Psychiatry in Aotearoa New Zealand

Over the last century, Aotearoa New Zealand has undergone an evolution in the care experienced by consumers of specialist psychiatric services.

Psychiatry in Aotearoa New Zealand
Image created by Paget Michael Creelman, 2018.

One of the most fundamental changes to care was the gradual shift in treatment starting in the mid-20th century, from institutions to community-care. As a result, during the 1990s, several new services across the regions were instigated.

To oversee sector growth, the Mental Health Commission was introduced to monitor service design and standards, and the Office of the Health and Disability Commissioner, to maintain standards of practice.

In the 2000s, community-based care increased even further, with psycho-pharmaceuticals the most common method of treatment. Treating disorders outside the rigidity of institutions, led to a focus on improving access to specialist services and the introduction, in 2005, of the National Mental Health Strategy.

Under this umbrella of reform came more funding, an emphasis on early intervention, and recovery-led care, as well as addressing issues of discrimination. The goal was empowerment, but stigma surrounding mental health has, however, cast a long shadow over efforts to dispel disparities. Systemic and equality issues remain ever-present, with Māori and Pacific Island communities especially over-represented as consumers of mental health services and more likely to require in-patient care.

Despite all the attempts at improving access to quality care, COVID-19 created a fresh wave of people seeking specialist services. The unique pressures created by the pandemic, led to increased levels of depression and anxiety for current, and new, sufferers, in particular young people. At the same time, the demand for services to treat schizophrenic conditions also increased, due to a rapid rise in methamphetamine, and potent cannabis use.

Due to these unique pressures and societal changes, a significant increase in numbers of those needing acute care and seeking referrals followed. The result was a system buckling under the pressure, including GPs, emergency departments, and schools, as well as an historical increase of unmet needs of those requiring in-patient care.

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The impact on well-being after Covid, may be seen for years to come. The sheer numbers of those seeking specialist care, compounded by the cost-of-living crisis, has led to even greater levels of unmet clinical care, and what some practitioners are calling, ‘a crisis upon a crisis.’

These problems have persisted, despite the $1.9 billion spent by the government in 2019 to improve services and tackle the ever-increasing demand. To investigate the mental health crisis, the government requested a new initiative, the Te Hiringa Mahara Mental Health and Wellbeing Commission, which led to a series of reports.

The reports’ findings are alarming, including poor outcomes for those seeking acute care, especially young people and Māori. Even more funding has been called for, particularly for Māori mental health and addiction services.

So, what of the future?

Psychiatric disorders have a devastating impact on the lives thousands of people in Aotearoa New Zealand every year. With so many people affected, it’s heartening to know that promising new technologies and treatment tools are on the horizon, including:

•  Pharmacogenomics (genes therapy)

•  Exploration via psychedelics

•  Transcranial magnetic stimulation.

Despite the challenges and inequalities, these new technologies, combined with the findings made in the various recent reports, indicate the country is focussed on well-being and determined to turn the mental health crisis around.

A huge part of this, is a renewed focus on Māori mental health, and the addressing of the long-standing effects of colonisation, including alienation from ancestral land, the suffering of in-direct and direct racism, and the loss of cultural identity. These issues, driven by environmental and socioeconomic factors have led to generational deprivation and suffering, transpiring in dire health outcomes, particularly mental health.

With new technologies and the goodwill of the hundreds of dedicated practitioners, country-wide, and a renewed focus on righting historical inequities, there is hope that in time everyone in Aotearoa New Zealand will receive the respect, care, and quality treatment they deserve.

Acknowledgements to Emeritus Professor Graham Mellsop for his support with this article.