- Panel holds more than 200 meetings, gets 5000 submissions
- Meetings showcase frustration at system focused on treatment not prevention
- Mental Health Commissioner shares some of public concerns
- Inquiry chairman urges sector to keep making changes - "don't wait for us"
WARNING: THIS ARTICLE IS ABOUT SUICIDE AND MENTAL HEALTH AND MAY BE DISTRESSING FOR SOME READERS.
They came with pain, mothers, fathers and siblings, armed with anguish and indignation.
They spoke, with anger and weariness, of suicide attempts, by them, by others.
They described a system that couldn't, or wouldn't, address the complexities of each case - a system that reacts to the sick instead of stopping people getting that way.
They showed little love for psychiatrists, resentment at a perceived over-reliance on medication.
They were bewildered that "consumers", as they are coolly described, are not listened to, that services run by people who've not had the same travails ("lived experience" as it's known) aren't fit for purpose.
For some there was cynicism: We're here again, another inquiry, another report, more recommendations.
But there was also, somehow shining amid the wreckage of broken lives, some hope. That true change might finally come.
These, then, were the public sessions of the Government Inquiry into Mental Health and Addiction.
There have been dozens, from Kaitaia to Invercargill, since consultation was launched in Palmerston North more than two months ago.
The Herald attended three meetings, in Tauranga, Whangārei and Hamilton. We're not allowed to report specifics – the meetings were set up so people felt safe sharing details of their darkest moments and we have no wish to breach that trust.
Each meeting had a slightly different tone, but there were common themes.
"Some meetings have had more heartache, pain and grief expressed volubly than others," said inquiry chairman Ron Paterson.
"There was some rage – the sheer frustration of family members who are trying to get help and the help's not there when they need it. It's pretty evident to me why we were asked to go out and hear the voice of the community as our first term of reference, because the community's had a lot to say."
Paterson was surprised by the openness and bravery of people who talked about their journey from addiction and those who live with mental illness.
"And young people have stood up and talked about their suicide attempts. Some of them are still struggling on and some of them are doing well. We've never had a public meeting where people have sat silently."
With one to go, more than 2000 people have attended public forums. The inquiry has received about 5200 submissions. Its six panel members have met well over 200 community groups, organisations and individuals.
They have visited a school in Hawke's Bay, the homeless clients of Auckand City Mission, prisoners in Auckland, Wellington and Christchurch, the Auckland judges of the Alcohol and Other Drugs Court - special courts that aim to reduce reoffending, alcohol, drug use and addiction.
The deliberations phase is upon the panel, but such meetings will continue until early August.
Outside the cities, they heard of challenges of distance and geography, the P epidemic, unemployment. Overall, said Paterson, there were more similarities than differences between regions.
Common complaints nationwide included a struggle to access help for people with mild to moderate ("but often pretty serious") mental health needs.
"That would also have been the case 23 years ago at the previous inquiry," said Paterson.
The previous inquiry: The one into mental health services led by Ken Mason that began in 1995 and reported in 1996.
Its findings are among more than 50 "major government documents" about mental health and addiction services written since 1994 that are listed in a report by Mental Health Commissioner Kevin Allan.
Several action areas were identified in his report, released in February. Considering they're couched in language befitting a senior public servant, the findings are relatively blunt.
"My findings … suggest a loss of traction in the sector. Issues with leadership and coordination have undoubtedly contributed to system inertia …
"Currently there is a lack of integrated, collaborative leadership in the sector."
He mentioned the "failure to track tangible progress" against the Ministry of Health's 2012–17 plan, Rising to the Challenge (another of those 50-plus documents), and to develop a plan to succeed it.
"The structure of the health sector … presents inherent coordination and leadership challenges. However, for a complex area such as mental health and addiction, effective, collaborative leadership within the sector and across the broader social system is essential for success. There is, therefore, a real risk that leadership will fail when it comes to delivery."
Allan welcomed the government inquiry, its broad terms of reference and timeframe. The panel has to give its recommendations by the end of October. That's fast, as these things go.
It's worth reminding ourselves how we got here.
In the run-up to last year's election, Labour campaigned strongly on boosting mental health outcomes. Their promises came amid a groundswell of public discussion prompted, in part, by widespread media coverage. That included the Herald's Break The Silence series, which had a specific focus on the mental health – and lamentable suicide stats – of our young people.
Meanwhile, Chief Coroner Judge Deborah Marshall released the provisional suicide statistics for 2016/17. They showed 606 people had died by suicide in New Zealand, an all-time high up from 579 the year before, itself a record.
Key policies that survived talks to form the Coalition Government included a commitment to free counselling for under-25s, the re-establishment of the Mental Health Commission and the inquiry.
Announced by the Prime Minister in January as part of the Government's 100 Day Plan, the inquiry team promise to "set a clear direction" for the next 5-10 years.
There are "unmet needs" to identify, recommendations for a better system and preventative measures to craft. A stocktake of relevant research, done here and overseas, has been ordered from the University of Otago.
A "mandate for action" is promised, solutions which are "practical and doable – for the short- and long-term, at national and local level".
The recommendations will not be binding. The Government will decide which parts of the plan are accepted and resourced.
Paterson, a former Health and Disability Commissioner, acknowledged the weight of expectation.
"We know that a lot of people are pinning their hopes on this inquiry. Hope for improvement and we've seen it that way ourselves. We believe what we've said at meetings around the county and in our documents, that we believe it's a once-in-a-generation opportunity.
"We appreciate that people are looking to us to be bold because people recognise that more of the same is not going to solve these problems. And for myself, there's a challenge to try to bring some simplicity out of complexity … there needs to be some clear recommendations that give a pathway to government and the community.
"And that's our job and, yes, it keeps us awake at night. But that's the job and we will get the job done."
But those 50-plus reports? Why should people expect this one to succeed?
"Well, I believe our report will be different. I can't speak for what the Government will do with it but when the inquiry was announced, the Prime Minister and the Health Minister said that nothing's off the table and the Minster has been very clear that the Government is listening and they expect change to follow … We've been told very clearly to think more broadly – not just about the acute end of things but what we can do to prevent problems from arising and how can we bring a community wellbeing focus.
"That's the job and it's a big job and the answers aren't going to all come from government."
Here are some of the issues raised at the meetings attended by the Herald.
On a night of heavy rain at The Historic Village in Tauranga, there were calls for more support for parents of disabled children – specifically those with Asperger Syndrome, for health professionals to communicate better - with each other and with patients, for police to get proper training in dealing with mental health patients, for children to learn how to handle emotional pain, for funding for alternative treatments as part of a holistic approach - including acknowledging the importance of diet, for more employers to give jobs to people with mental health issues.
At Forum North in Whangārei they wanted more accountability for health professionals, more help for deaf youth, for the transgender community, for people discharged from hospital.
In Hamilton, there was anger towards the Waikato District Health Board, specifically its Henry Rongomau Bennett Centre for mental health. One man was admonished by the convener after naming and criticising a Board employee. Another angry about over-medication compared the facility to the one in the movie One Flew Over The Cuckoo's Nest.
In a blog post about the Hamilton meeting, Dave Macpherson, whose son Nicky Stevens died after going on unescorted leave from the Henry Rongomau Bennett Centre, wrote that: "Waikato DHB, and the psychiatric profession copped a hammering, again in equal parts, from current and former patients, from families and whānau, and also from a few community mental health sector staff whose frustrations mirrored those coming from the community itself."
Of the complaints about over-medication heard nationwide, Paterson said: "You can't medicate grief and loneliness and people need much more holistic care."
Of the calls for a holistic approach, he said: "[There's a] very, very strong message that we should be focusing on wellbeing and we should be focusing on what we do to support wellbeing in the community and that includes eating well, physical health, spiritual health, connection with your family."
Of the shift towards prevention, he said: "A lot of people are talking about the need [to give] kids the tools they need to cope with life's crises. So many children and young people are presenting with anxiety. People are trying to think how we can give them the tools they need in schools."
The process had been gruelling, but there was positivity amid the pain.
"One of the privileges for us as panel members is that it's a chance to go around the country and see the amazing things that people are doing to help, to help each other and their community. That's been a strong thing that we've seen first-hand, particularly among Māori."
The panel has had plenty of time on the road to talk about what they've heard. The deliberation phase will help them firm up recommendations and shape their report. That, Paterson said, must be clear and accessible.
Mental Health Commissioner Kevin Allan isn't the only person to question "inertia" in the sector. Some fear many at a structural level are loathe to act until they see how the Government responds to the inquiry findings.
A spokesman for Health Minister David Clark said he would consider the report before taking it to the Cabinet for further consideration. There was no detail on timeframe.
In April, in one his regular updates for the inquiry website, Paterson said: "For those of you working on the ground – keep implementing changes – don't wait for us."
The next annual suicide stats are likely to be released by the Chief Coroner in late
August or early September. People familiar with the sector spoken to by the Herald said they wouldn't be surprised by another increase.
The angry, frustrated, pained and weary are waiting.
WHERE TO GET HELP
If you are worried about your or someone else's mental health, the best place to get help is your GP or local mental health provider. However, if you or someone else is in danger or endangering others, call police immediately on 111.
OR IF YOU NEED TO TALK TO SOMEONE ELSE:
• LIFELINE: 0800 543 354 or 09 5222 999 within Auckland (available 24/7)
• SUICIDE CRISIS HELPLINE: 0508 828 865 (0508 TAUTOKO) (available 24/7)
• YOUTHLINE: 0800 376 633 ,free text 234 or email firstname.lastname@example.org or online chat.
• NEED TO TALK? Free call or text 1737 (available 24/7)
• KIDSLINE: 0800 543 754 (available 24/7)
• WHATSUP: 0800 942 8787 (1pm to 11pm)
• DEPRESSION HELPLINE: 0800 111 757
• SAMARITANS – 0800 726 666.