A narrow bed
And they left him alone
Not totally of course
Poem provided by family member of service user
People wanted support in the community, so they are enabled to stay connected and receive help for a variety of needs – crisis support and acute care, addiction recovery, long-term support, respite care, drop-in centres, social support, whānau wrap-around services and employment support.
Examples of ‘step-down’ and other community-based services such as drop-in centres were highly praised. We heard that for people using inpatient facilities, the lack of such services made discharge planning fraught and, when combined with a risk-averse approach, the result was scarce inpatient beds being occupied by people who were ready and willing to return home, but could not leave because the required package of services could not be assured.
Very few submissions called for a return to institutions of old. A handful cited positive experiences or the ‘safety’ of being cared for in such an institution. Some people advocated for ‘places of sanctuary or asylum’, which could offer respite or long-term accommodation to people who needed a stable home and some sense of community. Many people, particularly family members such as parents growing older and looking after adult children, called for an increase in supported living.
We were told that some current accommodation options in the community leave people isolated.
Many people expressed frustration at the lack of a holistic response from mental health services. They wanted a choice of therapies, including more counselling, rongoā Māori, talk therapies and online therapies, Pacific healing, spiritual healing and mind–body practices such as mindfulness, “rather than a reliance on pharmacology” (provider). People also wanted services that address broader health and social problems such as chronic pain, physical conditions, addictions, age-related disabilities, trauma, violence, relationship issues and nutrition.
People told us that mental distress or psychiatric illness can compromise a person’s ability to continue full-time work, leaving them socially isolated and lacking a sense of purpose. Meaningful work was described as essential for healing, and long-term dependence on sickness benefits was seen as impeding recovery. Work of any kind – paid or voluntary – was said to give a sense of purpose, a reason to get out of bed in the morning.
We were told that mental health services rarely extend to assisting people to maintain work or return to work. We heard about employers and colleagues who facilitated a return to work, but also of the need for workplace education about mental health.
We heard calls to shift resources from DHBs to NGO providers, which are closer to the community and better equipped to provide the services and supports that people need. People saw DHB-provided services as institutional and bureaucratic, driven by rules that reflect the priorities of the organisation such as fixed budgets, deficits and competing health services rather than the priorities of individuals and families in need. Many feared that mental health services have a permanent Cinderella status among other DHB services and that addiction services are Cinderella’s poor cousin.
People saw NGOs as embedded in communities – more responsive and innovative, more likely to use peer-support workers and volunteers, more oriented towards achieving outcomes instead of ‘ticking boxes’. They voiced a perception that DHBs, with their dual funder–provider roles, will often favour their own DHB-provided services rather than those delivered by NGOs.