6 April 2000

The Mayor

Issues involving the mental health of citizens and the needs of those with a mental illness in the city have arisen in a number of forums over recent months. They are of real concern to many groups within the community and the Council could play important leadership, co-ordination, advocacy and service provision roles.

At present the Council has no policies in this area and it is appropriate that these be developed as the basis for future actions by the Council.

It is generally accepted that:

• 1 in 5 people (20% of the population) are seeking help with respect to their mental health at any point in time
• 1 in 33 people (3%) are experiencing a serious mental illness
• 1 in 3 people (33%) will experience some form of mental illness during their lifetime.
• 1 in 5 children (20%) experience severe stress and anxiety that can lead to depression and drug abuse unless treated early
• New Zealand has one of the highest rates of youth suicide in the world
• Suicide rates are very high by world standards for the 50 - 60 year age group and the level in other age groups is also high

This situation has not been assisted by:

• the individualisation and commercialisation of New Zealand society
• Rising levels of poverty including high levels of un- and under-employment, especially in the more at risk Maori and Pacific Island communities
• the health reforms, including the scaling down and closure of institutions and the restriction of support to those experiencing a serious mental illness
• the lack of support for people with dual diagnoses.
• the reduction in numbers of public health nurses and other primary prevention services such as Plunket.
• the difficulty many people have getting appropriate disability allowances and special benefits from WINZ to enable them to receive the required medical checks and medication and therapeutic mobility in addition to the basics of food and adequate accommodation. A telephone is also essential for health and safety reasons for people on the invalids benefit but meeting the costs is no longer acceptable for the disability allowance. Dental care is a major concern as medication hastens tooth decay necessitating greater treatment than others in the community need. This is expensive and is not adequately provided for.
• The practice of deductions being made from income support (eg for Court fines and WINZ overpayments) which reduce the level of income to below a level that can meet essential expenses
• The lack of awareness and understanding of many people of the nature and incidence of mental illnesses. Many support agencies are very reluctant to deal with people with any mental illness. WINZ has insufficient appreciation of the mental health effects of unemployment in its consideration of job-readiness.

1. Access to services for the targeted 3% are only half that required and this target will not be met without additional funding
1. The inadequate level of access to services for those with moderate to mild disorders has reduced.
1. While additional funding has been made available for new and additional services, under-resourced existing services remain significantly under-resourced.
1. Those with sub-clinical conditions are not catered for and must rely on their own resources which are often inadequate.
1. Medication is provided at no cost while the sufferer is in an institution. When discharged they must get their medication from their GP which involves the visit cost, and the medication also involves considerable cost.
1. Discrimination exists in many areas for those with mental health problems in the fields of housing, employment and banking. Several banks make it difficult if not impossible for those on low incomes to open or operate a bank account, all banks charge them fees that those on higher income do not pay and for those with a severe mental illness, the use of a cashflow card is very problematic and counter cash withdrawals are costly, thus adding further to living costs on an already inadequate income.
1. Inadequate income support and very high marginal tax rates on earned income. Many people with a mental illness would like and are capable of some part-time work. There are major disincentives for this.

1. Rising unemployment in the region, in contrast to national trends.
1. The impending closure of Manawaroa including the sale of the land and buildings and the relocation of the unit to be in with other wards. This is likely to see a downgrading of services and facilities, tensions between patients in other wards and a reduction in self-referrals
1. the restructuring of regional health services, whether Manawatu will be combined with Wanganui and any consequent shift in the focus and location of services and consequent shift in the associated communities of interest and support groups.
1. the restructuring of national health services and the place of mental health within this.
1. the possibility that people elected to the "health boards" will not adequately represent mental health issues.

Over recent months concern has been expressed at several forums including:

1. Previous Poverty Action Group meetings with you when community groups have expressed concern at the increasing levels of anxiety and depression associated with unemployment and poverty and way this intensifies and deepens over time.
1. At meetings between yourself and local clergy
1. At the Housing Forum when several agencies raised the issue of the lack of appropriate accommodation for those with a mental illness.

As the level of unemployment rises, the level of poverty worsens and the general stress levels in our community increase, the need to pay greater attention to mental health issues becomes increasingly important.

The link between unemployment and declining mental health is well known but the extent may not be. One local Doctor comments that the majority of his unemployed patients have some form of severe depression.

There is a major, widespread lack of services within the community for those suffering a mental illness.

Concerted action is needed to ensure the development, introduction and promotion of mechanisms for assessing the level of mental health indicators across the community and the establishment of support systems to deal pro-actively with any risk situations that may arise and any crises that may occur. Particular attention must be paid to all learning institutions and other bodies dealing with young people. Early diagnosis and treatment is very important. Delays in these result in the considerable escalation of effects, impacts and costs right across the community.

Co-ordination between mental health support agencies, both statutory and voluntary is important in ensuring that the services that are available are made the greatest use of. There is a long way to go before there are adequate services to meet the needs within the community.

The City Council can play an important role in facilitating this co-ordination and in advocating on behalf of the agencies where gaps are identified and services need to be extended.

The Council also has an important role in advocating on behalf of and in support of the community over any likely changes to the location and extent of services provided by statutory agencies.

The considerable lack of appropriate accommodation for those with a mental illness is a major concern within the city. MASH does not have the ability or capacity to meet this need.

At the recent Housing Forum, there was considerable interest in the partnership scheme developed between the Richmond Fellowship and the Christchurch City Council for the use of Council rental units for those with a mental illness under the care of the Fellowship. The arrangement was beneficial both to the elderly tenants and the Fellowship tenants. The Report by Council staff to the Forum indicated that appropriate units could be available. As such a development would meet a pressing and growing need it warrants serious, urgent investigation.

The Council may be able to further assist in the development of supported accommodation for those with a mental illness through the District plan, by ensuring that none of the provisions in it are negatively discriminatory on the basis of health status. It could also have an important role in actively promoting the development of a range of supportive accommodation options in the city.

It is important that both the Council officers and the community at large are aware of the human rights of all members of the community, including those with a disability or mental illness, particularly the right to have the same opportunities as anyone else to live where they want.

The Council could also play an important role in helping to break down the fears and suspicions of those with a mental illness which tend to be based on lack of awareness, understanding and acceptance of the realities of mental illness and the importance of mental health.

Difficulties people experience with WINZ again arises and the specific issues raised need to be included in any discussions and monitoring that takes place, with preference for a Mayoral facilitated meeting between all local WINZ managers, including the Operations Manager, and the 20 - 30 agencies in the city which have an advocacy function, as well as the systematic survey to be undertaken by Council officers and community representatives later this year.

Ian Ritchie
Independent Researcher
for the Poverty Action Group