Everybody seems to be talking about mental health…and yet, when it comes to the personal, no one wants to talk about mental health. It’s our loudest taboo.
For that reason all the people profiled here are anonymous, but each represents a group profoundly affected by gaps in our mental health system: young mums, teenagers, young men struggling to settle into employment or education, and – in an entirely contrary way – white, educated, middle-class women, who can get ‘help’…but it’ll cost them.
Pete works with men entering training and employment through a programme that takes into account their holistic wellbeing needs, not just their acquisition of skills. Many of them have struggled with mental health, which has played out in various forms: violence, homelessness, disengagement, addiction.
“It all goes back to making a connection with wairua, something bigger than us, this power that can take care of you if you wish to plug into it,” Pete explains. The panacea that’s needed is creating authentic connections to community and culture.
“These young fellas have connection to gang culture but they don’t really know about kaupapa marae. We all need to make real connection, back to whenua, back to being kaitiaki, back to being in our community. To be well we need to keep connections alive.”
Pete isn’t just talking theory, he’s got experience.
“I’d been inside, I’d been through rehab, I was facing charges, I didn’t want to be fighting over my shoes and blankets again,” he explains. “I’d got away with shit but it caught up with me, I was pimping myself out to have somewhere to sleep. I was a manipulative little pirate.”
It took a car accident to wake him up enough to seek help. Now he’s 17 years clean, a mentor and teacher. But hitting rock bottom isn’t a once-only, silver-bullet catalyst for getting help. “You get thrown about by the surf at the bottom for a while before something hits you and you look for help,” he says.
That ‘help’ is a knotty problem in itself, with most ‘solutions’ themselves having those same addictive qualities for many people. Pete’s view is ‘talk is good’ but warns: “With counselling, you are paying for a special, best friend, and it’s just like another drug.”
And there’s more work to do past that initial decision to take up therapy or a prescription.
“Admitting you’re an addict can give you an excuse to still be a prick, but you’re living in denial, ticking a box with medication and counselling. They are just tools, to take yourself more seriously, to make connections.
Getting the tools is almost impossible until you’ve completely bottomed out…hurt someone, hurt yourself. Then being strong enough to take on board what’s on offer is challenging when you’ve already lost so much. The last thing to go is often a sense of self, of pride, mana.
Pete believes that for men there’s an additional stressor around traditional roles as primary breadwinner. There’s a feeling that you should be providing, for yourself but more importantly for your family, he says.
“You feel shame. And guilt creeps in. You don’t want to be judged by peers and generally men don’t want to know … Men portray a sense of confidence. And when you don’t know what to do anymore desperation kicks in…you’ll do whatever it takes. For me I became manic.”
Pete’s own journey has been empowered by the gifting on of experience and knowledge to the young men he works with. The real power for change is the action that happens in his classroom beyond learning the skills of a trade. “It’s men making connections with men that are healthy and positive. There’s a lot of angry, desperate men who don’t realise there are other ways of operating. But gentleness is not weakness, it’s powerful. You can choose to be gentle.”
From the outside, she’s got it all. A nice house full of art, a getaway by the lake. A network of friends. Close family. But keeping it together and turning up to work every day takes everything she’s got … mentally, physically and financially.
“I spend more than what I make being well,” Angela explains.
Therapy once a week is $150, weekly massage, gym membership (she goes 4 times a week when she’s well, 8 times when she’s manic). There are props and crutches like retail therapy, and self-medication like drinks out with friends … or drinks at home without them.
“Not coping looks like withdrawing or it looks like over-socialising. I either pull back completely and hide under a rock or I tear around like a crazy butterfly and squish a manic amount into every day.”
Learning to live with mental illness has got Angela to her late 30s. But recently putting her emotions in a box caught up with her, she spun out of control, had a “meltdown” and it forced her to seek professional help. Now she’s on a hard road through therapy, unpicking years of trauma and its aftereffects.
“Sometimes I can ride a high and get some shit done. Two or three days is useful, three or four is not nice: I get brittle, tired and wired.” ‘Tired and wired’ she can still turn up to work but she can’t make real connections to people. She feels like a husk, it’s stopped her forming robust relationships. That in itself works against her when she’s at her most raw.
“What exacerbates it is not having a person who notices if you’re absent,” says Angela. It was only when she brought a therapist on board that she made real headway. Although even that wasn’t easy. If you can pay for a therapist finding one is still not easy, with a national shortage and waiting lists. Then finding the right therapist for this very sensitive and intimate work can come down to luck rather than availability.
“Sometimes it feels like there’s just not enough stability to go around, that’s clinical care and my cohort.”
The first step is opening up (or breaking down) at the doctor.
“But it’s difficult to go to your GP and fess up,” says Angela, especially when the feeling of privilege pervades … that ‘don’t sweat the small stuff’ mentality.
“On paper everything looks good. I am articulate, educated, I can advocate for myself in the health system, but this can happen to anyone,” she explains. Concern over the implications of seeking medical help for mental illness can leave the already vulnerable feeling desperate. The stigma that’s still firmly attached to mental health can be the very thing that stops people getting well.
“You get a red mark against your whole future. If you have a meltdown you could get carted away by police and end up in the unit for six weeks. You can’t unwrite that,” Angela explains once that happens you go from a person who needs some help to a “patient in crisis”. “You lose agency over your own journey and there are not a lot of winners coming out of that situation.”
Part of the change that needs to happen is a shift in perception. Talking about mental health openly and candidly, normalises it.
“It has taken me a while to accept that I’m not just being overly ‘woke’. We are learning to take this stuff more seriously.”
Having opportunities to seek help is many miles from what’s available to the majority of the population. Just having the time and money to see a GP in the first place is out of reach for many. Healthy ways to combat mental illness need time, resource, energy, support, professional help, including careful use of medication … Accessing all that is a privilege for most.
“The privilege is getting well,” says Angela. ‘Getting well’ by taking shortcuts, she explains, can look like hurting others, drinking, over-exercising, over-eating, being “just a little bit stoned” all day … “They’re all coping mechanisms.” And, they are more affordable and more available than the counselling Angela has every Thursday.
School counsellor at a large secondary school in Hawke’s Bay, Lou sees students in crisis every day. A large portion are Māori or Pasifika. Although the school is better resourced than many to provide mental health help there are still gaps, with time and money being the main constraints, but also a lack of awareness in many homes as to the scale, severity and repercussions of mental illness in adolescents.
“They make themselves visible through erratic behaviour, showing signs of self-harm, openly cutting themselves – that’s a huge one – disengagement, behaviour that’s out of character.”
These are all signals to Lou, her colleagues, teachers. They should also come as warning signs for parents.
At the school Lou works in she’s helped develop a “culture of ‘it’s ok’”… but once a teen asks for help the journey through getting them what they need can be an almost insurmountable challenge. Lou works with every student who needs her, initially to listen and make a safe space for them to share openly, then funnel them into appointments with GPs, then potentially therapists, working with parents to investigate the best use of any medications.
Lou’s team is overwhelmed by the volume of students needing their help, the sharp increase in high needs students, and the lack of support from the DHB and PHO in Hawke’s Bay.
“CAFS (the HBDHB’s Child, Adolescent and Family Services) is a broken system. We just feel the top 2% are being seen by them, and they’re the most at risk of hurting themselves or others … suicide attempts who end up in the emergency department,” Lou explains. There’s an iceberg of students hiding under the surface who need help but can’t access it.
The first issue often appears during that first step: seeing a GP. “That’s a barrier in itself,” says Lou. “Parents are working so they can’t take them or they don’t have the money, or they don’t want their parents to know.”
Public health nurses and school counsellors who have established relationships are not able to refer on to therapy. Only GPs can do that. “For me, this is our daily bread, we know our students, but it’s only when we really make a noise can we send them on to get help. I feel patronised.”
Many students – and this often depends on their home culture – are not comfortable or able to speak with their parents about mental health.
“There’s a stigma (around mental illness) and it might have taken a lot to share with me, let alone with their parents,” Lou says. She explains that in many homes – especially the homes of her Pasifika students – mental illness is a taboo subject, as is speaking to people outside the family about personal things. And there is a rise in Pasifika students openly cutting themselves.
An added stressor in what Lou sees in her students is the rise of children born with addictions.
“We suspect this is the first generation of meth-affected babies. The issues now are greater than last year’s intake,” says Lou. She explains the complex multiple issues in the background of many of her students: poverty, family violence, gangs, homelessness or being housed in emergency and transitional housing.
“They don’t know who they are. Their boundaries are lose. There are so many layers to work through before they even come to school.” Add to that learning challenges and study loads, and stress levels are “through the roof”.
“It’s very hard to get a counsellor, many at the DHB have set up privately, CAFS has lost many and we’re all scrambling,” says Lou. There’s a two-month waiting list just to secure an initial consult. “(HB’s youth health centre) Directions is swamped, the PHO is swamped, everyone is swamped.”
Nat had her first baby at 23. And now with Number Three on the way her life centres around her small children and her circle of friends, most of whom are young mums themselves.
Nat’s partner works away from Hawke’s Bay; she’s well supported, but left to carry most of the domestic duties and childcare on her own.
She’d experienced depression as a teenager. She never considered it would come back during what society often brands “the happiest time of your life”.
“I feel that all new mothers experience some sort of post-partum depression or anxiety whether it be in pregnancy or after birth,” Nat explains. “I think as a younger mother, it was more not knowing where to reach out for help to explain the feelings I was having as I thought I was supposed to just be so happy all the time.”
Nat is well versed in connecting with her community and in return is a ‘rock’ and a ‘shoulder to cry on’ for her friends. Her openness means friends feel comfortable to share their mental health journeys with her, while she wrestles with her own. In past generations mental illness was kept well hidden, now it’s often the subject of conversation. That doesn’t mean finding help is any easier.
“‘Not coping’ doesn’t always look the same,” Nat says. For some it might mean they stop caring for themselves, don’t find time to shower, wear the same clothes every day. For others it’s the opposite.
“We spend so much time trying to hide the fact we’re miserable, so we dress up, our house is cleaner than ever, we plaster on a smile and say, ‘Yes baby sleeps amazing’, ‘They feed like a dream’ when the reality is after you leave we struggle to pick up the pieces to keep going.”
For some in her circle self-medication is the easiest, most accessible and affordable remedy.
“Recently two friends had shocking advice in their post-care after the birth of their new baby. One turned to drinking heavily, which in turn made her mental health worse. The other struggled with breast feeding so was told by a professional to ‘give it up because clearly you’re not wanting to do the best for your child’ … once she stopped (breast) feeding she started drinking during the day to keep her calm enough to settle her baby”.
What’s needed, in Nat’s view, is wrap-around care that lasts in some form from before baby arrives to well after.
“I’d love there to be streamlined assistance from the minute your baby is born,” she says. “I’d love it to be an open topic where you know before your child arrives that there are protocols in place so you know you aren’t alone and there will be a way through.”
From those struggling on no sleep to those who have reached “the edge”, Nat sees a blanket, holistic and proactive service for all new mothers as the best way to combat the overwhelming cases of mental illness in her demographic. Free and accessible counselling is a must.
“I truly believe the mental health system for post-partum care is shocking and needs a massive overhaul,” says Nat. “After my second, I did get two free sessions and was recommended some anti-anxiety medication, which did help, but I needed to understand why I needed it in the first instance.”
“All I wanted was to understand why I was feeling this way and how to work towards overcoming it, and not to instantly have a quick fix of medication.”
Nat sees mental health issues in all the young mums she knows, in varying forms, and believes getting Mum well benefits baby, family unit and wider whānau.
“From the very worst cases of depression and anxiety to the people who are just having a rough start with no sleep, there needs to be a place where we can go that offers a varied level of help and assistance.”