Social Bonds for Mental Health are SCARY. Here’s what you can do

By   /   June 10, 2015  /   13 Comments

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one thing we ALL can do is add our signatures and our voice to the Action Station petition on this issue presently in circulation. At the time of writing, it’s on just under 7,000 signatures – and will be presented when it’s hit the target of 10,000.

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From where I’m sitting, as somebody recently discharged from hospital and presently going through a WINZ-moderated pathway towards re-employment and getting myself back on my feet … the Government’s recent announcement that mentally ill New Zealanders are about to be subjected to an experiment in policy called “Social Bonds” is hella, hella scary.

Forget energy company privatization- that’s a right-wing evil of a cold, impersonal and ultimately predictable nature.

Social bonds, by contrast, are new. Untested. Frightening.

Because while we can reasonably predict some of the pernicious and detrimental effects that will flow from this policy – as the commodification of human beings, and profiteering from human misery can only go so many ways – there are still many details which are yet to be hammered out in the cold light of day.

One factoid which ought to raise hackles for both mentally ill and resoundingly sane voters-cum-taxpayers alike, is the fact that the social bond scheme might actually wind up costing *more* to deliver than current mental health services. Again, for a highly uncertain return in terms of rehabilitation and reintegration as applies some of our most vulnerable citizens.

Bill English can’t even tell us whether the private sector investors stumping up cash on the condition you get better, will be paid out a fiscal return of 5% or anywhere up to SEVENTEEN percent.

With so many unknowns attached to the policy, it’s not surprising people are skeptical about why we’re doing it in the first place.

And when you think about the possible motivations, it’s hard to come up with anything other than a severely disappointing impression that Government has decided that in many cases, helping the mentally ill … just simply isn’t its problem any more.

Instead, the private sector is being left to pick up the slack from out of the “too hard” basket; in the vain hopes that this somehow generates an improved set of outcomes as compared to the status quo.

Because let’s be honest.

What we’re doing right now, as a society, is *also* not coming up with the goods.

I don’t think it’s an exaggeration in the slightest to insist that New Zealand is presently facing a Mental Health Crisis.

Whether we’re talking about the ongoing (and unaddressed) psychological impacts of seismic events down in Canterbury; the way Government has consciously chosen to underfund services dealing with the aftermath of sexual violence like RapeCrisis; or even simply the everyday run-of-the-mill experience of the average mentally ill person working their way through the public health system … in many cases, it’s simply not working.

Therefore, one thing many commentators are united upon when they talk about the Social Bonds program, is the point that something needs to change.

And it’s my challenge to ALL our Opposition parties – heck, even the Government and its lapdog support partners – to actually stump up with the goods and DEMONSTRATE that they’ve been thinking, consulting, and conceptualizing what we might do differently. In ways that will actually work FOR our mentally unwell whaunau – rather than as business opportunities available for the government’s rich mates.

One idea which we might like to explore … and I know this might sound radical and revolutionary … is actually putting money into frontline services that deal with these issues.

Because seriously. If Bill English, as Finance Minister, is quite comfortable saying “we don’t mind it being more expensive if we get results” about his precious social bonds policy – I feel quite entitled to ask why EXACTLY THE SAME LOGIC has not been applied to more conventional approaches to sorting and supporting the mental health concerns of our citizenry.

Anyway.

Now as for what you can do:

You might not be a psychotherapist, counselor, or cutting-edge PhD researcher at some tertiary institute somewhere. You might not even be in a position to directly support someone with mental health woes (or, perhaps, offer them a job).

But one thing we ALL can do is add our signatures and our voice to the Action Station petition on this issue presently in circulation. At the time of writing, it’s on just under 7,000 signatures – and will be presented when it’s hit the target of 10,000.

Beyond that, one thing I’ll definitely be doing – and something which I am URGING anyone else politically engaged who’s got a perspective to contribute on the present workings of our mental health system – is writing to MPs and other decision-makers.

Because most of them don’t have direct engagement nor experience with these parts of either the public health system or Work and Income. I can’t speak for all of them – but I can say with certainty that it’s highly unlikely that many of those at the highest level of our politics have a strong grasp of what it’s actually like to be either seriously mentally ill, or to have to support somebody on a path to wellness from some of the darkest places a mind can bare.

MPs are only as good as their information-flows and understanding. They’ve often got a capacious depth of goodwill, understanding and capacity for empathy – and that is commendable.

But if we’re serious about doing mental health better in this country … then that means helping our legislators to make the right choices.

And whether by signing your name to a petition; submitting to a Select Committee hearing; or calling up your Party’s Social Development spokesperson to have a yarn (Hi Darroch) …

If we want better policy, it’s time we spoke up and helped inform them what it looks like.

Over to you.

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13 Comments

  1. As someone who struggles to maintain mental health, and who has supported family members through serious mental health crises, I find this “social bond” concept truly scary, for all the reasons Curwen mentions and more. Like Curwen, I honestly cannot see how carving off chunks off the public health budget to give to private investors can possibly improve any health care outcome. Surely, using that money to fund the wages and salaries of doctors, nurses, psychologists, counsellors and other healers would be more effective, yet this government have been slashing the budgets of not-for-profit mental health support organisations like a horror movie serial killer; Problem Gambling, Relationships Aotearoa etc.

    This financialization of health care is just another sign that the 1% are desperate to find more couch cushions under which they can stash their undeserved and unneeded piles of wealth, and watch them grow at public expense. Charles Eisenstein’s describes this dynamic convincingly in his book “Sacred Economics”.

  2. J S Bark J S Bark says:

    “Because seriously. If Bill English, as Finance Minister, is quite comfortable saying “we don’t mind it being more expensive if we get results” about his precious social bonds policy – I feel quite entitled to ask why EXACTLY THE SAME LOGIC has not been applied to more conventional approaches to sorting and supporting the mental health concerns of our citizenry.”

    To me Curwen, this is the crunch question which none of our noble fourth estate have seen fit to ask. They have all watched the cuts to mental health in particular and health in general. There have been plenty of examples in the severe consequences of inadequate mental health support (violence etc). And yet not one of them has looked into the long chain of cause and effect in these cases prefering to use cop out expressions such as “falling between the floorboards”.

    It is a strange day indeed when a Minister of Finance becomes the expert on health and mental health issues.

    What are your qualifications for making this decision William?

    Oh yeah that’s right; Neo-Libertarian 1st Class (wiv honnas)…

    Give me a break dude! I’ve seen enough of my friends up against the inefficiency of the Mental Health Services to know that the problems come from insufficient funding.

    If you can fund your creepy Mengelerian approach going over cost you can certainly fund the expertise we have there right now. If you did that you might find the ‘problems’ not as heavy as you think they are now, because they certainly will be if you bring in this load of hogwash.

    • Andrea says:

      Once upon a time: “At the beginning of 1996, English became a member of the Cabinet and gained responsibility for Crown Health Enterprises, publicly owned healthcare providers created by the National Party’s reforms of the public health service…”

      Serene in his dogma and untroubled by rational thought.

  3. wild katipo says:

    Yes…..surely among other things – and not just pertaining to the mental health area but other social services as well ,….that there is something quite unethical about all of this slashing of funding.

    Correct me if I’m wrong but there are country’s that if you have a heart attack for instance…the ambulance wont come and the medical fraternity wont assist if you do not have medical insurance – or ready cash.

    I do know several states in the USA are like this…whereby poor people suffering chronic health problems are left unattended to – fill in the blank – suffer needlessly in the land of the free?

    The country that is the main exporter of arms and military actions?…it would seem it is the opposite – but the same – as a third world country ….but for different reasons.

    The other question is: WHY ….do we have a supposed shortage of skilled health workers here?

    We never used to have a shortage prior to the neo liberal ‘reforms ‘ that started under Roger Douglas and the ensuing neo liberal govts that came after …

    Do any of you remember the name ‘ Harold Titter ‘ ?…. he was the business man brought over in the age of the ‘consultants ‘ ( remember all the paying of these mysterious ‘consultants govt’s had ‘?)… and he was , in fact ,…nothing more than the neo liberal hatchet man that was paid to shred and dismantle our public health system.

    Basically he was brought in to lay the foundation to privatize our state health system across the board. The medical fraternity at that time – the doctors, nurses and orderly’s etc …had major protests in our main centers during the 1990’s…those protests went on for months.

    Is it that these neo liberals seek to maintain a bare skeleton of a ‘public’ health system that is the catch-net for the unwashed poor….?….to be gradually left to degrade through lack of maintenance and funding?

    That very funding of which would still be paid for by the taxpayer yet simply be a token gesture at maintaining the external appearance of ‘ community care ‘ for purely political motives ?

    My sister worked as a charge nurse … from gaining her diploma in nursing as a teenager to her middle years,….nursing was all she ever did. And as such – nurses worked in all facets of the hospital by the time they became seniors…A+ E , Oncology , Theatre ….all areas. Highly skilled people.

    Then , she left that for her own reasons and became head of the Salvation Army’s Bethany.

    Bethany , was a social service that provided care for single mothers with newborn baby’s who had come from lower socio – economic and often violent family backgrounds.

    It was shut down 2-3 years ago – because this govt ( Key again ) slashed funding.

    So after over 100 years of service to the community for all those young mothers – this govt denied funding and further denied that those young mothers and their new born children mattered.

    My sister was on TV regarding the issue , in her uniform – on TV3 , no less – with some other officials blathering on…I do believe , that the SA being the SA…has ..despite this mean govt , found other ways…but in an increasingly hostile economic environment created by this neo liberal govt in denying funding has to work that much harder on limited resources.

    Where do those young mothers go now.

    To another organisation that has had its funding cut?

    And it begs the question….that in this privatization of our health and public services…who benefits financially ?…those who invest and are shareholders …those who have political links?

    And just what checks and balances are there in force as of now to prevent overstating the turnover of ‘ clients’ for tax purposes?

    The standards and conditions of say , a prison , an oncology or mental health practice – when this govt cannot even admit that there needs to be a standard -a warrant of fitness – requirement for basic housing …

    A standard that even the coroner said was lacking and contributed to the death of a toddler recently – and which has been a factor in not just one but thousands of respiratory and other chronic illness cases .

    So just why are our our taxes deemed insufficient to provide a first class social services system when viewed in light of the so – called and much touted ‘rockstar economy ‘ ?

    Was it because we are now borrowing $300 , 000 , 000 each week because Key – under the guise of funding for ‘welfare’ /social costs’ – actually borrows that to follow through with a promise of tax cuts to those on higher income brackets?

    And yet not delivering on social services while seeing an angle for private concerns to make a buck out of the public of NZ ?

    I think you will find after considering these things ….that this is the true motive of the neo liberal silent backers behind this govts motives.

    Not for any patronage , concern or regard for the social well being of the population of this country.

    But simply from a motive of greed.

  4. High Tory says:

    My own view is that the proposed social bonds to provide incentive for a few supposedly mentally ill people to transfer to some sort of work is the minimum response of a socially guilty Bill English who knows the current system is a disaster, a poor degraded compromise from the mental health reforms. The only people who benefit much from the present system are the highly paid psych nurses, social workers and the psychiatrists who are usually timid souls themselves who are psychiatrists because they unsuited to the stress and strain of dealing with ordinary patients as GPs.
    In the 1980s and 1990s there was a disinstitutionalisation in NZ, although in truth most patients who were at all promising had been released by the 1970s and in the 80’s most hospital stays were 4-6 weeks. Every generation of drugs could have had revolutionary effects but they have always been used in far too high doses. My own view would dose should be limited to 2mg of risps or 10mg of Olanzapine and the patient should have the right to determine their own dose and agent and write their own perscription as they system is a kafka like nightmare to actually work through and most patients dislike visiting nurses and psychiatrists because each change of drugs presents them with a new personality and set of problems.
    However I thing the new drugs were a great thing and exploded people into a new life a new job a new university or career if only they had been given a chance to work. One of things that has to change is the belief that psychiatrists know much, they understand little about the drugs or the supposed illness’s they are probably the only people who have never tried the standard agents. The psychiatrists assert, the prognosis is no good, people don’t recover,, they cant work they are degenerating. To me a psychiatric consultation is outright abuse of the patient. You are constantly told by nurses you are failure, the system imposes downward mobility and often forces people into degrading jobs far below their capability. This is the greatest social crime.

    • Andrea says:

      I’m not sure why you’ve been down-thumbed.

      The points you raise are about effects that are still far too lively in our society, and impact on far too many people.

      The usual ‘we know best’ attitude.

      And you spoke about actual work placements. How dare you be practical?! Those People should be grateful for their stress-attached benefits and persistent hounding. Forbid it that Those People should want to be like normal people. (intense sarcasm)

      If this is your personal experience, or that of someone you honour – my respect and sympathy.

      • High Tory was down-thumbed by me because of his ridiculous and insulting claims about the motivations of mental health workers. He/she has clearly never spent any time in a mental health ward. I have, regularly visiting a number of family members and friends during their stays in wards in Tamaki Makaurau, Te Whanganui-a-Tara, and Ōtautahi. I also have friends who work in mental health. As a student of psychology I have many general criticisms of modern mental health practice – especially the over-dependence on drug-based treatment and the lack of consideration of environmental and nutritional factors – but I have nothing but respect for the people who go into those incredibly difficult work environments day after day.

        With all due respect to GPs and the work they do, it just doesn’t compare. GPs work usually involves spending ten minutes talking to people in normal states of mind, and writing a prescription. GPs start on $100,000 – $150,000. Yes, hospital psychiatrists/ psychologists start on more than that, but so do all hospital specialists. Only psych doctors regularly deal with people in profoundly unbalanced states of mind, who may be anything from catatonic to aggressive. Mental health work is as dangerous and upsetting as police work, but while police get a minimum annual salary of at least $52,000 to deal with this, registered psychiatric nurses start on $47,000. If mental health workers were in it for the money, there are much easier and more lucrative doctor and nursing jobs around (“appearance medicine” for example).

        Yes, the way de-institutionalization was carried out in Aotearoa was driven by neo-liberalism, and as a result much of the community-based care that was designed to replace permanent hospitalization was either never delivered, or has been de-funded. But the focus on helping people become well enough to leave hospital, and keep them well enough to avoid coming back, remains the core of the mental health practice I’ve observed. The mentally ill are not being farmed for funding, as HighTory suggests.

        Finally Andrea, nobody is objecting to people who’ve had mental health challenges being able to get jobs. Again, helping people get well enough to cope, and then thrive, in paid work is a normal part of the current mental health system. What we’re objecting to is someone making a profit from pressuring people into a job – any job – regardless of whether or not they are ready to return to work, or whether the job, employer, workmates etc are supportive of their continuing mental health. As usual with neoliberal “solutions”, expensive ambulances are parked at the bottom of cliffs instead of much cheaper fences being built at the top, and the “solution” ends up costing much more, and delivering much less to the public, while bleeding off funds for private profit.

  5. Mike in Auckland says:

    The Ministry of Social Development (MSD) has for over a year now been contracting so-called “mental health employment services” from a number of private providers. Yet they have to this date failed to provide any transparent, real and reliable figures on how many participating “clients” have actually been placed into “suitable” jobs. They have failed to provide this upon an OIA request that was already made in October last year, and that was only responded to in late February this year, as a source has revealed:

    https://nzsocialjusticeblog2013.files.wordpress.com/2015/04/msd-oia-rqst-mhes-waa-other-support-services-issues-reply-anon-26-02-2015.pdf

    https://nzsocialjusticeblog2013.files.wordpress.com/2015/04/msd-o-i-a-reply-d-power-mhes-waa-information-complete-24-04-2014.pdf

    So if these services are supposedly so successful, then why do they not provide us figures on how many were placed into what kinds of jobs, how long they lasted, and how many are still in some form of stable employment?

    I have NO faith in social bonds offered to investors in such services, but I smell a rat. Perhaps the existing trials are not delivering what they are expected to, and perhaps providers are not able to deliver, because the admittedly generous fees are not earned in enough cases, and thus not sufficient to meet the costs.

    Maybe the idea with the social bonds for funding services for mental health sufferers is to enable the government to change the operation of such schemes, so they can leave yet more risks with the providers and their paying investors, to achieve more “throughput” and “results”, so they can say, it is bringing better results now? And if they bring no results, the “investor” will simply not get paid, certainly not the offered “interest” or “dividend”.

    It seems the government is actually quite desperate in trying this approach, because if the present trials work, then there would be no need to change the whole approach.

    Despite of much talk about “new” government investment in mental health services, they are still largely underfunded, and it is rather due to the dependence of the many public and private providers that there are, on government contracts and funding, that few dare speak out the truth about what the state of the services looks like.

    I have learned from flatmates and friends, how hard it is to get proper, affordable treatment, as community mental health services only cater for the most extreme clientele, and largely only hand out medication, sometimes by “trying” one or the other, not being sure whether it will do the job.

    Other services I know of had funding capped or cut, and had to introduce fees, had to restructure and cut some services, or find sponsors in the form of businesses prepared to donate.

    So while we have that scenario, we should ask, what additional treatments are offered, to enable mentally ill to work, and where are they? How can WINZ staff rely on clients being “fit for work”, or do they simply rely on their little army of “designated doctors”?

    I would strongly suggest that all readers here sign up with Action Station, and I think Labour have also got a petition going!

    Stuff to consider is found here:

    http://accforum.org/forums/index.php?/topic/17163-mental-health-employment-service-sole-parent-employment-service-oia-info-implies-msd-trials-a-failure/

    Also a must read, an article by Dita De Boni in the Herald a week ago:
    http://m.nzherald.co.nz/opinion/news/article.cfm?c_id=466&objectid=11459339

    • wild katipo says:

      Just read the article by Dita De Boni.

      Says it all.

      Exactly the motives of this neo liberal govt.

      Totally disgusting . Immoral. And deceitful.

    • I said above that “the mentally ill are not being farmed”. In hindsight I might have qualified that by tacking on “by mental health workers”. I’m not so confident about the motives of pharmaceutical companies on the other hand. I think it’s scandalous that drug companies can patent not just their invented *method* for making a drug, but the actual *chemical* itself, so nobody can invent another method for making that drug for 20 years (from when the patent was filed) without paying royalties:
      http://www.news-medical.net/health/Drug-Patents-and-Generics.aspx

      A number of commentators have claimed that if you study the timing of psych drugs being replaced by “next generation” drugs to treat the same illness, there is a disturbing correlation with the timing of the patents on the older drugs expiring. I haven’t researched this myself, so take it with a grain of salt, but here’s a list of some drug patents whose expiry is imminent, and a quick web search should turn up whether the companies who own any of these patents are already marketing a newer (patented) drug to treat the same condition:
      http://www.drugs.com/article/patent-expirations.html

      From my own experience, I know that there is a tendency for drugs to be re-purposed to treat different illnesses, which I suspect is also driven by a desire to maximize returns on patents. The ritalin I was prescribed as a teenager for ADD was a synthetic amphetamine originally marketed as a diet pill, and I can attest to its appetite suppressing effect. Ritalin certainly made me feel more confident and energetic at school, but so would drinking five double-shot espressos or smoking a point of P before school. I wouldn’t recommend either of these to schoolchildren, and I wouldn’t recommend Ritalin to anyone under 18 for exactly the same reason. Besides, I no longer believe in ADD, a child who is smart, curious, enthusiastic, creative, and boundary-testing is not diseased, and needs appropriate stimulation, not medication.

  6. High Tory says:

    Its largely a waste of time, arguing with people like Daniel. I actually have seen plenty of time in mental health public hospital units and think the system functions passably in inpatient units but the sector and community units which police and medicate people in the community are largely a disaster, assume the patient is a write off and are massively unfair to patients. The point Mary O”Hagen made that while the patients have left hospital the old system still prevails and the patients are treated like failures, never believed against the police and their story is just one of increasing doses and progression from serotonin based drugs to mood stabalisers. Without doubt a minority of patients are hopeless and probably suffer from wrongly wired brains etc. I reject the genetic causation theories of psychiatrists and the DSM diagnosis guidelines are based neither on scientific truth or even elementary statistics and are rather just a loose clerical checklist.
    Many of the drugs still in use, like Olanzapine and Lithium are fairly ghastly in their effects and constitute a violation in human rights. Even in a small dose Olanzapine is massively fattening, often reduces sex life because real sex is largely impossible on it and is very tiring leading to a restricted life unsuited to 9-5 work or hard study or vigorous nightlife. Apparently National is planning to include the mentally ill in a disability rights bill, I regard this as an insult as in my view mental illness is a matter of degrees of resilience and most mental illness is simply the body and minds natural response to a difficult, unhappy, stressful or uncomfortable situation. The mentally ill need human rights and any disability is usually due to the medication
    I do not withdraw my criticism of the social worker and psych nurse professions, as their industry depends on people not recovering and most people with supposed mental illness just want to be left alone and allowed to drink coffee in cafes, drink alone in bars and explore the city 24/7. Many of us always wanted to escape from our families and live individualistic lives, and really feel that a view of mental health professionals, is wrong. Its actually the individual patient who should be listened to rather than the familiy or psych staff. Even for people on the benefit in the past, if they had an extra say $150 of family money in the 1990s, 2000s quite a bohemian life was possible on a $300 benefit for a single person and the assumption that that being on a benefit was an indication of mental illness and incapacity could be wrong.
    I fortunately have no experience of the system in South Auckland, I am aware of violence in psych wards but it often indicates those individuals should be in prison and they often people who simply lack the IQ to function in society and have only been born because of past overgenerous support of low IQ ordinary people ( probably 50% of white males and 20% of white females in NZ) to have families through family support and insulated work.
    I realise my views are uncomfortable on this blog which is a social workers charter, but their are few tolerant right wing blogs, as most are business, catholic or rabid, like whale oil. I do feel the mental health industry is very much one of industry capture, (I have passed stage 3 economics).

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