What is ‘mental illness’?

As a broad classification, it is incredibly common, with 1 in 4 people accessing mental health services at some time in their lives … as much a problem in Hawke’s Bay as it is anywhere else in
New Zealand.

There’s a spectrum of support too. Some people can make great strides after only a few sessions with a counsellor; others will require care, housing and very hands-on assistance for the rest of their lives.

Hawke’s Bay has a number of agencies working at both ends of the spectrum to help patients attain some form of recovery. As much as the illness looks different for everyone, so too does the healing.
The ‘too hard’ basket

The Hawke’s Bay District Health Board runs an in-patient unit, and is in the early stages of planning another; there are recovery centres, places for respite care and day programmes.

There are also residential units being built locally by the Whatever It Takes Trust (WIT). The overarching idea is that the community will embrace patients, but the community does struggle.

WIT began 12 years ago and works with people who experience severe mental illness. It employs 45, including peer support workers and project managers. 80% of staff have accessed mental health services.

“We grew out of our personal experiences of mental illness,” says general manager Doug Banks, who has traversed his own journey with mental health.

“Part of my own reality check was finding a whole bunch of people way worse off than me. It’s hard to continue feeling sorry for yourself working alongside people, many of whom have been abandoned by the mental health system.”

Doug and his team work with some of the very worst-off mental health patients in Hawke’s Bay. Most are living with bipolar disorder or schizophrenia, where people find it much harder to communicate with the world and have a natural fear of new situations. This is often set alongside a drug and alcohol dependency – what’s known as ‘dual-diagnosis’.

WIT helps hundreds of people a year, with some getting better and some needing assistance for life. “If you lack the power to have your voice heard and you have a mental illness then you’re going to do very poorly. We used to call them ‘the too-hard-basket’. Those are the people we help.”

Doug recounts the story of one of his clients who was found living under the umbrella of the low-slung branches of a Marine Parade Norfolk pine. “It had become his home and he had nowhere else to go. But the neighbours complained, and how was the problem fixed? The council came and cut down the branches.”

Doug struggles with labels, especially when they seem to move in and out of fashion. It’s a constant battle for funding and support, with more socially acceptable illnesses often taking the limelight.

“There’s a syndrome and diagnosis for everything and it becomes hard for agencies and funders to prioritise. We’re competing with the dark days: everyone is running off to the doctor when their child feels isolated, or they’re not coping. We’re left asking – ‘Is the human condition one giant mental illness?’ – while there are definitely people who require our help.”

The person is not the problem

Mandy Pentecost is just as invested in the mental wellbeing of the region, but in many ways she is working at the opposite end of the continuum. As well as being the Counselling Stream Coordinator in the Bachelor of Applied Social Sciences at EIT, Mandy works part-time at the Napier Family Centre. There she helps people experiencing mild to moderate anxiety and depression, and demanding family dynamics, especially in terms of relationships with teenagers.

“Mental health can be a rewarding area, and most people who want to be counsellors or social workers do so out of a need to help people. For me I like being around people who are making changes in the way they do their life.”

Although stress is a common part of life, it’s how individuals cope and their specific brain chemistry that determine whether or not they’ll require professional help.

Doug Banks

“Life can be tough and there are lots of pressures. Some people don’t get the good start that helps them when things go awry.”

Mandy is careful to point out that although a person may be suffering with a mental illness there is much more to the individual than any diagnosis, or label.

“You may have depression but you are not depression, you bring with you other supports, strengths, and a willingness that are also part of you and are all just as important.”

Doug Banks also comes from a school of thought that says, “The person is not the problem; the problem is the problem.”

He aims to not just provide therapy, but also the necessities of life, including a place to live, a job, a social network.

“We are completely non-medical and non-clinical … we can communicate better when we aren’t hamstrung by a clinical diagnosis.

“A lot of things people need are not medical: they are lonely, they become disconnected with the world – 90% of our people don’t have partners, houses, jobs, family, cars – it’s a pretty bleak picture. A lot of families don’t understand, and a lot of people burn bridges and family deserts them.”

Gaps in the safety net

Simon Shaw, Clinical Director of Mental Health at the Hawke’s Bay District Health Board, believes mental health should be treated no different than physical health. As a clinician, diagnosis is important and part of a formulation that asks, “Why is this person presenting with these indications at this time?” If there is no diagnosis, and therefore no definition, then mental health fails to be a scientific practice, which for DHB practitioners it is.

Simon has seen much change in mental health services, even over the past seven years in his role as Clinical Director. He is now working on the early stages of a new In-patient Unit that will bring with it new ways of working with patients and with partner agencies.

“Mental health now has a central place and recognition. Where as it has been traditionally a Cinderella service, now we are right in the middle of the meetings that matter. That has benefits for our clinicians and for consumers.”

In the DHB system, multi-disciplinary teams work with patients experiencing medium to acute mental illness. The team is made up of psychiatrists, psychologists, social workers, nurses and occupational therapists. Together they see about 5,000 people a year.

Anxiety and depression are quite common; bipolar and schizophrenia are not so common – but all can slip through gaps in the safety net.

To Mandy Pentecost: “The biggest hole we have in the net is costs and limited funding. Even for people who used to be able to pay, it’s gone down their list. I’m an idealist so I believe if anyone needs help they should be able to get it.”

EIT does run a free clinic where its senior students work. It’s well used and patient numbers are on the increase.

The work undertaken by Doug Banks and the Whatever It Takes Trust is also requiring more and more resources. WIT has one seven-unit residential centre, recently completed another with ten units, and is currently building a third centre with 14 units.

Whether it’s those in the ‘too-hard-basket’ or those finding the stresses of everyday life too much to handle, for one person in four, mental health care is a vital service. In its broadest sense it’s about people feeling connected, wanted, cared for, loved.

Doug Banks observes: “In our culture we’ll use words like aroha and wairua but we find it hard to talk about love and spirit. Services struggle to go there with any of those words. But these are the things we all yearn for, people just want to feel part of something.”

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