GUEST BLOG: Dave Macpherson – ‘Devolution’ of Mental Health services gathers pace

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For ‘devolution’, the reader can insert ‘corporatisation’, or ‘’dismemberment’, or a host of other descriptions of the cuts to community and public health services that new right philosophies are delivering.

On our whanau Facebook page (’Nicky Autumn Stevens’) in the last week, we have covered the closure of the Lifeline telephone counselling service, due in June next year; a trial addition to St John’s ambulance services where the ambos will become frontline mental health professionals; a story about suicides among the country’s armed forces; and more on the Coronial process relating to suicides.

Lifeline have been operating for about 50 years, and are widely recognised as a national early intervention/recognition service for people with a wide range of mental health problems – and have been particularly important for many in the suicide prevention area. The calls to Lifeline for help have increased by over 40% in the last year.

They lost out in the Government’s latest ‘contract round’ (read ‘how to use your mates to save money at the community’s expense’) to a series of call centres specialising in different types of mental illness. Imagine if you will, a young person with suicidal thoughts decides he/she wants to talk to someone, but they have to make a decision – in the state they are in – should I call the Depression hotline? Or the Schizophrenia centre; or Bi-Polar; or who do I call if I haven’t been diagnosed? Forget about calling anyone – its too confusing and I can’t find the right number anyway. What do you think might happen then?

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This particular devolution is likely to go the same way as the aged-care sector has; all those local church and community trust-run rest homes being swallowed up by a small number of large, well-connected and highly profitrable corporates.

The Nelson-Marlborough St Johns Ambulance mental health trial is set to be rolled out around the country. On the surface it seems to be a good idea – training ambos in mental health recognition and support strategies. Many of their callouts are for people with mental illness issues; quite similar to the Police, who are facing 50-60,000 mental health-related callouts annually. The numbers of these for both services are growing alarmingly.

The failure of public mental health services, both institutional and community; witnessed by suicide and mental health statistics all moving in the wrong direction, is causing devolution of front line mental health services to St Johns and the Police, who are themselves embarking on more in-depth mental health recognition and support training for their trainees and existing staff.

New Zealand is one of the few countries that doesn’t record suicides among former armed forces members, but anecdotal evidence apparently shows a growing problem there, with armed forces leaders identifying both a lack of support for ex-service people suffering from mental illnesses and a slowness in the coronial process meaning it is hard to get accurate information.

This brings us to the coronial system itself, where many ‘suspected’ (i.e. well-know by all except the Govt agencies) suicides are not investigated for 4-5 years, or even longer. Recent legal changes – largely unchallenged in Parliament – have led to Coroner’s offices avoiding contentious and expensive hearings by employing legal firms to run desktop reviews of suicides – often, it seems, the same legal firms that represent DHBs and other health agencies which have actually been responsible for the treatment of mental health patients. Full hearings are not held, and answers for whanau & friends are often even fewer.

 

Dave Macpherson is TDBs blogger on mental health issues

3 COMMENTS

  1. hi Dave,

    The Medical Health Minister & department should be taken to the UN Rights Commission for their loss of care for those whom their system harms after administering those toxic drugs in such a irresponsible manner as they know how those drugs “can cause patients to have clinically recognised “adverse reactions to some drugs” happen to them.

    These “adverse drug reactions” to some drug therapies is given as a warning in “The Physicians desk reference” chapters say so and that is the Doctors bible and is produced by DuPont Chemical/pharmaceutical company no less, so is based in facts from the very industry who makes these harmful drugs..

    See here Dave; Best of luck mate, we are all with you on this.

    http://www.merckmanuals.com/professional/clinical-pharmacology/adverse-drug-reactions/adverse-drug-reactions

    Adverse Drug Reactions

    (Adverse Drug Effects)

    By
    Daphne E. Smith Marsh, PharmD

    Click here for
    Patient Education

    NOTE: This is the Professional Version. CONSUMERS: Click here for the Consumer Version

    Adverse Drug Reactions
    Adverse drug reaction (ADR, or adverse drug effect) is a broad term referring to unwanted, uncomfortable, or dangerous effects that a drug may have.

    Adverse drug reactions can be considered a form of toxicity; however, toxicity is most commonly applied to effects of overingestion (accidental or intentional) or to elevated blood levels or enhanced drug effects that occur during appropriate use (eg, when drug metabolism is temporarily inhibited by a disorder or another drug). For information on toxicity of specific drugs see Table Symptoms and Treatment of Specific Poisons. Side effect is an imprecise term often used to refer to a drug’s unintended effects that occur within the therapeutic range.

    Because all drugs have the potential for adverse drug reactions, risk-benefit analysis (analyzing the likelihood of benefit vs risk of ADRs) is necessary whenever a drug is prescribed.

    In the US, 3 to 7% of all hospitalizations are due to adverse drug reactions. ADRs occur during 10 to 20% of hospitalizations; about 10 to 20% of these ADRs are severe. Incidence of death due to ADRs is unknown; suggested rates of 0.5 to 0.9% may be falsely high because many of the patients included had serious and complex disorders.

    Incidence and severity of adverse drug reactions vary by patient characteristics (eg, age, sex, ethnicity, coexisting disorders, genetic or geographic factors) and by drug factors (eg, type of drug, administration route, treatment duration, dosage, bioavailability). Incidence is higher with advanced age and polypharmacy. ADRs are more severe among the elderly (see Drug-Related Problems in the Elderly), although age per se may not be the primary cause. The contribution of prescribing and adherence errors to the incidence of ADRs is unclear.

  2. “This particular devolution is likely to go the same way as the aged-care sector has; all those local church and community trust-run rest homes being swallowed up by a small number of large, well-connected and highly profitrable corporates.”

    The devolution or outsourcing of services by this government may serve the interests of certain profitable corporates, yes, but I think they main goal is to simply get more services for the same money or even less money that they intend to spend on them.

    This is happening in the health sector, where medical staff are already so stressed out and working up to 16 hour shifts on a rather regular basis, there is now talk of strike action.

    The per capita spend on mental health services has not kept up with population growth, as recent reports reveal:

    http://www.stuff.co.nz/national/health/83383719/Labour-MP-calls-on-mental-health-services-to-do-more-for-those-in-need

    http://www.radionz.co.nz/news/political/314124/govt-criticised-over-mental-health-funds

    http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=11714686

  3. Outsourcing and private contracting of services are also increasing at the MSD and WINZ. Remember this for instance:
    “Govt will pay to shift mentally ill into work”
    http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10893823

    There was much fanfare about this new approach and how it was all based on “evidence”.

    Then not long ago came this report:
    “Back-to-work programme labelled a fail”
    http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=11514141

    We had Carmel Sepuloni ask the Associate Minister for Social Development, and she responded that an evaluation report would be due later in the year (2015):
    https://www.parliament.nz/en/pb/hansard-debates/rhr/document/51HansS_20150917_00000477/sepuloni-carmel-oral-questions-questions-to-ministers

    We NEVER got an evaluation report that was published, it has all been swept under the carpet, and even Labour did not bother digging deeper, it seems.

    Now we do quietly get this relaunch of a similar program, called “Work to Wellness”:
    https://www.beehive.govt.nz/release/helping-those-health-conditions-work

    So here we go, first attempt failed abysmally, as I suspect, hence NO reporting, and hence they go and run further TRIAL on the vulnerable, following their ideological approach to welfare and health.

    It is indeed criminal what is going on. They are basically using mentally ill as guinea pigs for their trials.

    And they use a hatchet doctor for Principal Health Advisor, who likens benefit dependence to drug dependence:
    http://www.gpcme.co.nz/pdf/GP%20CME/Friday/C1%201515%20Bratt-Hawker.pdf

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