Recommendations for Change: Personal Reflections.
The following recommendations for change come from a person with Lived Experience in Te Waipounamu. These are part of a larger report of personal experiences this person has prepared to raise awareness of the effects of current mental health systems and services, and to inspire positive change.
Changing Minds is sharing these recommendations with permission, and we hope it encourages the Lived Experience community to share your own ideas to improve mental health and wellbeing in Aotearoa
Throughout these recommendations you will see the author describe themselves as ‘high functioning’, describing an experience where on the surface this person meets the prejudiced expectations of others such as being fully employed and actively engaged with their hobbies, but underneath is facing mental health challenges. Because of the disconnect between external appearances and internal reality, this person was inspired to write this report to counter the difficulties they experience when accessing support.
This phrase may or may not resonate with you. We know our community understands our experiences and how we chose to share these are unique.
It is essential that clinicians within an in-patient and out-patient setting are interested in their patients’ life, history and wishes for the future, and are not just prescribing medication. This also applies to nurses within the in-patient setting. It is critical that nurses are not just medication monitors. It would be a positive outcome if there are no fishbowls for nurses to hide in when designing facilities.
Accessible and flexible services – High functioning individuals may have demanding schedules or responsibilities, such as work or school, which make it difficult to access mental health services during traditional business hours. An ideal system would offer flexible scheduling, such as evening or weekend appointments, and telehealth options to increase accessibility.
Customised treatment options – high functioning individuals may have specific mental health concerns or preferences for treatment approaches. An ideal system would offer a range of evidence-based treatment options that can be customised to individual needs and preferences.
Support for stress management – High functioning individuals may experience elevated levels of stress due to their responsibilities or pressure to succeed. An ideal system would provide resources and support to help individuals manage stress, such as stress management workshops, mindfulness practices, or coaching.
Career and education support – High functioning individuals may be highly invested in their careers or education, and mental health challenges can impact their ability to perform or achieve their goals. An ideal system would offer resources and support to help individuals balance their mental health needs with their career or education goals, such as coaching or career counselling.
Prevention and early intervention – An ideal system would prioritize prevention and early intervention efforts to identify mental health concerns early on and provide support before they become more severe. This could include regular mental health check-ins, mental health screenings, or workshops.
Peer support – High functioning individuals may benefit from connecting with others who share similar experiences or challenges. An ideal system would provide opportunities for peer support, such as support groups or online forums.
More options and support should be available to support transitioning between inpatient services and the community. This might help relieve pressure on inpatient beds while also offering intensive support outside of the inpatient setting, for example for those who are on a new medication regime. It will depend on the person, but increased options could include temporary accommodation and respite care, supported by the peer workforce and with a discharge plan developed between the person, their GP, support team and their care team rather than the care team working in isolation.
An ideal mental health service would relocate far more mental health professionals to primary care. It would recognise GP’s and their teams as key mental health professionals, with others there to offer support to this role. It would encourage GP’s and psychologists to see patients together, offer each other supervision, or regularly learn from each other’s experiences.
GP’s see many patients who elude formal diagnosis and may in fact have major psychological needs. There may not be DSM-IV labels for people struggling with complex social and family problems, existential crises, long term loss of confidence, permanent lack of direction or intractable self-absorption, however, they place great demands on primary care, and their levels of subjective distress may be no less than those who harm themselves or have hallucinations. An ideal mental health service would recognise the scale of difficulties experienced by people without a severe and enduring diagnosis and would make adequate provision for them.
GP’s now inhabit a world where it is routine for patients to know more about their conditions and treatment than anyone else. GP’s and medical specialists are learning how to follow-up leads that patients have offered them in order to advance their own knowledge and assist them with their decisions. There is no reason why most patients suffering from mental health problems should be regarded as less competent than any other patients to make an informed choice of treatment, or nontreatment. An ideal mental health service would work from this premise and would take heed of patients who tell mental health experts clearly, for example, that they prefer talking treatments for depression to pharmacological ones.
An ideal mental health service would ensure individuals are met with a compassionate, non-judgmental, therapeutic, and trauma-informed response that is timely and stable. This provides individuals with an opportunity to be treated as an equal within the therapeutic relationship. Buy-in within the relationship encourages individuals to feel they have ownership of their own care.
Programmes that are designed, implemented, and overseen by those with numerous lived experiences and can incorporate representation from differing intersections. There is no token representation, but real inclusion and respect.
It is important that funding from Central Government for mental health treatment is delivered to the right places and the correct procedures are in place to ensure greater transparency in tracking expenditure.
An ideal mental health service will fund at least one Health Improvement Practitioners (HIPs) to work in every General Practice around New Zealand on a full-time basis. This funding should also enable Medical Centres to be modified/extended to provide a suitable office or space for HIPs to meet with patients. Alternatively, General Practices are funded to employ psychologists/ counsellors to treat people with mental health or addiction issues within a primary care setting.
An ideal health service will fund extended GP consultation appointments for those patients that are on waiting lists to access intervention through the public health system.
An ideal mental health service will enable individuals to be met with a health response that is tailored to individual needs and preferences whilst being supported by a peer workforce and social support system, especially when transitioning within and between services and supports.
An ideal mental health service would ensure individuals are provided intensive support that enables access to good physical and mental health outcomes and care that are joined up between integrated services – urgent referrals can be made between physical and mental health care, and between primary care and mental health care.
An ideal mental health service would ensure Psychiatrists, Mental Health Nurses and Social Workers working within the Community Mental Health sector work alongside private and ACC clinicians, Psychologists, Counsellors and Social Workers in an integrated manner for the benefit of the individual rather than work in silo systems.
An ideal mental health service would fund Psychologists/Counsellors to work full time within the in-patient setting to offer individual and group therapy to those during times of suffering, rather than leaving individuals to sit isolated within their room’s day and night without a support structure.
An ideal mental health service would provide suitable activities within the in-patient setting throughout the day to mentally stimulate recovery. Providing individual and group activities will prevent individuals from withdrawing and isolating themselves, which could exacerbate their illness.
An ideal mental health service will provide a recovery oriented and trauma-informed service that are co-designed by people with lived experience in the mental health setting.
An ideal mental health service will have adequate, well-supported and stable mental health workforce with safe and supportive working conditions.
An ideal mental health service must ensure a therapeutic relationship is built over time (no time limit) so that they are based on trust, value, respect, understanding and compassion.
An ideal mental health in-patient service would provide separate wards/areas for females and males as well as for differing mental health illnesses rather than use geographic location as a point of difference. The wards/areas would need to be resourced accordingly.
There is regular communication between clinicians, GP’s, the individual and relevant support teams. This means all relevant notes are circulated to the entire team rather than just to a GP. This will ensure accuracy of notes/reports and accountability.