Articles
Caring for a shaken city - Canterbury’s mental health sector continues to flourish and falter under the weight of many crises
In 2021, 85,881 people accessed the mental health and addictions sector in Waitaha Canterbury.
As the reverberations from multiple earthquakes, the mosque shootings, a global pandemic, and the cost-of-living crisis continue to be felt, the city’s collective mental health continues to suffer.
The 2021/22 New Zealand Health Survey reported that 23 per cent of Cantabrians were diagnosed with a mood or anxiety disorder and in the four weeks prior to being asked, 11.2 per cent of Kiwis experienced high or very high levels of psychological distress.
Of the 85,881 people needing support from services, 20,086 received that support from non-government organisations (NGO), 1,031 adults required hospital admission and 53 people sadly lost their lives to suicide. These statistics are a snapshot of the number of people and their families that require support and care every year.
In offices and buildings across Waitaha, countless people are working tirelessly to support those struggling with their mental health.
Julie Sparks, General Manager at Step Ahead, spends her days running a programme that supports up to 100 people a day in the community.
Step Ahead is a not-for-profit organisation that helps those with mental illness by offering a range of classes, workshops, and groups in a community setting.
The range of programs on offer includes gardening, arts and crafts, hiking, and swimming.
Started 40 years ago by a parent concerned at the lack of options for community care, Step Ahead continues to offer support and connection to those who need it most.
Sharon first became a member of Step Ahead three years ago, after being referred to the service by her doctor.
After battling with her mental health throughout her adult life, she was struggling to manage her anxiety and found it difficult to leave the house.
Since joining Step Ahead, Sharon has taken part in a wide range of activities, from archery and jet boating to arts and crafts and aqua jogging. She is now secretary of the Step Ahead board.
Sharon said having somewhere to go where she was accepted and not judged made a significant difference to her life.
“I have made real friends here. We all understand each other.”
“And we get so many opportunities to do things we wouldn’t otherwise. It’s about getting out and about.”
“The focus used to be much more on medications. But this is about offering something else.”
In recent years there has been a large push for more support for programs like Step Ahead, which support people in the community and focus on living well. But a large need remains for more clinical care, which is often provided by Specialist Mental Health Services [SMHS].
The core purpose of Waitaha Canterbury Specialist Mental Health Services is to provide care to people with serious and acute mental disorders.
In a typical year, SMHS provide 210,000 consultations and care for roughly 12,000 people. This increases year on year.
Services are provided at Hillmorton Hospital, Princess Margaret Hospital, Christchurch community sites and Ashburton Hospital and cover adult services; adult inpatient services; forensic mental health services; intellectual disability services; child, adolescent, and family services; and speciality and alcohol and drug services.
Vicki Dent, Acting General Manager, says in recent years there has been a shift of focus and funding to support those in the community with mild to moderate needs.
“That means that we are dealing with the top end—people who are acutely unwell, often with chronic and complex needs.”
“We are a tiny part of the system—and that’s how it should be. We hope that we are a very small part of someone’s story, and that they can then go on to get the support they need in the community.”
SMHS have more than 5,000 people under their care at any given time. They employ more than 1,300 staff.
“There are a lot of pressures in this space—increasing demand and complexity of cases, staffing, wait times … ” Ms Dent says.
“It’s about making sure people get the right support in the right place at the right time. We want to make sure that a person with significant needs is seen right away.”
While SMHS care for those with acute illness, most Cantabrians access mental health support through their primary care providers or general practitioners [GPs].
Someone struggling with their mental health might be referred by their GP to a community mental health service, brief intervention talking therapy or, in recent years, to Te Tumu Waiora.
The new program has integrated health improvement practitioners [HIPs] and health coaches into general practices across Canterbury.
GPs and practice nurses introduce people to the HIP or health coach, who provides free sessions to give people tools to manage whatever is causing their distress, and if needed, links people with services or organisations that may also be able to help.
At the centre of any provision of care is the tāngata whaiora, or person seeking care.
For over 30 years Eve (who's name has been changed) says she has lived with a "rollercoaster of moods and big feels" that often lead to suicidal and self-destructive thinking and at times over-whelming anxiety.
Eve, has been hospitalised a number of times, had case management, used respite care, counselling, hypnotherapy, medication and found the ‘winning ways to wellbeing’ really helpful in her recovery.
Last year, after a particularly stressful work issue, Eve became very mentally unwell, usually she would contact Crisis Resolution but her GP offered her a HIP worker. Eve reports this really helped.
"I was able to talk to her on the same day as I went to my GP. We made a plan for the next 24 hours with my partner and she gave me a contact number if I needed to talk to someone. Then, I met with her a few times over the next few weeks - each time we identified things that had worked for me in the past - things I'd forgotten about like hypnotherapy and new strategies like cold therapy. Having a HIP worker gave me enough support in those really early days of a big blip in my mental health to take a breath and re-group - she helped me put in place some changes to make my life less stressful. It still took many months to recover but unlike other times I didn't need specialist services."
Māori continue to experience significant inequities in the mental health and addiction system.
Māori adults are about 1.5 times as likely as non-Māori to report a high or very high probability of having an anxiety or depressive disorder.
He Ara Oranga, the 2018 landmark report of the government inquiry into mental health and addiction, recommended that more funding was allocated to Kaupapa Māori services within a Māori cultural context and a whānau-centred framework.
He Waka Tapu is one Kaupapa Māori provider doing the mahi to support those struggling in the community.
Last year, the service cared for 6,458 tāngata whaiora, with the support of 140 kaimahi and 32 programs and services. It receives more than 100 referrals each week.
Tanith Petersen, Operations Manager, says that Kaupapa Māori services fill a gap for people who have been hurt by the system, and offer a more holistic model of care.
The western framework of care often overlooks important aspects of Māori culture and wellbeing, including whanaungatanga, or relationship and connection, and manaakitanga, or hospitality and care.
“There is often a focus on the clinical side of things. We try to take everything into account—the person’s social health, whānau, physical health … those things are often just as important,” Ms Petersen says.
“We provide what other services do but we also provide extra, wrap-around, more holistic care.”
Prolonged levels of stress and anxiety across the motu continue to have an impact on the people of Canterbury.
Many tāngata whaiora have reported a lack of service and information, issues navigating a complex system and overburdened staff who desperately want to do their best.
They also report stories of discrimination, racism, and stigma.
The demand for mental health care is unrelenting, and Te Whatu Ora, Te Aka Whai Ora, non-government organisations, general practitioners, concerned whānau and tāngata whaiora struggle as they work towards an improved system where all Cantabrians live well.
- 20 October 2023