We all experience some degree of depression and anxiety in our lives - they're part of being human. But when should we seek help? What treatments are available?
September 23-29 is Mental Health Awareness Week. The Mental Health Foundation of New Zealand this year is asking Kiwis to explore their way to wellbeing, to discover things that make you feel good.
Sometimes, a chat with friends, exercise, reading and meditation can lift us out of a funk. But what happens when sad and anxious feelings interfere with our lives? Reporter Dawn Picken spoke with people about what has worked - and what hasn't - to manage emotional pain.
Surfing waves of wellness
"I just wanted to change my life. I was really depressed. Nothing was really happening for me." - Brandon, aged 23
Brandon Judd-Symes says surfing saved his life. The 23-year-old says he used to be depressed, unemployed, smoked weed daily and was on the verge of homelessness.
"If it wasn't for a phone call last year I don't know what would've happened. It was pretty bad. I was never into self-harming or anything like that, but I just wanted the pain of living to end, the pain of struggle."
Judd-Symes' probation officer suggested he join the Live for More programme for at-risk young men. The Mount Maunganui-based non-profit group was established by licensed drug and alcohol counsellor Krista Davis in early 2016. It pairs surf therapy with other support services. The Tai Watea surf course runs for eight weeks, but participants can stay connected indefinitely through weekly meet-ups.
"There's something magical about being in the water, how it helps with your mental health," says Judd-Symes.
He says he bounced around foster homes as a child, leaving him feeling abandoned and depressed. Early counselling sessions fell flat.
"They were always saying, 'Oh we're here to fix you,' and my biggest thought in my head was like, 'Well, you're sitting here asking questions about me and I'm telling you if I can't fix me, what makes you think that you can?'"
Judd-Symes says people need to reach out to others battling depression, and men shouldn't be afraid to ask for help.
"Men are viewed by the world as not being allowed to cry, not allowed to show feelings, but that's what makes us human. Until people know what you're feeling, they can't reach out and be able to help you."
Today, Judd-Symes mentors other young men in the Live for More Programme, has his driver's licence and has earned a supervisor role at his kiwifruit job. In February, he'll start studying social work at Waikato University.
"I definitely want to work with addiction. I've done a lot of stuff and been addicted to a lot of things. It was never a positive addiction. Surfing's an addiction for me now; I can't get enough of it."
He says back in his weed-smoking days, no one seemed to care about him. He says mental health campaigns aren't much use if people don't take time to ask how others are doing.
"Everyone wants to post on social media about mental health but when it comes down to it, they're just kinda looking after themselves."
Judd-Symes is proud he has the chance to help his peers.
"I'm looking out for other boys on this course, making sure they're okay."
Working solo mum seeks help
"I'm struggling here, and she said the best thing I can do is put you on anti-depressants." - Wendy,* Bay of Plenty
Wendy* says a messy relationship break-up threw her into depression. She asked that her name not be published as her former partner had been in a gang. At the time, she had a child. Wendy replaced dinner with wine, cried in the toilet at work and couldn't sleep.
"Me and my son had to live with a friend for nine months and shared a room so I could save money to get a bond for a rental property. I hardly slept ... it was a struggle just to try to keep it together and pretend I was okay."
The Bay mum saw her GP and asked for a counselling referral.
"They said they'd be in contact. I waited six months and heard nothing, so I contacted them and they said it was declined three months ago."
When asked why she couldn't get help, she says she was told working 32 hours per week disqualified her. Her doctor offered to put her on anti-depressants.
"I said 'I don't want anti-depressants, I just want to talk to someone. I have friends that work at Winz - they said go on the benefit, you'll get everything. I don't want to, and I don't think it's easily accessible to get counselling."
Wendy did get three free talk therapy sessions through her employer but says the counsellor wanted to share her own experiences and suggested she return to her ex-partner, who was then using drugs.
"What sort of advice is that?"
She says she paid to see another therapist after that. "I had two sessions but they were $100 each and I just couldn't keep up with it. I spent three hours telling them everything. It felt like I spent $200 just to tell the same story again."
She eventually decided to take anti-depressants and has been on them for about a year.
"The first week I felt a little out of it. Sometimes, I was driving thinking, should I be driving? Probably after two weeks, I started to smile again."
Wendy says she enjoys activities recommended by the Mental Health Foundation such as exercise and spending time with friends. But her part-time job and being a fulltime mum means she doesn't have much time for walks and socialising. She believes more funding for counselling is needed, so people who work can get help.
"I'm just the type of person that needs to be around people and I need to go to work. There are times I wanted to give in because of stress and thought I couldn't do it anymore. It would've been nice to have someone to talk to, rather than going to work and crying every day."
Working to change her life
"It's been a long road and sometimes I think, 'Why me?'" - Jody, Tauranga
Jody Spriggs says childhood trauma left her feeling "like I was angrier than everyone else".
To cope with that rage, she tried to drown her sorrows in booze. It nearly killed her when she got behind the wheel.
"I hit gravel and I was sliding off a bank. I was in self-destruct mode. I haven't drunk since. It scared me out of drinking."
Spriggs says she is working in therapy and group counselling to get her life on track.
"Going to these groups, when you get there and hear stories it's quite inspirational. You don't feel so all alone."
Spriggs lives by herself and sees a drug and alcohol counsellor and case worker.
The Tauranga resident has 13 guinea pigs and says the rodents get her out of bed each day.
"My guinea pigs have heard me whinge and bitch. I curse the world and they don't say anything back."
Spriggs says exercise, "is definitely a mood-lifter, 100 per cent", and she enjoys walking in the park whenever she can.
Spriggs has tried several anti-depressants but says they all had side effects. She says one medicine gave her dramatic mood swings; another helped her pack 12kg on to her 65kg frame within two months. Today she relies on breathing techniques that encourage mindfulness.
"It's taught me heaps going through the system - our minds can be our own worst demons at the best of times."
The difference in free or subsidised help available to people like Jody, who's unemployed, versus Wendy, who works, illustrates the difficulty of accessing mental health treatment in the Bay and beyond.
Rotorua's Mike Naera is advocacy alliance specialist with the Mental Health Foundation of New Zealand. Naera says statistics show one in seven New Zealanders will experience depression before they're 24. One in eight men are experiencing depression and one in five women suffer depression.
Overall, Naera says one in four New Zealanders will experience anxiety. And many of these people, he says, will need services.
"That's the grey area we haven't solved yet: Are our mental health clinicians capable of seeing people who come through the door? They're feeling under stress themselves trying to cope with the influx of people."
Naera says the Mental Health Foundation encourages people who are feeling psychologically unwell to first look at exploring nature, connecting with whānau and friends, with schools and exploring how you can improve your own wellbeing.
"If those things aren't working, go and see your GP and maybe they will prescribe you medication."
Naera says a short-term intervention can get people back on track but should always be monitored by a doctor, as anti-depressants have side effects including the potential to cause suicidal thoughts.
"If you're having side effects like that, your GP will change your medication. We think it's like Panadol, take it and it works instantly, but as with any psychological medication, it takes time to work."
In addition, Naera says the internet, which at its inception was touted as a way to connect people, has become a powerful force for disconnection and discontent.
"People aren't having dinner together, they're looking at friends on holiday overseas wishing they were there."
Or they're looking at filtered selfies portraying unrealistic body images, or have become addicted to video gaming or are victims of trolling and cyberbullying, he says.
Bay of Plenty District Health Board mental health clinical director Dr Fiona Miller says that how we use social media is key. She says social media and video games are designed with psychology in mind and can impact mental health.
"Ultimately though, it is a tool that can be used to help connect people, show support for those who are struggling, provide validation for people's experiences, and direct to appropriate online or face-to-face supports."
Miller also echos Naera's concern about negative impacts of online activity.
Naera says big societal problems also threaten our psyches.
"People living in poverty, the housing crisis, homelessness ... these all impact on spiritual wellbeing in some form. If spiritual wellbeing isn't good, someone can become mentally ill as a result of constantly living in negativity."
Miller says chronic stress caused by housing insecurity is known to increase rates of depression and anxiety. She says it also affects the transition of people well enough to return to the community.
"If they become homeless or are unable to find accommodation for some reason this is a major risk for relapse."
Waiting for the money
Prime Minister Jacinda Ardern announced on September 15 that mental health services at 22 general practices nationwide would receive a $6 million funding boost. It comes as the number of suicides in New Zealand has reached its highest-ever level, with 685 people dying in the year to June 30. The Ministry of Health will also soon put out to tender $30 million of new contracts to begin rolling out new free front line mental health services in new areas starting early 2020.
But local health officials say they've yet to learn how those dollars will flow into our region.
"Currently there is an ability to access free counselling via a number of avenues but they are all a finite resource, and GPs often 'run out' of their allocation or the criteria excludes some individuals."
Miller says another initiative mentioned in the report is the ability to access needed support quickly.
"It is likely that some of the money outlined in the budget will go towards supporting staff working with, and in, GP practices to provide this in a timely manner."
Mental health service for older people
The Bay of Plenty DHB's Dr Fiona Miller says the highest number of referrals for secondary services, when broken down into five-year age groups, is in the 15-19-year-old age group, followed closely by those in the 20-24-year-old group, and then the 25-30 year-olds.
But referrals for older adults have grown. The Mental Health Service for Older People received 1210 referrals last year, compared with 897 five years ago. That's an increase of nearly 35 per cent.
GPs or internal DHB clinical service providers can refer patients to the programme. It provides assessment and treatment for persons aged above 65 experiencing an acute mental health illness or people living with dementia of any age who are experiencing significant behavioural and psychological challenges.
Miller says some mental health issues are the same for older patients as for younger ones. But they see in the elderly presentations due to medical conditions or events, as well as people presenting with dementia or cognitive impairment. Miller says patients over age 65 are often handling grief or losses such as that of a partner, child or of being able-bodied.
"In over 65 year-olds talking therapies and groups are a very important part of treatment and should be offered wherever possible. Medications still play an important role alongside this."
Free or subsidised counselling services
Bay of Plenty Therapy Foundation
Offers subsidised counselling for locals who qualify for aid. http://www.boptherapyfoundation.co.nz
Beachaven Family Services, Pāpāmoa
Offers counselling and advocacy
07 542 1725
BOP Sexual Assault Support Service (BOPSASS)
Provides a support and counselling service for children, adolescents and adults who have been affected by sexual assault and abuse
Grief Support Services
Free and subsidised counselling for children and adults experiencing grief and loss.
Mental health and community helpline services, specialising in the delivery of counselling, support and suicide prevention education.
Pāpāmoa Family Services
Community social service agency whose services including counselling
Salvation Army Tauranga
The first counselling session is free. Further sessions are $30, but the organisation can talk about cost options. A staff member said the waitlist just re-opened this week and runs about four weeks long.
Services for Asian, African and Middle Eastern women including referrals for counselling. 07 579 0532
payment of counselling costs in some cases after serious crimes: especially homicide, death by a criminal act, and sexual violence http://www.victimsupport.org.nz/
Te Puna Hauora provides whanau counselling for tamariki, pakeke and CEP (Co-Existing Problems) assessments and treatment for rangatahi and whānau members.
Te Runanga o Ngāi Te Rangi Iwi Trust
Māori health provider offering whānau support and counselling
(07) 575 3765
Turning Point Trust
Mental health and addiction service provider offering peer support and advocacy
Payment of counselling costs in some cases after serious crimes - especially homicide, death by a criminal act, and sexual violence