LET'S face it, the mental health system of New Zealand, measured by outcomes, is a failure.
Mike King is right and Jonathan Coleman stands squarely in the path of progress and needs to get out of the way.
Dr Coleman's refusal to hold an inquiry following the grassroots People's Mental Health Review is unfortunately illustrative of the failure of government to meet this or any crisis -- instead, denying that it exists.
This year's review highlights the critical failure by virtue of the stark fact that police -- not the government-funded mental health service -- are responding to 90 mental health incidents daily.
Let's not forget that police here represent the ambulance at the bottom of the cliff. The mere need for police in these circumstances is an indicator of failure.
In the United States, it must be noted, the two largest "treatment" centres for mental illness are the Miami Dade County Jail and the Los Angeles County Jail. Now that's what ultimate failure looks like -- and we need to learn from it.
The 2006 Ministry of Health mental health survey acknowledged in its prefaces that the models for mental health understanding and for treatment were largely adopted from other countries, particularly the US.
The 2017 people's survey of New Zealand's mental health landscape is a good starting point for discussion.
That report, headlined as damning in media descriptions, paints a picture of an overstretched system, unable to respond adequately to the needs of people in distress. with 95 per cent of the 500 respondents having a negative view of the system, its long wait times and over-reliance on medication.
The 531 suicides last year are an indictment of a system too sick itself to provide the care that's needed.
The US system, which has been the model for New Zealand's, is similarly flawed.
Yes, the system here is underfunded and the people's report was partly in response to further planned cuts to funding, but if all that has done is to throw more money at the problem, then -- as Mike King predicts -- we'll be back here in five years staring at the same dismal facts.
For a start we need to move in a wholly different direction.
From the Heath Ministry's own survey of 2006 and its stated figure of 46.6 per cent of us who would be affected by diagnosable mental "illness" in a lifetime, we can conclude that mental health issues affect you and me and everyone else we know.
That survey highlights the even higher prevalence for Maori and Pacific people -- and that was known 11 years ago.
We need now to recognise facts, first through a commission of inquiry. Beyond that, we need a new paradigm for dealing with emotional and cognitive problems, one that recognises the continuum of mental health and mental dysfunction.
And we need to recognise the central core of psychological well-being and of its apparent opposite as existent in the structure of family as a basic unit, and not only in the atomised view of individual illness.
This would be a radical departure from old thinking which, with a singularly pharmaceutical therapeutic approach, continues to lead to a cycle of dead-ends and despair.
We need to create a uniquely New Zealand perspective on mental health, one that takes in the known science and which organises its thinking from the bottom up, from ordinary people alongside the potential treaters.
This is as opposed to the top-down paternalism represented by decades of government ministers with a political agenda designed to paper over what's really happening to people -- and especially Maori and Pacific people -- in the vain hope it will all go away until the next election.
If we start now with an inquiry and well-funded research -- not the current know-nothingism of less than 1 per cent of total budget -- and a national will, maybe in 10 years we'll have a mental health system that, instead of shame, we can be proud of.
Jay Kuten is an American-trained forensic psychiatrist who emigrated to New Zealand for the fly fishing. He spent 40 years comforting the afflicted and intends to spend the rest afflicting the comfortable.