Mental health. It's a topic being talked about more and more. To round off Mental Health Awareness week, Cira Olivier talks to providers about what life is like in the field, how it's changing and how they are adapting to change.
Jocelyn Wooller wakes up at 5.30am. She enjoys a bit of quiet time before heading to work at 7am.
The Bay of Plenty District Health Board associate clinical nurse manager never knows quite what a day in Tauranga Hospital's Te Whare Maiangiangi acute mental health unit will bring.
It's a complex environment and often, the best-laid plans change. Being responsive and fluid is key.
"People experiencing psychological distress will often present in a variety of ways which requires an immediate response.
"You can't be too rigid in your thought processes about how the day is going to go."
Wooller has worked in mental health for the past six years after a mid-life career change.
"I'm a people person and I've always been interested in understanding people, seeing where they're coming from and why they might act or present in a certain way."
Wooller is one of three associate clinical nurse managers. Her day involves setting up breaks, co-ordinating staff with patients who have any activities outside the ward, and ensuring staff are aware which patient mental health reviews need to happen during the shift.
The acute unit deals with people who are "very unwell, often at their lowest points" and sometimes that means the impacts of work go home with her at the end of her shift at 4.05pm.
"There's a bit of processing which needs to take place regarding the conversations you've had and the narratives you've been involved in, which can often contain themes of trauma and other difficult subjects."
Work-life balance is a challenge as she is working towards a masters qualification.
This year, she's been more deliberate in her mindfulness - eating well and taking time for regular breaks.
"That's something we're really focused on with our staff, the need to care for self before we can care for others.
"Mental health can be challenging but it's also very rewarding and we're privileged to be in a position where we're helping people at their most vulnerable."
Her studies have involved looking at compassion fatigue, a condition characterised by emotional and physical exhaustion which leads to a depleted ability to empathise or feel compassion for others.
As well as bringing people out of their lowest points, the married mother of three adult children enjoys time with loved ones, the odd glass of wine and running, walking and paddleboarding.
Last week, the Salvation Army released the State of our Communities Report, shining the spotlight on social issues in Rotorua, Johnsonville and Queenstown.
Mental health services were a top concern in the report as people experienced the impacts of stress, anxiety and hardship as a result of the economic downturn.
Existing mental health issues were amplified by job losses, social isolation, lack of income and other lockdown-related social challenges.
A changing field
For Lexia Brailey, mental health is a changing field.
Owhata Medical Centre's clinical manager said children as young as 9 and 10 were showing depression and anxiety symptoms. The reasons are complex and varied but could be linked to child poverty, the home environment, socio-economic or financial issues or a family history of mental illness.
"There's just a lot ... you can't really refine it down to one. We're seeing children with lots of issues."
Brailey said the practice had also seen a rise in sexual, physical and emotional abuse in the past five years.
"There's an increase in family violence, there's an increase in drugs and alcohol-related disorders which is having a significant effect on our children.
"It's a matter of putting treatments and interventions in place to get them out of those situations."
She said online bullying and social media pressures also fed into youth mental health problems.
To tackle the "unprecedented task" the practice had made "significant" changes in the past six months including on-site intervention for patients.
Primary health community mental health services, health improvement practitioner services, Te Arawa Whānau Ora were now in the centre to support staff in providing timely, attainable and relevant care for the rising number of children and adults needing it. They also provide a collaborative service with Eastside Community Collective and Lakes District Health Board.
"The beauty of these services here is we now have the ability to refer them to these services on the same day ... So they're not falling through the cracks.
"It's a one-stop-shop."
She feared for lives if timely treatment was not provided.
"We'll continue to see an increase of mental health [issues] and potentially a lot more deaths.
"We definitely need more resources including support workers and investment and retainment of New Zealand general practitioners and primary care nurses.
"There needs to be investment in the general practice to close the pay gap. If this gap is not addressed general practice will struggle to recruit, support nurses to ongoing education and retain primary care nurses. This will further increase pressure on the delivery of high-quality general practice services in the community."
With mental health a changing world, Te Whare Oranga o Whakaue, Rotorua Hospital's acute inpatient unit, has been pioneering a new way of treatment with a patient-centred approach.
Feedback informed treatment sees clinicians take client input into account to identify what is and is not working in therapy and how to better meet clients' needs.
The person receiving treatment provides critical feedback on what improvements can be made and where they see their wellbeing headed.
Lakes District Health Board clinical nurse director and director of Area Mental Health Services Joanna Price and Darren Malone, the clinical director and psychiatrist at the health board, are the only nurse and doctor respectively trained in the treatment.
Price said it was person and whānau centered and gave the person a voice, in a nutshell, it is the live monitoring of a person's progress. She said the approach strengthened the relationship between patient and practitioner.
"It moves away from a medical model approach into a contextual approach.
"Lakes is leading the way in feedback informed treatment.
"A strong therapeutic relationship is more likely to achieve positive outcomes."
Research on the treatment model shows it produces a higher chance of better outcomes.
The live progress monitor allows for any lack of improvement to efficiently be picked up and be aligned to the individual patient. The programme shows information on a graph depicting whether the patient is progressing, not progressing, or at risk of non-progression.
"Without the [feedback informed treatment] tool, we don't know if someone's progressing with us or not."
Feedback informed treatment has been used for five years within the primary care team, peri-natal team and 18 months within the mental health unit.
"In an ideal world, I'd love to see this implemented across all health boards," Price said.
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
• Helpline: 1737
• Anxiety Helpline: 0800 ANXIETY (0800 269 4389)
If it is an emergency and you feel like you or someone else is at risk, call 111.