: …and like to actually do that I mean, I I I don't, like, this, Uhm Health New Zealand thing that might bring some change around some of the bigger structures, but I'm not 100%. It's pretty radical and some..uhm not radical, it's different. Yeah, yeah you know that is a major change, and it's interesting that they're willing to do that on such a large system level, but not actually address welfare issues despite all the recommendations they had from the welfare working group, and you know, I don't. I haven't seen the results from the mental health thing. I'm not sure if they're even out yet, but I doubt that they're going to be actually implementing much more than just gonna be tinker around the edges, so yeah.
Ross: I think that's it. It's same as it ever was. You know, like it's, you see it in, you know so many other aspect. Again, like having had experience in education and it's it's just that feeling of the government will have reviews and will have reviews of the reviews. And then there'll be a report made on the review. And it's like we know what, I think fundamentally, people know what's needed, you know, like you need people to have the basics so that they can live with dignity. You need people who've experienced a traumatic event to be able to get support, after, following that traumatic event, you need systems and processes in place to prevent traumatic events from happening in the 1st place. One of the things I'm really interested in is, you know, working with victims of sexual harm, is how do you prevent that sexual harm from happening in the first place? That seems like such a massive part of the discussion is always best, like there's very little provision to support people who are concerned about their behaviour and I just feel like we know what needs to be done, but it involves talking about some things which people find a bit uncomfortable. So instead of having those big courageous conversations and actually moving the needle will just review and will reflect and will will as you said, we just tinker around the edges but not actually do anything that's going to make any meaningful change.
Kyle: Yeah, it feels like often we will have the mental health equivalent of a tooth magnet, right?
*laughter*
Mikey: Ah, hahaha, my brain. It took my…
Ross: Ah yeah.
Mikey: …brain, like I had to dredge back to Twitter last week to get what that reference was.
*laughter*
Ross: forever in, forever in our hearts man.
Kyle: But you know what I mean, right? It's just yeah, just like, hey, here's a here's a crazy new way to solve a mental health problem.
Ross: It's an app 'cause it's always an app.
Mikey: Yeah.
*laughter*
Mikey: And even like like some of some of the researchers I know who've developed apps in the past have then done research to show how ineffective apps are…
*laughter*
Mikey: Because like we have so many apps and there's heaps of research that shows apps are really effective and they are effective in the if you use them under research conditions. But once they're in the real life people use them for five days and never look back because it's not something they're going to do. Do you know what I mean?
Ross: Yeah.
Mikey: And yeah. So it's just. It's never...
Kyle: No yeah, there's always a disconnect between tech and and humanity as well, right? I wonder why?
Mikey: But there's a new app that I can't remember the name of it, but it's being sold to work places and part of it is that like employees are able to check in with their mental health needs each day. And if they you know are low, then there's a way to anonymously provide support to them. Uhm, I can’t, you, you're making faces like maybe you know what it is, I can't remember what it's called, but.
Kyle: Now I'm just imagining the KPIs that are going to be associated with this in about 6 months, you know.
Mikey: Specially 'cause there's a big cost to it.
Ross: Oh yeah.
Mikey: And, it it it was sparked by somebody who lost, you know, it was sparked with good intentions. Somebody who's a tech person lost a friend, a family member to suicide and then came up with this idea. But there's no it's there's no evidence based to it. It's being implemented as a workplace intervention, so.
Kyle: Yeah.
Ross: I think yeah and you lose it. That's another thing like the corporatization of of mental health and well being as well. Like can you imagine? Letting your boss know on a day by day basis your mental state. Like you said like I, we do not exist in a place where that is not going to be misused within seconds. Dear God, but also that, yeah, you know, we've got EAP, OK great, but it's that. Like the this sort of have you tried like workplaces? Have you tried yoga or we're going to have a mental health day? We're going to have a morning tea and there's never any discussion about what is it about our workplace that means that we have lots of staff needing to access counseling. There's never any, maybe we need to pay people more so that they're not quite so anxious about paying paying the rent. Maybe we need to make paying, living, like living conditions a little bit better. It's like no. As a workplace, we've got someone who's come in to do yoga a couple of times, so we've we've fixed it now. And again it comes back to that. It's your responsibility. It's your problem.
Kyle: Let's do a survey, but leave the questions intentionally vague so that we can claim that we have good well being.
Ross: Yeah, like nobody is gonna answer a survey that says no, I'm feeling extremely depressed as a result of my my working conditions and I can't like, nobody, nobody going to share that with their boss. Even if the boss is the nicest person in the world, because that's going to work that day. You know.
Kyle: It's anonymous so so say, say whatever you want.
Ross: Sure it is. Sure.
*laughter*
Mikey: The DHBs do these surveys all the time in their mental health services in the health services and they almost always find everybody is fucked. They almost always find pervasive reports of bullying on the anonymous surveys, and like very like high stress levels, low mood, especially so even within mental health services, which is like one of the most ironic things. It's why it's it's, you know, such a uh you know, an area where there's a huge turn over where there's very few people wanting to go in, 'cause we've also taken that corporatized kind of model and put it into our health services, even in the DHB level. And nobody wants to work there. 'cause you've got your KPIs, which are, how do you put a KPI on helping people, you know?
Kyle: Cause your budget says, you gotta.
Ross: Yeah, for a lotta you know for a lot of counselors, if you're providing if you're providing counseling, that's that's being funded like you're expected to at the end of the session to ask your your client, like on a scale of 1 to 10 how, how helpful do you feel that the session was, that you actually have to provide some quantitative data and I'm just, like, as someone who has provided counseling support, you know at the end of that session it in a lot of cases you you've done some really quite raw quite deep work, the idea that they weren't going to turn around and go, you know, can you just like on a scale of sad face to smiling face? How do you? Rate the service that you've had.
Kyle: Yeah, this actually relates to high performance space. So yeah, yeah, it's it's you have NPS. So would you. Would you recommend me to someone else who needs mental health support. Yeah, just give me a 8-9 or 10 if that's the case.
Mikey: Yeah, and like the worst like 'cause I see that with some of the funded like some of the yeah some of the funded mental health counseling services were what's expected is when someone first sees a person they have to fill out all these forms and get a baseline. And then when they last, see the person they have to fill out form, we get an exit survey that ends up taking up, you get funded for counseling sessions. You use two basically, one for rapport and then filling in this form and the last one for closure and filling out another form. You end up only with two sessions. You know, yeah.
Ross: Yeah, absolutely that it's, it's useful to get that baseline and find out what brings someone to counseling, but the the the expectation that that's going to take an hour and it's going to be a several, you know. So it’s series of questions and I know where there is risk assessment, you're trying to find out if you know what, what level of, of risk, the client is at, which is fair enough, but yeah, you're right. If you've got four sessions funded and one of them is is the assessment form and one of them is goal setting like your.
Mikey: What’s left?
Ross: Yeah, what’s left?
Mikey: And you still have to build rapport like that's that's the most important bit like, we know that, like your modality doesn't matter as much as the actual personal connection that you build.
Ross: Yeah, absolutely.
Kyle: Hey, we're, we're coming up to time. This has ended up being…pretty dark.
*laughter*
Mikey: All right, we've ruined every listener’s mental health.
*laughter*
Ross: Yeah sorry guys.
Kyle: But but I think there's like, we’ve managed to enter some stuff that we we don't often have open conversations about, right? Which is also really good, but I did want to end on kind of something hopeful, if possible. Uhm. What can of look towards or where can people look for help or where can they offer, uh, support or organizing or engagement to to help in these spaces.
Ross: Well, that's yeah that's gonna, asking the tough questions there.
Mikey: Well, like like to be honest, you know, like I I come from like an anarchist background and that sort of thing, so my usual responses fuck em we'll do our own things and you know, like some of the activists radical left groups in Auckland of kind of put together mental health peer support group specifically so that we can be, like you know what? We're not going to get that support from these systems, so let's just do it ourselves and kind of have have done that. And to be honest, I think a big chunk of it is that we've got to just not like we can't expect anything from these from these people you know we actually have to be building our own communities and that mutual aid support that can extend beyond our material needs, but also the emotional mental spiritual needs as well and that, kind of from my perspective, although I'm doing work within the mental health system, I actually think community building that will be much more even effective.
Ross: Yeah, I just I. I want to talk with that. Actually, I think there's those of you. We talk about resilience a lot and resilience has become one of these dirty words, but, some of the best things that you can do, as you said, is that kind of mutual aid that learning to, we talk about, you know and I have taken the piss out of it a little bit today, but you know, sitting down for a cup of tea in a chat, like actually practicing really, listening to people and actually being open and vulnerable with how you feel about things might feel a bit weird at first, but if you practice that for the small stuff when it comes to sharing the bigger stuff, you're going to be better at it, and that you know that's a really important skill, and I think, especially if you're in activist spaces, if you're working in any kind of social justice, like being aware of your own emotional well being and and and others, and being able to offer that support before you burnout is really, really important. You know, like 1, uh, 1737 has had a lot of variable press recently, but I do know people who've had a good experience of it and it it is something that is out there, so don't completely discount it. There are certainly, you know, obviously, as a member of the the Rainbow Community, OUTline is a free service that's available between 6:00 and 9:00, seven days a week, they also have counselors and and they have peer support. As you said, like we're going to do this ourselves, that they've got peer support for trans and gender nonconforming people. Yeah, there's there's lots of groups out there working to keep each other and ourselves well, and just because your GP hasn't been able to help you doesn't mean that help isn't out there. Yeah, so that's, not trying to be, they say too much of a downer, but certainly Bulger Bulger networks were possible and I can be online as well. You know, we'll we'll here. 'cause of Twitter? After all, which is a hell site 99% of the time?
Kyle: But I honestly don't understand why people think that because I have a great time.
Ross: That's nice for you.
*laughter*
Kyle: Hey thank you both so much for coming on and sharing your experiences and knowledge about this this evening. If people want to find you and being on Twitter or other social media, Mikey, where can they do that?
Mikey: Don't find me don't find me, why?
*laughter*
Mikey: Why would you want to do that well? But yeah, like yeah, if you're a sucker I'm I'm like @MikeyTheNurse on Twitter. My Instagram is not worth following, it's just it's just me posting photos of my cats and coffee mugs. There's no valuable content.
Kyle: That sounds like valuable content to me.
Ross: Pretty feel good content there. Yeah yeah you can find me on Twitter @ThatBikeDad, I I blog as well, but I post everything up to Twitter. Don't come and find me elsewhere because I'm not there.
Kyle: So I to our listeners find them or not after those glowing uh.
*laughter*
Ross: Going offline for my own mental health.
Mikey: We really sold it.
*laughter*
Kyle: And glowing endorsements from themselves. Yeah, yeah, beautiful. And if you've enjoyed this shared around, if you feel like you've learned something from it, if you think it's really helpful to pass on to friends and family who you think could learn something from it as well. You can also find our articles and like at one of 200 dot NZ. We're on Twitter, Instagram, SoundCloud and at the website so hit us up. Always happy to talk to people in the DMs as well, or if you just want to jump into my feed and say any old shit, I'll probably respond. Thank you so much for listening. We'll catch you next time.
Ross: Cheers, goodnight.