Mental health in New Zealand

Site of an old asylum near Dunedin, now a public park after patients were shifted to a village and then the wider community.

Mental health in New Zealand generally follows the trends of mental health in other OECD countries.[1] New Zealand's 'outdoor life style' and high standard of living are balanced by isolation and a self-reliant culture, which discourages asking for help.[2] Historically, people with mental health problems were institutionalised, whereas now the focus is on care in the wider community.[3] The stigma around poor mental health has been lessened in recent years as a result of this change and public education campaigns. However, New Zealand's minorities and youth continue to be over-represented in the negative mental health statistics.[1][4]

## Definition of mental health

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In New Zealand, mental health is considered the capacity to think and act in ways that increase your enjoyment of life and help you overcome challenges.[5] This is similar to the Māori concept of holistic health, known as Hauora.[6] Tangata whaiora (people seeking wellness) try to learn to incorporate their condition into their daily lives so that they have a full and satisfying life.[5] The term wellbeing is currently included in the general census as an indicator of general mental health.[7]

Negative conditions of mental health are divided into two groups based on how negatively they affect the sufferer's life. Mental health problems are unwanted behaviour that does not interrupt the routines of the individual's social life. A mental disorder (or illness) can be medically diagnosed by definition and more damaging effect on the sufferer's life. It includes hallucinations, delusions, violent behaviour, depression, addiction, anxiety or suicide attempts. Mental illnesses distinguish themselves from mental health problems by significantly adversely affecting the person's life.[8]

## History of mental illness

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Seacliff Lunatic Asylum & Cherry Farm Hospital

Karori Lunatic Asylum

Kingseat Hospital

Lake Alice Hospital

Porirua Lunatic Asylum & Mount View Lunatic Asylum

Seaview Asylum

Sunnyside Hospital

Tokanui Psychiatric Hospital

Wakari Hospital

Whau Lunatic Asylum

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Major historical psychiatric institutions in New Zealand.

Seacliff Lunatic Asylum, built in the 1870s.

From the settlement of New Zealand (c. 1300 AD) till into the 20th century most Māori believed in a supernatural origin of mental illness. They did, however, distinguish between the insane, demented, the intellectually disabled, and people who were spiritually possessed.[8] There is no significant reference to suicide in the Māori oral tradition.[9][10]

Many European early settlers found life in the colony hard and alienating. Instances of depression were recorded and many attempts were made to make New Zealand more like their home country.[11][12] In the 1840s, the societal response to people with mental illness was imprisonment in specially-built sections of local jails; no treatment was provided. However, two doctors were required to testify in order to commit a patient.[13]

### Asylums and mental hospitals

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In the 1860s and 1870s, provincial governments opened asylums. Patient were given less restraint than before and encouraged to work and be involved in community activities. This system followed closely to the English model. The earliest of these institutions were small and near city centres, while later in the century they became immense hospitals built in secluded locations, such as Seacliff Lunatic Asylum.[13] Some patients were admitted to these institutions for being difficult, confused, or because there was no other place for them.[14]

The treatment patients received in these asylums was inconsistent and staff had no medical training. However, some innovators like Frederic Truby King in 1887 introduced better food for patients and more discipline for staff.[15] The ward size was shrunk and patients given more freedom. Treatment, however, still remained cruel by modern standards.[16]

In 1911, it became possible for people to admit themselves to asylums (now called Mental Hospitals) and patients were referred to as inmates instead of lunatics. This reduced some of the public stigma around mental illness. Separate parts of the hospitals were also reserved for diagnosis and early treatment. Hospitals were designed around multiple buildings so that patients of different age and sex could be more easily separated.[17]

By 1916, halfway houses were being built to provide accommodation for veterans with 'shell shock' (post-traumatic stress disorder), which sometimes led to substance abuse. The public sympathy for these returned servicemen also helped improve the public image of mental illness. These halfway houses were also used for more minor mental health concerns and took some pressure off the mental hospital system. Psychiatry started to be practiced as a medical science and outpatient visits were also started. However, in the medical and public consciousness, there was still a division between people suffering from illness or bad experiences and the incurably insane.[17]

In the 1930s, a number of medical procedures were introduced, including brain surgery, induced insulin coma, and electroconvulsive therapy.[18] While once thought miraculous, they were discontinued due to negative side-effects and questionable health benefits. In the late 1930s, almost a quarter of patient admissions were voluntary. Treatment became free from 1939 in the now-renamed 'psychiatric hospitals.' Trial releases into society became more common but were still far from being the norm. In the 1940s, the roles of social worker and occupational therapist were introduced.[19] Janet Frame, a famous New Zealand writer, was held at the asylum during the 1940s and was wrongly diagnosed as a schizophrenic.[20] By 1969, a quarter of all mental patients were still in then-outdated asylum era buildings that lacked the design improvements from the previous 50 years.[17] From the 1960s on, new hospitals epitomised the village-asylum atmosphere in name and design, contrasting with the old asylum model.

### Treatment in the community

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From the 1960s, patients were encouraged to take charge of their own care, ideally in the community. No extra beds were provided in psychiatric hospitals from 1973 on, and a push towards community care (outside of hospitals) was introduced. This was intended as a cost saving measure but was also due to the poor reputation of the hospital system. By the 1990s, almost all psychiatric hospitals were shut down, sometimes with the consent of their patients. The government still provided funding, but now through multiple agencies and charities.[21] Patients were either transferred to remaining hospitals, or to residential care or supported accommodation in the community. People with intellectual disabilities moved to new lives in the community with care provided by a range of community agencies.

The 1990s also saw the separation of intellectual handicaps from mental health services,[22] and more attention was paid to Māori, who were over-represented in the mental health system. From 2012 on, the Health and Disability Commission has overseen the integration of New Zealand's response to mental health issues. LGBT people have more mental health issues than the general population today in New Zealand. As in many countries, homosexual people were historically committed to mental institutions and given 'treatment' for what was believed to be a mental illness.[23] About 4,000 people in New Zealand are committed to compulsory-detention on the grounds of a mental disorder every year.[8]

From the 1980s on, there has also been attempts to reduce the stigma of sufferers of mental illness or at least draw attention to their situation. In 1981, the band Blam Blam Blam satirised New Zealand's optimistic self-image with the song 'There is no depression in New Zealand', which also mentions the use of the drug Valium.[24] John Kirwan, a famous All Black, has openly spoken of his battle with depression and is actively involved in mental health and depression awareness campaigns in New Zealand. He has written about his depression in the books All Blacks Don't Cry and Stand by Me.[25] There are guidelines for the media when dealing with mental health issues.[26]

## Conditions, causes, and treatment of illness

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See also: Classification of mental disorders and Rights of mental health patients in New Zealand

All mental health problems can occur in ways that have only minor effects on daily life. However, diagnosable mental illnesses include depression, bipolar disorder, anxiety, obsessive compulsive disorder, eating disorders, post-traumatic stress disorder and schizophrenia.[27] Obsessive compulsive and eating disorders can have similar symptoms and causes.[28] Post-traumatic stress disorder does not have to have a wartime cause; however, a new generation of military sufferers are present from the War on Terror.[29]

## Effects on the individual, family, and society

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The effects of poor mental health range from lost work hours to suicide and damage the whole community.[4] New Zealanders who are sentenced to prison have a three times higher rate of mental illness than the rest of the population. In 2015 62% of inmates stated they had a mental health or substance abuse problem in the last year.[8] People who have experienced mental illness may be treated unfairly in the workforce.[30]

### Youth suicide

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While New Zealand's suicide rate is comparable with similar countries, the youth suicide rate is much higher.[31] Before the mid-1980s, the suicide rate increased with age, however, after this time the pattern has reversed. By the mid-1990s, people aged 15–34 had suicide rates of over 25 per 100,000, while rates for those over 45 years old fell to 13 per 100,000.[32] This fell to the still unusually high 16.9 per 100,000 in 2015.[33] Many reasons contribute to New Zealand's high youth suicide rate, including child poverty, high rates of teenage pregnancies, or family unemployment. New Zealand also has a record of high rates of bullying in school.[2] It has also been argued that as economic inequality in New Zealand has grown, there has been a dramatic increase in the youth suicide rate.[34][35]

## See also

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* Hauora
* Ministry of Health (New Zealand)
* Healthcare in New Zealand
* Mental health in the United Kingdom
* Rights of mental health patients in New Zealand

## References

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1. ^ a b Taonga, New Zealand Ministry for Culture and Heritage Te Manatu. "Mental health services – Te Ara Encyclopedia of New Zealand". teara.govt.nz. Retrieved 23 December 2018.
2. ^ a b Illmer, Andreas (15 June 2017). "New Zealand's shocking youth suicides". BBC News. Retrieved 20 December 2018.
3. ^ Taonga, New Zealand Ministry for Culture and Heritage Te Manatu. "Mental health services – Te Ara Encyclopedia of New Zealand". teara.govt.nz. Retrieved 22 December 2018.
4. ^ a b McAllen, Jess (27 October 2018). "History repeating – New Zealand's mental health inquiries". Radio New Zealand. Retrieved 23 December 2018.
5. ^ a b "Mental Health – Glossary". www.mentalhealth.org.nz. Retrieved 21 December 2018.
6. ^ Durie, Mason (1994). Whaiora; Maori Health Development. Oxford University Press. p. 90.
7. ^ "Well-being | Stats NZ". www.stats.govt.nz. Retrieved 25 December 2018.
8. ^ a b c d Taonga, New Zealand Ministry for Culture and Heritage Te Manatu. "1. – Mental health services – Te Ara Encyclopedia of New Zealand". teara.govt.nz. Retrieved 22 December 2018.
9. ^ Cultural Interventions and the Treatment of Māori Mental Health Consumers (PDF).
10. ^ KAUPAPA MĀORI MODELS OF PSYCHOLOGICAL THERAPY & MENTAL HEALTH SERVICES (PDF).
11. ^ Ball, Christopher Allan (2010). "Mental Health Legislation in New Zealand from 1846 to Date: A Discourse Analysis" (PDF). DigitalNZ. Retrieved 22 December 2018.
12. ^ McLintock, Alexander Hare; Janet Fay Swann, M. A.; Taonga, New Zealand Ministry for Culture and Heritage Te Manatu. "Formation of Acclimatisation Societies". An encyclopaedia of New Zealand, edited by A. H. McLintock, 1966. Retrieved 23 December 2018.
13. ^ a b Taonga, New Zealand Ministry for Culture and Heritage Te Manatu. "2. – Mental health services – Te Ara Encyclopedia of New Zealand". teara.govt.nz. Retrieved 23 December 2018.
14. ^ Hospitals, Mental – Early Problems (from Te Ara: The Encyclopedia of New Zealand)
15. ^ From the pen of F Truby King, Truby King Booklet Committee, Auckland, undated
16. ^ Compo for psychiatric patients 'a difficult issue' – New Zealand Press Association, Friday 29 June 2007
17. ^ a b c Taonga, New Zealand Ministry for Culture and Heritage Te Manatu. "3. – Mental health services – Te Ara Encyclopedia of New Zealand". teara.govt.nz. Retrieved 23 December 2018.
18. ^ Taonga, New Zealand Ministry for Culture and Heritage Te Manatu. "ECT treatment, 1956". teara.govt.nz. Retrieved 23 December 2018.
19. ^ Taonga, New Zealand Ministry for Culture and Heritage Te Manatu. "4. – Mental health services – Te Ara Encyclopedia of New Zealand". teara.govt.nz. Retrieved 23 December 2018.
20. ^ A survivor against the odds – noted New Zealand writer Janet Frame dies – Rees, Margaret; World Socialist Website, 2 March 2004
21. ^ Taonga, New Zealand Ministry for Culture and Heritage Te Manatu. "5. – Mental health services – Te Ara Encyclopedia of New Zealand". teara.govt.nz. Retrieved 23 December 2018.
22. ^ "People with intellectual disabilities missing from mental health announcement | IHC New Zealand". ihc.org.nz. Retrieved 21 December 2018.
23. ^ Laurie, Alison J (15 August 2018). "Lesbian lives". Te Ara – the Encyclopedia of New Zealand. Retrieved 11 October 2018.
24. ^ "No depression in New Zealand | NZHistory, New Zealand history online". nzhistory.govt.nz. Retrieved 23 December 2018.
25. ^ Kirwan, John (2010). All Black's don't cry : a story of hope. North Shore, N.Z.: Penguin. ISBN 978-0-14-320480-0.
26. ^ "Talking about suicide". Ministry of Health NZ. Retrieved 20 December 2018.
27. ^ "Mental health". Ministry of Health NZ. Retrieved 21 December 2018.
28. ^ "International OCD Foundation | The Relationship Between Eating Disorders and OCD Part of the Spectrum". International OCD Foundation. Retrieved 21 December 2018.
29. ^ "The hidden cost of war: A new generation of veterans are suffering post-traumatic stress disorder". Stuff. 26 August 2017. Retrieved 23 December 2018.
30. ^ Taonga, New Zealand Ministry for Culture and Heritage Te Manatu. "7. – Mental health services – Te Ara Encyclopedia of New Zealand". teara.govt.nz. Retrieved 22 December 2018.
31. ^ "Youth suicide – New Zealand Parliament". www.parliament.nz. Retrieved 23 December 2018.
32. ^ Taonga, New Zealand Ministry for Culture and Heritage Te Manatu. "2. – Suicide – Te Ara Encyclopedia of New Zealand". teara.govt.nz. Retrieved 24 December 2018.
33. ^ "Suicide Facts: 2015 data". Ministry of Health NZ. Retrieved 24 December 2018.
34. ^ Wasserman, Danuta; Cheng, Qi; Jiang, Guo-Xin (1 June 2005). "Global suicide rates among young people aged 15–19". World Psychiatry. 4 (2): 114–20\. PMC 1414751. PMID 16633527.
35. ^ "Rogernomics and Rupture: Huntly's Response to the Corporatisation of State Coal Mines in 1987". Ir.canterbury.ac.nz. Retrieved 5 September 2018.

## External links

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* New Zealand Ministry of Health
* Mental health at the New Zealand Ministry of Health
* Mental health services at the New Zealand Ministry of Health