Trust is a hard thing to define. In many ways, it requires faith and blind adherence to the idea that things will work out. Trust is the cornerstone of human relationships. Without it, couples fall apart, friends drift apart, things end.
The first lesson we learn in relationships is trust, when we (hopefully) experience our parents meeting our needs, being there when we need them, failing, fumbling, trying again and through it all: caring.
We all know there are problems with the way we care for people struggling with their mental health in New Zealand, but few people are as well qualified to comment as Dr Brad Strong.
Brad is a psychiatrist and the Clinical Director for Mental Health and Addictions Services for the Southern DHB, covering Dunedin, Invercargill and surrounds. He is also a Harvard educated psychiatrist, and he was our guest on the NewstalkZB show, The Nutters Club on Sunday night.
We asked for his views on what we need to change in our mental health system, and why he thinks we need an independent review.
He said people needed to trust us, and the system, again.
"The public trust in what we do, the public trust in how we're run, how we're funded, and how we're overseen in our model of care in some ways, is shaky, or it's even started to fall off ... trying to work in a system that is feeling shaky to the public, that's no small thing. How do you regain trust from the people you serve? I think that's our biggest challenge right now."
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And he's right.
We've reached the point now where people can't trust that if they call a crisis team someone will answer. Nor can they trust that their loved ones will be safe in a psychiatric hospital. We've reached the point where families are sueing DHB's for failing to protect their children in psychiatric care.
Without trust, we have nothing. Without trust, we have no relationship. And without a relationship, treatment fails.
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It's little wonder compulsory treatment has risen: staff and consumers are struggling to trust each other. We lock them up rather than listen.
"We need to have an independent review of what's going on to regain the public's trust ... [We need to] have the discussion, about where we stand, and where we're going, and what kind of model of care we want to deliver to the people of this country regarding mental health. It can't hurt. I think it's time we got a breath of fresh air, blow through the mental health service in this country."
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In a relationship, when trust has been broken reconciliation is possible. But it requires the fresh air of honesty, vulnerability, openness and the willingness to try again.
Clinicians like Brad, myself and many, many, others that I talk to want to rebuild that trust. But we need a fully public and independent review to do that. It can't be politicised, and it can't be done in private.
Trust can't be rebuilt until we have fully admitted what we got wrong, and commit to fixing it.