The lack of services for Christchurch shooting survivors and adults with ADHD highlight gaps in New Zealand's mental health plan, writes Dr Dougal Sutherland.
The two-year anniversary of the Christchurch terrorist attacks reminds us of the pain and trauma many innocent people suffered at this time. This suffering was both physical and mental, yet many of those who suffer mental injuries are unable to access help and support.
Treatment of physical injuries (and mental distress linked to those injuries) is funded by ACC. Not so for mental injuries, meaning many who witnessed the horrific events at the Christchurch mosques are left to deal with this trauma on their own.
Minister of Health Andrew Little told media the Government isn’t considering changing ACC legislation to include coverage for mental injury, saying to do so would mean changing the law for everyone for all time. This begs the question as to why that would be a bad thing. If the Government is serious about implementing the structural changes in our mental health system recommended in He Ara Oranga (the 2018 report of the Government Inquiry into Mental Health and Addiction), surely changing things for all people for all time is exactly what should happen.
The lack of government action on implementing He Ara Oranga can also be seen in the paucity of services for adults with Attention Deficit/Hyperactivity Disorder (ADHD). If referral rates to private psychologists are any indication of demand, there appears to be a whole generation of people struggling with undiagnosed ADHD.
This is possibly due to an historical misunderstanding of the condition, which was originally thought to disappear as children reached adulthood. We now know that, although some people with ADHD do experience a reduction in symptoms as the grow older, the majority continue to experience difficulties throughout their adult life.
Many adults who missed out on an assessment during childhood are now realising they may benefit from help and support, only to find this isn’t available. Many of these people fall into the group dubbed the “missing middle” in He Ara Oranga. This “missing middle” are those with mild–moderate mental health needs who don’t qualify for publicly-funded mental health services as these only allow access to people with the most severe and complex mental health problems. Many district health board mental health services turn away adults requesting an assessment and/or assistance for ADHD, leaving individuals either to bear the costs of seeking help from the private sector or left to languish.
In order to meet the needs of those who miss out, a substantial increase in the size of the mental health workforce is needed. Little has commented that the Ministry of Health is part-way through a four-year plan to address this shortage. There have been some new initiatives (e.g., the introduction of Health Improvement Practitioners or HIPs to GP practices), but this has largely just seen a reshuffling of proverbial deckchairs, with most HIP roles being filled by psychologists, nurses, and other professionals already working in mental health.
If the Government is serious about growing the mental health workforce, further investment is urgently required. As someone involved in training clinical psychologists, I have seen no evidence of a substantial growth in investment in the workforce, nor any evidence of a long-term plan about how to do this. The Government needs to act fast if it is to fulfil the hopes and promises contained in He Ara Oranga and help alleviate the mental suffering of hundreds of thousands of New Zealanders.
Dr Dougal Sutherland is a clinical psychologist in the School of Psychology at Te Herenga Waka—Victoria University of Wellington.