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We heard from mental health and addiction workers who love their jobs and are committed to helping people recover, even to the point of jeopardising their own health and wellbeing. They talked about overwork and burnout and the increasing risk of assaults.

We are under-staffed, burning out, told to just get on with it and suck it up. No breaks are allowed on an afternoon shift as they pay us for this time. Abuse towards staff is on the rise … We are always over 100% capacity. We are asked to do double shifts every day, we feel under-valued and paid. (Staff voice)

There have been many times when my stress levels are so high I have been unable to think clearly and make decisions. I feel my clients have not had the optimum care from me as I fumble through the paperwork and the liaising between other health professionals who are often themselves pushed for time. I run out of time to see my young people which is the whole reason I do this job. (Staff voice)

We also heard of the need to attract more people to work in mental health and addiction services – and to retain current staff.

All the dreams of the Inquiry will come to naught if we don’t have a workforce. (Staff voice)

Workers described a lack of career planning, limited training and limited professional development. We heard about a short-term focus on immediate staffing needs, the lack of a clear ‘pipeline’ of new skilled staff and inadequate facilities.

Mental health always feels like bottom of the hierarchy – we don’t get amazing facilities like Elective Surgery – or state of the art teaching facilities, we get shoved into little offices with little resources – not enough cars, not enough space, not enough treatment rooms, poor technology and systems. Eventually this depletion, transcends down, our practitioners feel it – our clients feel it. (Staff voice)

We were told that a markedly different workforce is needed, with more peer-support workers, community-based workers, and Māori and Pacific support services.

2.11.1 More peer-support workers

Numerous submissions praised services led by people with lived experience of mental distress, psychiatric illness or addiction. We heard that peer-support workers give people a sense of hope that inspires and sustains the healing process and provides a counterbalance to the medical focus of clinical services.

However, peer-support workers described being undervalued, poorly paid and provided with limited training and career options. We heard that, despite some good examples, mainstream services have not fully embraced the concept of incorporating peer-support workers into all aspects of service provision, including design and planning. People wanted peer support to be acknowledged as a basic component of services and to receive better funding.

People who have gone through this journey understand the feelings, pitfalls, distorted thinking and challenges that addiction brings. (NGO provider)

My [family member] attends a support group run by people with mental health for people with mental health and this for him is one of the most important therapies that he attends. (Family member)

2.11.2 Cultural competence and cultural workforce

People were concerned at the lack of cultural competence among workers. They said mainstream health services (especially hospital services) can be alienating and culturally unsafe environments for Māori, Pacific peoples, ethnic minorities, Rainbow communities and the Deaf community. We heard calls for more staff who work entirely within a Kaupapa Māori or Pacific framework.

Professionals should also be aware that when they meet with a client, even one they might not immediately recognise as Māori, the person standing before them may be struggling with their cultural identity; asking about identity and making space for it as an area that clients might want to develop could help with building relationships and their recovery. The potential healing that can happen as a result of being acknowledged as Māori could be an important factor in recovery, as well as in building a relationship with mental health services. (Researcher)

Having a staff member from one’s own culture was described as crucial to feeling safe and building the trust needed to recover from distress and anxiety. Māori and Pacific staff spoke of regularly working double shifts so Māori and Pacific tāngata whaiora had someone from their culture available to provide help and assurance. The Deaf community submitted strongly about Deaf culture and the need for services to meet their needs.

We also believe it is essential to give Deaf people training and learning opportunities to be involved in this sector; to work alongside current professionals, in order to not only up-skill but also to ensure that the necessary Deaf cultural accommodations are being provided. The power of having trained Deaf people providing access to another Deaf person cannot be underestimated. (Group New Zealand Sign Language submission)

2.11.3 Understanding of mental health and addiction in other sectors

Some submissions noted that other workers in other sectors need to become competent in recognising and responding to mental distress and addiction in their workplace. Examples cited included teachers, prison staff, police and social workers. We heard that these staff and managers also need practical understanding of issues such as trauma and depression.

Several submitters, including some GPs, said that medical and general practice training in mental health is limited to a theoretical understanding of conventional diagnoses and psychopharmacology. They called for improvements in mainstream primary health care and medical education.

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