Recent media reports suggest that staff from police and ambulance services are attending too many mental health/addiction crises. Both these services play critical first-responder roles in the community and without enough mental health staff on crisis teams they will continue to do so.
Emergency Departments of hospitals are also not designed for a person experiencing a mental health/addiction crisis, so having alternate more "wellbeing-friendly" places to assess and support people experiencing distress that has escalated to crisis level is also critical.
• Lizzie Marvelly: Mental health report a huge wake-up call
• Talk on mental healthcare crisis not enough says National
• Mental health system overhaul welcomed by experts
• Ambulance call-outs on rise
In the early 90s, the second author was the psychiatrist in Aotearoa's first crisis team in West Auckland. This team implemented an evidence-based model of community-based crisis assessment and treatment, to provide earlier response to crisis and an alternative to hospital admission. The team was well staffed, provided support to people in their own home, as well as having funding for a range of "respite" options, and proved so effective that within 10 years all areas of the country were funded to provide an equivalent service.
In 2001, the first author led a team who reviewed crisis mental health services in Aotearoa for the then Mental Health Commission. The report was called "Open All Hours". Crisis respite stood out as a very effective way of averting escalation of a crisis and as an alternative to admission.
However, key problems evident then were: A lack of national planning and consistency in the model of care; variability of access around the country; and a lack of culturally responsive services for Māori and Pacifika peoples which resulted in much higher rates of admission to inpatient care.
Access thresholds differed around the country and there were gaps in crisis services for children and youth, older people and those with alcohol and drug problems.
Unfortunately the recommendations of the Open All Hours report were not consistently implemented; funding for crisis services has not kept up with increases in population and demand; and, as exemplified in the recent media reports, police and ambulance first responders have increasingly found themselves having to be defacto "crisis services".
In 2018, the Mental Health and Addiction Inquiry (He Ara Oranga) Panel found that the number of people accessing specialist mental health and addiction services has increased by 73 per cent over past 10 years. It was noted that: almost all DHBs reported being overwhelmed by demand for crisis services and there were large increases in numbers of people with distress as a result of multiple complex challenges in their lives – relationship breakdown, financial stress, employment, housing, trauma, grief etc. Other themes were (still) sadly similar to those found in 2001.
Since the Mental Health and Addiction Inquiry, we have had the largest investment ever ($1.9 billion over five years) in mental health and addiction services via the recent Wellbeing budget, with $455 million dedicated to a new frontline service for people with mental health and addiction issues seen in primary care and community settings, with a target of reaching an additional 325,000 people per year by 2024. The budget also included $40m for suicide prevention services, alongside the establishment of a Suicide Prevention Office to lead national work to reduce our very high suicide rate.
All these actions will help to support better responses to people experiencing a mental health or addiction crisis.
So, to the future. We need more peer-led respite services as an alternative to hospital. One example is "Tupu Ake" in South Auckland.
All mental health/addiction crisis services need to pay attention to people's experience of trauma and the new Suicide Prevention Strategy and Office will help with this.
The current focus on earlier intervention within primary care will also help to prevent crises.
We can learn from other countries (while acknowledging our unique indigenous and Pasifika communities). The first author has seen a model of mental health/addiction staff responding with police and ambulance to crisis which works very well in large cities (e.g. Vancouver in Canada).
In the US, instead of "air traffic control" for planes, people are suggesting "care traffic control" whereby technology tracks every person and considers options to provide the best possible support.
The authors note that addiction crisis teams are also important. Both authors have tried to find urgent assessment and treatment for people with life threatening addiction issues – but have failed.
Having to be "clean/dry" may help an agency's statistics but does not help people in dire need.
It would also improve responsiveness and consistency for Aotearoa to have one crisis mental health/addiction line for the whole country.
• Janet Peters is a registered psychologist and the New Zealand Liaison for the International Initiative for Mental Health Leadership; and nationally respected psychiatrist Dr David Codyre is the clinical lead for Tāmaki Health's Wellness Support Team.
Where to get help:
• Lifeline: 0800 543 354 (available 24/7)
• Suicide Crisis Helpline: 0508 828 865 (0508 TAUTOKO) (available 24/7)
• Youth services: (06) 3555 906
• Youthline: 0800 376 633
• Kidsline: 0800 543 754 (available 24/7)
• Whatsup: 0800 942 8787 (1pm to 11pm)
• Depression helpline: 0800 111 757 (available 24/7)
• Rainbow Youth: (09) 376 4155
• CASPER Suicide Prevention
If it is an emergency and you feel like you or someone else is at risk, call 111.