Mental health failings

OUT OF MIND

Is New Zealand’s Mental Health System Failing Our Youth?

Words by Taleta McDonald

Olivia Smith’s parents watched in horror as their daughter was removed from the clinician’s room and returned demanding medication. “It was like a conspiracy had taken place” says Mrs Smith.

Olivia, 14, was referred to the Kari Centre (Auckland Central Child and Adolescent Mental Health Service), by the family’s GP in July 2012 with suspected depression and anxiety after having an emotional breakdown caused by school bullying.

Mrs Smith says they waited 3 months for their first visit and in the months leading up to Christmas her daughter attended regular sessions at the Kari Centre, however, she noticed there were no set goals or treatment plan in place.

In a tragic turn of events, Mrs Smith says her daughter was admitted into The Child and Family Unit (child and adolescent mental health inpatient unit), in December 2012 after attempting suicide and it was here she was administered her first round of medication.

Is our mental health system failing our youth?

It’s no secret New Zealand has one of the highest youth suicide rates in the developed world. Latest figures released by Chief Coroner Judge Neil MacLean show sixty-nine 10-19 year-olds took their own lives during 2012-2013 and the highest number of suicides was recorded for 20-24 year-olds.

Sadly, it is young people within the 15-24 year-old age bracket who are most at risk of suicide, and research shows mental illness is the largest contributing factor. According to statistics from the Canterbury University Suicide Project, 90 percent of all youth suicide deaths can be linked to mental health conditions.

In August this year, the Ministry of Health (MOH) released the Burden of Disease study which shows young people suffer an 11 percent health loss due to mental disorders.

A staggering 1 in every 5 young people will experience a mental health problem in this country and despite what we are being told the situation doesn’t appear to be improving.

Researchers supported by the National Institute of Mental Health (NIMH), the world’s largest mental health research institute, have found that half of all lifetime cases of mental illness begin by age 14 and three quarters have begun by age 24. The study also reveals that an untreated mental disorder can lead to more severe, difficult to treat illness and to the development of co-occurring mental illnesses.

The Smiths say their daughter became manic and more suicidal on medication so they took their concerns to the team of Kari Centre clinicians but they suggested they give her more time on it.

From here on in, Mrs Smith describes being in a state of crisis with her daughter every day for a period of 9 months.

“I felt the Kari Centre weren’t taking Olivia’s situation seriously. We tried ringing them for help when she continued to have violent flip outs but were told to either phone the police or the crisis number.” Mrs Smith said she waited 6 hours for a mental health professional to arrive after phoning the crisis number and soon realized that port of call was of no use.

Why does New Zealand have such a high youth suicide rate and what is the nation doing to reduce it?

Dr. David Codyre, Auckland Psychiatrist and Mental Health Lead at East Tamaki Healthcare, says there are many dimensions to what drives suicide rates.

“Countries that have retained a strong element of religious faith have lower suicide rates, for example the strongly Catholic countries. We have very easy access to alcohol and drugs and yet we know that the earlier the onset of drug and alcohol use, the greater the risk of subsequent addiction and mental health issues and therefore the greater the suicide rate. Adding to this, Maori and Pacific are ethnic groups who are much more on the receiving end of various kinds of socioeconomic and cultural adversity.

“These risk factors are present at a relatively high level in New Zealand, where currently we are in economically difficult times, and on the other hand, I guess the question is to what degree have we been effective in doing the things that we know will help to reduce the suicide rate.”

Dr. Codyre says these things include addressing economic disparity, good mental health promotion and early intervention through people in key gate keeping roles such as school counselors, GP’s and other people who are in position of having contact with young people who are struggling.

“It is vital to get them into effective help and support and getting good treatments in place for people who have an actual mental health condition which puts them at risk of suicide.”

2013 saw the release of the NZ Suicide Action Plan, with $8 million going towards Maori and Pasifika communities, following the Prime Minister’s $62 million youth mental health package in 2012.

Is throwing money at a system that appears to be failing, enough to improve it?

Hugh Norriss, Director of Policy and Development at the Ministry of Health, says the funding in mental health services is currently over represented towards adults and there needs to be more even funding between adults and children.

“DHBs have a very difficult time taking money off existing adult services and then putting it into children’s services so it was necessary to have something like the Prime Minister’s youth mental health initiative as a circuit breaker to start getting the money away from more and more adult services and getting the proportions right so that the services for young people have the same percentage of resources if not more going to them.” 

“Obviously if you look after the mental health of young people you get the benefits of that right through adulthood because if people don’t get good treatment as children then their problems get bigger and then when they become adults you’ve got to spend money looking after the problems in adulthood so it’s a much better investment of the health dollar to spend it early particularly in early intervention.”

Latest figures from the Ministry of Health reveal the government spent 12 percent of the total mental health budget on child and youth mental health services during 2011-2012.

If evidence shows that early intervention in a range of mental health conditions in youth can result in better outcomes, why is there a disproportionate amount of funding between adult and child mental health services?

In desperation, and after feeling like their medication concerns fell on death ears the Smiths went back to their family GP, who became the family go-between with the Kari Centre.

Mrs Smith says, “The Kari Centre were unhappy that we had sought alternative help outside of their system and things went downhill from there.”

Kari Centre clinicians prescribed another medication but the Smiths say their daughter became like a drugged zombie so after raising their concerns again and receiving the same response they decided to stop the medication for a period of time.

Mrs Smith explains, “I felt they weren’t listening and they wanted to continue her on the medication despite it having bad side effects and it not working. They would argue with us that it couldn’t possibly have those side effects as she was on such a low dose.”

Mrs Smith says the Kari Centre clinicians were unhappy they had stopped Olivia’s medication so in fear of lack of support, she and her husband decided to try it again, however, the same results bought even more despair and they became increasingly frustrated with the Kari Centre.

“I felt like my parental rights were being taken away. I did not want my child on that medication.”

The Smiths were eventually given a new team of clinicians, however, their experience was much the same.

“We once again felt ganged up on over the medication issue and we were horrified when one of the clinicians told us; we work as a team of three and if you can’t trust our judgement and expertise then we can’t work with you.”

“We were hoping for help, support, resolution, and answers. But we got heartache, disappointment and betrayal. We were made to feel judged and persecuted and they didn’t work with us to come up with resolutions within the home. We felt as though they were on a witch hunt.”

Mrs Smith says the Kari Centre diagnosed Olivia with emotional dysregulation even after her daughter disclosed to clinicians she had been hearing voices in her head since February 2012.

The Smiths say they received no explanation as to what emotional dysregulation was nor were they given any strategies to move forward.

“It wasn’t until I did my own research that I started to understand what emotional dysregulation is,” explains Mrs Smith. “Olivia received no effective therapy sessions throughout her time at Kari Centre,” she says, and Mrs Smith describes the process to be a one way system. “It was either their way or the highway.”

Mrs Smith says she would like to see Kari Centre clinicians allow parents to have more involvement around treatment and be given consent before coercing with the child around medication.

Mr Smith is clearly still angry after his experience with the Kari Centre and expresses his opinions bluntly. “They need to be shut down because they have no accountability of service.” Mr Smith says they would never use the Kari Centre again, and thinks there needs to be a huge change in every area they operate.

The Smiths say they are now seeking private help for their daughter and feel relieved to be no longer in the Kari Centre.

So how do mental health professionals diagnose and treat mental disorders?

The Diagnostic and Statistical Manual (DSM), published by the American Psychiatric Association (APA), is the handbook used worldwide to diagnose and treat mental disorders.

Some say it is the holy bible in psychiatry, however, its latest version, published in May 2013, has caused widespread controversy amongst health professionals.

The two main criticisms of DSM-5 are; an unhealthy influence of the pharmaceutical industry on the revision process and an increasing tendency to ‘medicalise’ patterns of behavior and mood that are not considered to be particularly extreme.

Prior to its publication on April 29, 2013, the US National Institute of Mental Health withdrew its support of the DSM due to the manual’s perceived lack of validity. Director of NIMH Thomas Insel wrote, “while DSM has been described as a ‘bible’ for the field, it is, at best, a dictionary, creating a set of labels and defining each. The DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure.”

Soon after, though, a press release issued on May 13, 2013, by the NIMH, jointly written by Insel and Jeffrey A. Lieberman, President of APA, said: “Today, the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM), along with the International Classification of Diseases (ICD) represents the best information currently available for clinical diagnosis of mental disorders. Patients, families and insurers can be confident that effective treatments are available and that the DSM is the key resource for delivering the best available care. The National Institute of Mental Health (NIMH) has not changed its position on DSM-5.”

Dr. Codyre describes the DSM as being a useful tool but controversial in the way that it is being applied in some settings.

“Medical labeling can have detrimental effects but on the other hand accurate diagnosis is key to the right intervention and a good outcome.”

Dr. Codyre explains, “A useful element of the DSM is that if it’s used properly between clinicians it allows communication that helps with predicting what the most helpful interventions are going to be. The unhelpful thing about it is when it is used very inflexibly or rigidly because really it is just an imperfect tool that at the moment is the best that we’ve got.”

Dr. Codyre says the DSM’s set of diagnosis includes a whole chapter that is about conditions in childhood and adolescence and while it’s very difficult in childhood to diagnose mental health conditions there are established, quite serious or different diagnoses compared to those in adulthood.  For example attention deficit disorder or the various kinds of learning or developmental conditions are easier to diagnose in young people, as opposed to mood disorders such as bipolar and depression.

“What’s really challenging, particularly in children, is when they seem to be struggling with issues around mood state. There’s a lot of controversy around that and particularly in the U.S where there’s been quite a high level of diagnosis in children of bipolar disorder.”

Dr. Codyre explains, “Compounding that, there can be different understandings about what symptoms mean. For example there is an overlap between symptoms of borderline personality disorder, attention deficit disorder and mild affective disorder (bipolar), so part of the imperfection of the DSM as a diagnostic tool is that because there is that overlap of symptoms, it can be seen as one thing when really it’s the other and that’s where you have problems.”

Dr. Codyre says while there are a significant amount of people who have had good experiences with public mental health services and generally it is because it has worked for them, he is also aware there are significant subsets of people who have had bad experiences.

“When you listen to them it is one of feeling unheard, and of a service system that is not responsive to their wishes and needs, and that is a real issue for mental health services in this country.”

“The other thing that is concerning when you listen to families and consumers is they say that the system seems impervious to their feedback when things are not working for them.”

“Youth mental health services have to take a very individualized approach and get the delicate balance right between effective diagnosis and access to effective intervention but also in helping to support a young person and their family to understand what’s going on in ways that are helpful to them.”

Dr. Codyre says the main difference between a public and private mental health service is the element of choice.

“If you see someone and they don’t work for you, you can choose someone else, whereas in public sectors that choice doesn’t exist, and when you combine the lack of choice with the lack of capacity to listen and be responsive to the given individual and their family I think that’s where the problem lies.”

Dr. Codyre reveals a real-time consumer feedback project, funded by the Health and Disability Commission, is currently underway, which will give families and consumers a voice about their experiences when accessing mental health services.

“It is going to be implemented in four mental health service systems across the country over the next 12 months and the expectation is it will be rolled out over time across all mental health services. My hope is it will fundamentally change things because it will give people a voice around whether their experience of accessing services is working for them or not.”

Dr. Codyre says, “Measuring feedback is important as evidence suggests there is a direct relationship between a person’s experience of mental health services and their outcome so if you experience a service that is hearing you and responding to you then that is going to predict a much better outcome.”

“We’ve got a very defragmented system with all of the bits of a great system working in isolation as opposed to working as a coherent whole. A big part of the focus of the current national mental health policy is about better integrating and really moving from what we do, to actually how we can work together with patients and their families.”

Dr. Codyre says mental health conditions are among the highest health related disability and research carried out internationally into the economic cost of health conditions says it’s a huge burden on society.

“The peak incidence of mental health conditions is in youth and from there on it declines. New Zealand Work and Income data shows 40 percent of people on a long term sickness benefit are there by virtue of a mental health or addiction condition and yet most of those conditions are inherently treatable as long as people access the right help and get it early.”

“There’s really clear evidence for most of the major mental health conditions that the earlier you effectively identify and intervene the better the outcomes. We know that the peak age of both self-harm and suicide is in youth and young adulthood so I guess that’s the sharp end of the iceberg of consequence.”

The Walkers arrived in NZ in January 2013 after living for a period of time in France. Mrs Walker, a NZ citizen, adopted her son Jack from an orphanage in Cambodia when he was just 3 weeks old. Jack, 15, lives with his aunt while the family work towards setting up a home.

Mrs Walker says Jack had been receiving treatment in France for anxiety associated with attachment disorder and was referred to the Kari Centre by his private counsellor when he started recognizing serious psychiatric problems.

The Walkers had three visits in total with the Kari Centre and promptly pulled out after what they felt was a lack of support.

Mrs Walker’s sister described feeling optimistic after her first visit with her nephew. “They told me they could help him but in order to get the medication he was currently on he had to try two others first.”

Mrs Walker says she was hesitant to change her son’s medication because of the bad side effects he had previously experienced and it took 3 weeks for him to adjust to the medication he is currently on.

On the second visit the Walkers were alarmed when Jack was separated from them and taken into a separate room for questioning.

Mrs Walker explains, “After 20 minutes the psychiatrist returned with Jack and they told us they don’t recognize attachment disorder and what he had was most likely post traumatic stress disorder (PTSD) and anger management issues but they don’t treat that here.”

Mrs Walker says the clinicians spoke to her in a condescending way, “They advised me that I needed to be parenting differently and using consequences.” However, Mrs Walker adds, implementing consequences was virtually impossible. “They didn’t believe my son could go ballistic.”

On the third visit Mrs Walker says she was shocked and outraged when she was told they wouldn’t treat her son until all family members were living in the same house. “I tried explaining to them that my son couldn’t live with his sister because of his behavioral issues and his aunt and extended family are his family.”

Mrs Smith says she was then instructed to ring Child Youth and Family to get a file going with them.

“That same week I found out from Jack’s counselor the Kari Centre had contacted him to inform him he should cease working with my son as he was now enrolled with the Kari Centre. They went behind my back and they had no right to do that, especially after they told us they couldn’t help.”

After receiving mixed messages and feeling lied to, the Walkers decided to have no more involvement with the Kari Centre.

“We went to the Kari Centre for help and had a frightening experience. There was no personalization and I felt like we were going through a factory, being a cog in a production line. It wasn’t very human. I would never use Kari Centre again.”

Mrs Walker says Jack’s counselor recommended a good psychologist who prescribed the medication he so desperately needed and since then things have improved.

Arran Culver, Deputy Director of Mental Health at the Ministry of Health says ensuring people most in need receive quality care, especially in mental health, is a top priority.

“We work closely with the Health Quality and Safety Commission to identify and address any adverse events or service concerns and aim to have sound processes in place to catch any problems quickly.”

Culver says there are robust complaint pathways for families to follow if their needs or expectations are not met and encourages people to use these processes, both to ensure their own needs are met and also to highlight any instances of poor quality of service so it can be investigated by the appropriate authority.

Culver suggests firstly addressing concerns with the provider itself and if that is unsatisfactory he encourages people to follow up with their local DHB or other agencies.

According to a 2011 World Health Organization (WHO) report on NZ’s mental health care delivery, prescription regulations authorize GP’s and nurses to prescribe psychotherapeutic medicines (with restrictions), however, official policy does not permit nurses to independently diagnose or treat mental disorders within the primary care system.

Additionally, it says, the majority of GP’s and nurses have not received official in-service training on mental health within the last 5 years, however, officially approved manuals on the management and treatment of mental disorders are available in the majority of primary health care clinics.

Dr. Codyre says GP’s are currently getting a little bit of undergraduate training but are not receiving adequate access to mental health training.

Culver says GP’s receive as much as 10 weeks of mental health training as part of their degree at Auckland and Otago Medical Schools and are required to undertake some training in mental health within clinical settings after graduation.

“The Royal New Zealand College of General Practitioners (RNZCGP) requires all GP’s to undertake continuing professional development as part of its Maintenance of Professional Standards (MOPS) program, which often includes on-going education in aspects of mental health/psychiatry.” Says Culver.

With a shift towards mental health care in primary settings, are these guidelines enough to qualify GP’s to diagnose and treat mental disorders?

Dr. Codyre explains, “Mental health services have historically operated within total isolation so you’re either all in or all out and if you got in then mental health services took over your care and didn’t really communicate back to the GP or involve them in ongoing care so those people disappear from primary care, and if you didn’t get in, primary care was left dealing with it with no support.”

“Over the last 10 years there has been a focus in NZ on developing a primary mental health care program so there has also been a focus on work force development for primary care clinicians. A lot of my role and my teams’ is in the ongoing, up-skilling and supporting of GP’s to lift their game in this area.”

“The reality is, with access to better training and support  we could be assisted to a point where most or all GP’s and practice nurses were at a good level of understanding, knowledge and skills around mental health care.”

Interestingly, the same WHO report says NZ spends over 1.7 million U.S dollars each year on psychotherapeutic medicines per 100,000 population. That’s a large number considering NZ has a population of over 4.4 million.

The Ministry of Health’s Hugh Norriss says, “What we need to do as a country is to monitor carefully what we are using medications for and if they’re getting to the right people and what are the general statistics and patterns about who is getting what drugs. It would be good to have better information about that because we do know that there has been a big rise in the use of anti-depressants in New Zealand.”

Steve Taylor, social services researcher, condemns NZ’s mental health system and describes it as being a dysfunctional culture of collusion.

“It’s a philosophical and ideological position that mental health services take. They think that community mental health care is the best care of all and it has a one size fits all approach.”

Taylor says the biggest challenge for families is getting their child or young person into the bracket of acute presentation before mental health services will see them and once they are in the system their philosophy around intervention is brief and there is no continuity of care.

“There is a grand charade going on in community based mental health services where simply showing up is seen to be sufficient in terms of service provision.”

“There are clinicians who deliberately misinterpret or misrepresent what is occurring for the patient, for example, emotional dysregulation for adolescence is actually borderline personality traits. Taylor explains, “If they give a broad diagnosis, like emotional dysregulation, they can keep it within the realm of behavioral and if it’s behavioral they don’t have to get involved. They can then blame the parents and often the parents are blamed quite cruelly.

“The director of a mental health board or service will often sing the party line ‘we stand by [x]’ regardless of what the clinicians do, which is astounding in its ignorance and arrogance.

“Agencies defend to death their models and how they do things. When all the evidence is saying to them it’s not working.

“Until we get some transparency in terms of naming and shaming clinicians and for them to be meaningfully accountable or have to go through a meaningful consequence, people aren’t protected by their district health boards, professional associations, supervisors or the ministry of health, and we are condemning more people to die within mental health services.”

Taylor thinks a big problem within mental health services is they are not measuring patient outcomes. “Funding is based on the assumption of service provision and throughput, not on success of outcomes.”

“There has been enormous resistance to measurement of performance within the industry and that is where the actually knowledge exists of how these services are doing. Social services are the only industry that I can think of that actively resist what could improve their services.”

The challenge in measuring health outcomes, Taylor says, is if the patient doesn’t give truthful feedback in fear of what their key worker they are giving feedback on might say or do.

“When a health professional takes a particular ideological position, for example, pro medication or anti medication, and places their idea above treating their patient holistically, it is a potentially dangerous situation as each person is different and their therapeutic needs will vary and may not necessarily match the clinician’s ideas.”

Taylor says there are a number of people who work within mental health services who are incompetent. “Some clinicians think ‘this is my biased position now I get to adopt my neurosis and apply it to a clinical team’ and in the absence of supervision or transparency, some people in mental health treat it like a cult.”

Taylor says there is a lot of suppression of information going on and if the information was released, mental health services will have to deal with shame, humiliation, embarrassment and the acknowledgement of gross incompetence.

“Even if a health clinician belongs to a professional association, it makes no difference to achieving positive client outcomes,” says Taylor.

“Humility needs to come into play. If we don’t know what to do then we are supposed to say so. Clinicians are responsible for helping the patient and their family find a solution and they should do that with them not over them. It’s about having power for, as opposed to power over.”

Taylor explains, “If the dominating paradigm within community mental health services is the issue is in family, then everything is built upon that platform. I’ve seen some families driven to absolute devastation because they’ve been blamed for stuff that’s not their fault by professionals’ who don’t actually have an answer.”

Taylor says it takes professional humility and a fair degree of emotional resilience to admit when they don’t quite know what to do.

“Unfortunately in mental health services there’s some very unwell people in very senior roles doing very unsafe things.  These people are dangerous to vulnerable clients and families and the tragedy is they don’t know it and even if they did it makes them potentially sociopathic.”

Taylor says a disparity between public and private mental health care exists because there is a lack of accountability. “If a state funded mental health care provider does something wrong they may lose their contract after 3 or 4 years.” However, Taylor explains, private health care providers lose a lot more than a contract.

Taylor encourages people to get bold and tell their stories. “It’s one way to bring about change within mental health services.” And he says the court of public opinion is the safest medium for people to talk. “Families need to summon the strength and not feel intimidated and get informed.” He says it’s important that people learn the language so they can recognize if their being lied to.

“Revolutions often start with one person, we need some radical change and we need some radicals to push it.”

“Often the word reform is used but the time for reform is long gone we are dealing with a fractured broken matrix which is not only unsustainable but unfixable in its current form. We need to clean house and we need to rebuild the service placing the clients’ voice at the centre of the phoenix like resurrection. Forget reform, if I was in the position I’d shut the whole thing down and rebuild from the ground up with a consumer advocacy committee. So therapists would have a minority voice because the evidence to date shows that what they are doing doesn’t work and the only thing that’s missing is the client’s voice. Place the client’s voice at the centre of the service and 7 years of outcome research shows that things will get better.”

Hugh Norriss, a Ministry of Health policy director, says change needs to happen on a community level. “In order to address mental health issues, we need to look at and address social issues.”

Norriss explains, “The Mental Health Foundation’s role is to promote the idea, which is based on evidence, that we shouldn’t rely on doctors or mental health professionals at the end of the line, to be totally responsible for our own mental health. If we just rely on ambulances at the bottom of the cliff to pick something up, that’s not going to work and it’s not fair to expect clinicians to take the burden of all of the things that we’re doing wrong. We need to stop just thinking about people getting treatment we need to think about what we can do to have a more psychologically healthy society.”

Norriss says, “There are things we need to do collectively as a community, and as individuals if we want to maintain good mental health. So much of mental health is affected by what happens to people early on before they get to mental health services so it can go back to quality of their attachments in the first few years, what the parenting was like, if they were taught how to manage emotions when in crisis and building up resilience. A lot of these things effects peoples’ mental health and when things go wrong for people often it’s quite complicated because you’ve got all of these past events and processes and the services have to try and untangle it.”

Norriss points out, mental health is harder to measure than physical health but thinks it would be a good approach to take patient feedback surveys “It means you’re treating the people who are using the services with respect and that you want to listen to what they have to say.”

Norriss acknowledges NZ’s youth suicide rate as being one of the highest, however, he says the measurement of suicide statistics is questionable as NZ measures more accurately compared to other countries.

“It’s absolutely tragic that New Zealand has such a high youth suicide rate because we are such a great country where people can grow up.”

However, Norriss doesn’t think youth suicide statistics indicates poor performance within our mental health system but says services could be a part of it.

“We have to ask; what is it about our society overall and what sorts of messages are our young people getting and why, when they get into emotional strife, do they think the answer is suicide rather than choosing life.

“We want to acknowledge that adolescence is a hard time and how do we, as a whole community, give the message that life is the choice and suicide is not a solution at all which is often what young people think.”

Norriss says, most people who commit suicide have been struggling with their mental health but if you turn it around most people who have a mental illness don’t commit suicide.

Norriss is critical of the western model of health “It’s not really a health system it’s more of an illness management system, you don’t find your good health by going to mental health services, you find it with what you do in your life, through your relationships, with how you manage your emotions, your ability to have resilience and so forth. Those are the healthy strategies that young people need so when they do have a crisis in their life they’ve got some emotional strength and resilience to draw on.”

“Early intervention is important but we also advocate for the stage before early intervention, as in, what can we do to keep people mentally healthy.”

Norriss suggests investing money into the community through mental health promotion programmes, targeting key areas such as emotional literacy, positive role models, anti-bullying, family violence and zero tolerance towards people with different sexual identities, would be a good start. “Some of the new youth initiatives touch on some of these but we need more.”

“There needs to be more of a preventative approach to mental health care and it shouldn’t be seen at just the services level.”

Statistics show mentally unwell young people are tragically taking their own lives and NZ’s high youth suicide rate is a problem. We have a seemingly robust national suicide plan and a significantly large amount of money is being spent on mental health however gaps in the mental health system remain and youth suicide numbers are not significantly decreasing.

The shift towards mental health in primary care signifies the urgent need to address the lack of mental health training available to GP’s and nurses, considering it’s legal for them to be administering medication and treating mental disorders.

Figures show a large amount of money is being spent each year in NZ on psychotherapeutic medications and anti-depressants are on the rise, however, there are no signs that the mental health of young people is improving.

Families are speaking out about their horrific experiences within public mental health services and are asking for change.

The hope is, a patient feed-back system will be implemented across the country to give a voice to families who feel unheard, but will it be enough to generate change and is the diagnostic tool used in clinical practice fundamentally flawed, considering it is linked to generating profits for the pharmaceutical industry.

Insights from key industry professionals reveal an agreement towards change within our mental health system however the road to change varies somewhat in opinion.

As author Criss Jami said, “Seemingly minor yet persistent things penetrate the mind over time making it difficult to ever realize the impact; hence, though quite unfortunate, the most dangerous forms of corruption are those that are subtle and below the radar.”

“Let us not look back in anger, nor forward in fear, but around us in awareness.” James Thurber.

     The Auckland District Health Board were invited to comment but declined.

     The names of the families have been changed to protect their identity.

Helpline Numbers: Youthline 0800 376 633, Lifeline 0800 543 354, Depression helpline 0800 111 757, What’s Up 0800 942 8787 (noon-midnight)

Quick Facts Side-box:

1.    There are numerous government funded child and adolescent mental health services throughout NZ, each run by its own district health board (DHB).

2.    Accessing these services is usually done by referral from a GP or school counselor.

3.    The free service is made up of a range of clinicians including psychiatrists, psychologists, occupational therapists, social workers and cultural advisors who diagnose and treat vulnerable young people with mental disorders.

4.    Arran Culver, Deputy Director of Mental Health at the Ministry of Health, says the government is introducing wait time targets for child and adolescent mental health services, where 80 per cent of young people will be seen within 3 weeks and 95 percent within 8 weeks of their referral.

Case Study Side-box:

     Kelsey Mason (not her real name), 15, was referred to Whirinaki, (South Auckland community child and adolescent mental health service) in late 2011.

     Her first visit at Whirinaki was 8 months after the referral.

     Mason describes feeling uncomfortable with one of her clinicians, however she was not given the option of a different one.

     Whirinaki discharged Mason in February 2013 after receiving family work and one on one counseling.

     Mason describes feeling like they had given up on her, which added to her emotional distress.

     Mason’s mother recognised her daughter’s distress and tried to get her referred back.

     In August 2013, Mason was admitted into hospital after attempting suicide.

     A hospital psychologist diagnosed her with depression.

     Mason’s GP prescribed her with an anti-depressant.

     Mason, now on medication, awaits further sessions with Whirinaki with the hope they will help her.

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