Recognising the social determinants of mental distress
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EDITORIAL
Recognising the social determinants of
mental distress
This issue contains a special section on long and growing wait times for access
mental health, co-edited by Simon Lowe and to mental health services (Cardwell, 2021;
Joanna Appleby. Our thanks to Jo and Simon Quinn, 2021). These news reports highlight,
and all the contributors and reviewers. not only the crises in the public system,
but that the private sector is also becoming
In their commentary on the “Social work overwhelmed. Quinn (2021) cites comments
practice implications of upcoming mental by the Executive Advisor of the College of
health reforms” in this issue, Genevieve Clinical Psychologists that, “[t]he private
Smith and Joanna Appleby offer an system always used to be the overflow
informative account of the key challenges from the public system, but now we’re
for mental health services and for people getting to the point where the overflow is
experiencing mental distress in Aotearoa overflowing.”
New Zealand. They contextualise their
discussion with reference to the impact These appalling service failures are also
of four decades of neoliberal reforms on reflected in our stubborn youth suicide
our people and on our health and social statistics, where Aotearoa New Zealand
services—reforms that have fostered deep leads the world (OECD, 2017); and in
economic inequality, racism, precarity and the overwhelming prevalence of mental
despair in the lives of the many (see, also, the health or substance use disorders in the
review of Ferguson, 2017 in this issue). These Aotearoa New Zealand prison system (91%
reforms have also devastated mental health of all prisoners). The Chief Executive of the
services through underfunding, service Department of Corrections has declared, “[t]
rationing and managerial business models he high prevalence of mental illness among
that alienate service users, pressurise front- prisoners means that the Department of
line workers and fracture service provision. Corrections is managing more people with
Smith and Appleby explore four challenges mental illness than any other institution
faced by those who would reform mental in New Zealand” (The Department of
health services: the steady growth in demand Corrections, 2017).
for services along with the severity of
presenting problems, the failure to maintain In a study comparing mental health services
or increase the supply of services leading to in 14 developed countries, Aotearoa New
issues with service accessibility, the postcode Zealand was found to have the second-
lottery of service variability between the 20 lowest number of general psychiatry
District Health Boards, and staff retention beds per 100,000 of the population and,
and burnout (partly a product of the first two consequently (at 70%) the highest rate of
challenges). involuntary admissions and emergency
readmissions (NHS Benchmarking
The material results of this long-standing Network, 2019). Of course, a low ratio of
neglect have been highlighted in a series of psychiatric beds might indicate a positive
recent news reports: on the decrepit, damp, policy preference to invest in accessible,
mouldy and rat-infested infrastructure of community-based services, but the evidence
mental health units (Donovan, 2021; Lewis, above—and the emergency readmission
2021); on acute crises in mental health teams rates—suggests otherwise. It is small
AOTEAROA
where staff feel scared, distressed and unsafe wonder that Andrew Little, the health NEW ZEALAND SOCIAL
at work (Cook, 2020; Meier, 2021); and on minister responsible, expressed alarm that WORK 33(2), 1–5.
VOLUME 33 • NUMBER 2 • 2021 AOTEAROA NEW ZEALAND SOCIAL WORK 1EDITORIAL
the government’s 2019 decision to invest experience of suicidal ideation and/or
$1.9 billion extra in mental health services, attempt. In “Reflecting on lived experience:
as part of the reforms discussed by Smith Suicide prevention and the importance of
and Appleby, has, to date, resulted in only social work in mental health”, a variety
five extra acute mental health beds, and that of effective interventions are identified
many patients are sleeping on mattresses including: exercise, addressing physical
on the floor of mental health units (Lynch, health needs, practising mindfulness, use of
2021). medications and spirituality. The authors note
that social workers can make an important
In their commentary, Smith and Appleby contribution towards wellbeing through
argue that the “upcoming reforms provide the provision of psychosocial interventions
an opportunity to address some of the within a holistic health approach. They also
long-standing issues” in our mental health emphasise the importance of involving
services; and that “there needs to be individuals with lived experience both within
adequate funding so that mental health research (to inform policy and practice), and
services can move from a business model by a collaborative approach to treatment
to a recovery model.” We agree. Indeed, decisions.
arguably, one of the central barriers to
achieving the reforms necessary to all public In “Forgotten but not gone: A heuristic
services (including Oranga Tamarikii) is a literature review of sibling suicide
bankrupt business culture with its alienating bereavement”, Leah Royden notes that,
language and inappropriate processes. while Aotearoa New Zealand’s suicide rates
Despite its obsession with “stakeholder are amongst the highest in the developed
engagement”, “long-term pathways” and world, there is a lack of research literature
“transformational change” (Ministry of which focuses on the sibling experience
Health, 2021) the Ministry of Health stands of suicide loss. Royden notes that suicide-
accused of failing to deliver. The toxic bereaved siblings experience significantly
managerial culture and lexicon of customers higher rates of mental illness compared to
and business processes need to swept aside control groups. Royden’s literature review
in favour of a public service orientation that clarifies what international research on the
values a cooperative approach, supports sibling experience of suicide bereavement
staff and welcomes the active involvement tells us and in a rich contribution, draws
of service users in service delivery, design on her lived experience to examine key
and improvement. More than this, we themes of guilt, “unacceptable” anger, social
need to build a social order driven, not by stigmatisation, self-judgement, isolation, and
the demands of profit or cold managerial the shattering of relational trust. She calls for
efficiency, but one based on meeting human further attention to the needs of bereaved
need—a social order that the recognises siblings in both practice and research.
the social determinants of mental distress,
one that the Marxist psychoanalyst Erich In “Cessation strategies used successfully
Fromm (1955) described long ago in his by individuals in recovery from
book, The Sane Society. The articles in the methamphetamine addiction”, Yvonne
special section on mental health in this issue Gordon and Christine Stephens report
all emphasise the importance of listening on an exploratory study which aimed to
to the voices of those with lived experience gain insight from individuals in Aotearoa
and strengthening collaborative ways of New Zealand who have experienced
practising. methamphetamine dependence and now
identify as being in recovery, to discover
Behiye Ali, Barbara Staniforth, and Carole which strategies, approaches or treatment
Adamson report on a qualitative study appeared helpful in their recovery. In-
conducted with individuals with lived depth interviews provided rich data
2 VOLUME 33 • NUMBER 2 • 2021 AOTEAROA NEW ZEALAND SOCIAL WORKEDITORIAL
which were analysed using interpretative In “They feel like it’s all based around the
phenomenological analysis. offender: Professionals explore how victim
participation in family group conferences
Four themes emerged to describe the can be enhanced”, Tracy Williams and
lived experience of recovery from Julia Ioane explore the effects of a 2019
methamphetamine misuse: getting away, pilot project that aimed to increase the
support, personal sources of strength, and participation of victims in Youth Justice
treatment. These elements provide an insight family group conferences (FGCs). Earlier
into their journey of abstention and recovery. experiences of participation had led
victims to feel that it’s “all based around
On the same themes of recovery from the offender”, despite the reconciliation
alcohol and other drug addiction, Rachel aims of FGCs. This Auckland-based trial
Jowett, Michael Dale, and Lareen Cooper’s changed the process of information sharing
article, “Mitigating barriers to addiction and preparation roles for FGCs, ensuring
recovery in New Zealand: A lived that Victim Supportii were notified by
experience perspective”, report findings Police at the time Oranga Tamariki was
from a qualitative study. Jowett and also notified, and victims were contacted
colleagues utilised a constructivist approach, initially by Victim Support and offered
conducting semi-structured interviews information and support. This mixed
and undertaking thematic analysis. This methods evaluation found that the pilot did
article identifies themes highlighting what increase the participation of victims and also
contributed to, and created barriers to, the identified enablers of implementation. These
interview participants’ successful AOD enablers included training and resources,
addiction recovery. Barriers were societal, better streamlining of the information
widespread and pervasive stigma, for flow between Police, Oranga Tamariki and
example, and were systemic, where services Victim Support, gaining feedback from
did not meet needs and funding and other victims before the FGC and ensuring timely
supports were inadequate. Enabling factors information sharing. The importance of
included the ability of health professionals preparing victims for the FGC and offering
to build effective therapeutic relationships, emotional support in a culturally responsive
participants’ own internal processes, good manner helped ensure that victims could
boundaries, ethical care and supportive participate in meaningful ways. Seldom
friends and families. studied, this project provides important
insights into victim experiences in youth
Our Classic Book Review section is a space justice FGCs and how to improve their
where authors are encouraged to reflect on woeful levels of participation.
the nature and significance of texts that have
had a profound influence on the social work The role of the insider researcher and
profession. In this review, commissioned the extent to which they are members of
for the special section, Iain Ferguson, the group being studied is an intriguing
author of Politics of the Mind: Marxism and feature of qualitative research, and Richard
Mental Distress, discusses R. D. Laing’s The Brown bravely and creatively explores
Divided Self: An Existential Study of Sanity and this dynamic in the article “Messages to
Madness and extends his review to include first responders from a bereaved parent.”
several other texts by this highly influential Using autoethnography, Brown records
Scottish psychiatrist (1927–1989). In effect, and analyses the tragic circumstances of
Ferguson provides us with a comprehensive losing his child, doing so from a dual insider
overview of Laing’s profound contribution to perspective—exploring his experience as both
a humane understanding of mental distress a bereaved parent, and a registered health
and offers insight into the life of the author, social worker. This piece of work can only
warts and all. be described as taonga, a gift generously
VOLUME 33 • NUMBER 2 • 2021 AOTEAROA NEW ZEALAND SOCIAL WORK 3EDITORIAL
offered from the depths of painful personal Liz McCafferty provide practice reflections
experience to create awareness and offer on the experiences of participants in student
deep insight to professionals who are first to placements during the Covid-19 lockdowns
respond to such events. Brown concludes that in Aotearoa New Zealand. McCafferty and
parents require care for both their immediate colleagues offer insights into what helped
and long-term needs, as what happens in and what could have been done differently.
those first moments will impact on the well- Regular debriefing, supervision and a post-
being of parents over the years that follow. crisis debrief are all important elements that
aid the learning and support the wellbeing of
Social work supervision in statutory child the student.
protection settings is the subject of Matt
Rankine and Andrew Thompson’s article, Our book reviews for the special section
“‘Moving out of the safe zone’: Promoting include two on mental health topics.
learning communities and reflective Barbara Staniforth reviews Trauma, Women’s
supervision in a social work statutory Mental Health, and Social Justice: Pitfalls and
child protection agency.” Rankine and Possibilities by Emma Tseris. Neil Ballantyne
Thompson utilised critical reflection as a reviews Politics of the Mind: Marxism and
methodological lens, working with four Mental Distress by Iain Ferguson.
experienced Oranga Tamariki supervisors
in a learning community where supervision Lastly, Diane Smithson reviews Effective
recordings were brought to each meeting Leadership, Management & Supervision in
to improve reflective capacity, critical Health and Social Care edited by Richard Field
reflection and skills. Data were collected and Keith Brown.
from the learning community and thematic
analysis was undertaken to explore current
Neil Ballantyne and Liz Beddoe
supervision practice in the organisation. The
Follow us on Twitter (@AotearoaJ)
three themes generated from the learning
community discussions were: identification Notes
of supervisory skills and interventions; the i Oranga Tamariki is the statutory service for children
structure of supervision; and working with and families in Aotearoa New Zealand. https://www.
emotion and trauma. These themes highlighted orangatamariki.govt.nz/
the significance of the learning community ii Victim Support provides a free, nationwide support
as a forum for supervisors to engage in service for people affected by crime, trauma, and suicide
in Aotearoa New Zealand. https://victimsupport.org.nz/
positive and constructive feedback with their
colleagues in a supportive space. References
Cardwell, H. (2021, July 16). Fears lives are being put at risk
Frank Ainsworth’s contribution, “The best due to mental health wait times. Radio New Zealand.
interests of the child: More questions about Radio New Zealand. https://www.rnz.co.nz/news/
this construct”, critiques the hegemony of national/447009/fears-lives-are-being-put-at-risk-due-to-
mental-health-wait-times
this doctrine in Anglophone child protection
Cook, C. (2020, September 23). Wellington Hospital mental
systems, uncovering the issues which this health unit unsafe for staff, patients – union. Radio New
overly simplistic imperative has obscured Zealand. https://www.rnz.co.nz/news/national/426710/
over time. Attention is given to the legalistic wellington-hospital-mental-health-unit-unsafe-for-staff-
patients-union
origins of this doctrine and the benefits to be
Donovan, E. (2021, June 15). Housing the mentally ill when
gained from developing a wider and more the roof is caving in. Radio New Zealand. https://www.
inclusive community focused approach to rnz.co.nz/programmes/the-detail/story/2018799648/
working in the field of child maltreatment. housing-the-mentally-ill-when-the-roof-is-caving-in
Fromm, E. (1955). The sane society. Rinehart & Company.
In a Viewpoint article, “At home: Field Lewis, O. (2021, June 15). Dangerous mould found in leaky
mental health units. Newsroom. https://www.newsroom.
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David McKenzie, Bronwyn Powell-Grub and units
4 VOLUME 33 • NUMBER 2 • 2021 AOTEAROA NEW ZEALAND SOCIAL WORKEDITORIAL
Lynch, J. (2021, June 22). Health Minister Andrew Little
orders stock take of mental health spending. Newshub.
https://www.newshub.co.nz/home/politics/2021/06/
health-minister-andrew-little-orders-stock-take-of-mental-
health-spending.html
Meier, C. (2021, August 3). Staff feeling unsafe at mental
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https://www.stuff.co.nz/national/health/125953916/staff-
feeling-unsafe-at-mental-health-emergency-department-
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Ministry of Health. (2021). Mental health and wellbeing
long-term pathway. https://consult.health.govt.nz/mental-
health/3420983a/
NHS Benchmarking Network. (2019). International mental
health comparisons 2019 Child and adolescent, adult,
older adult services. https://s3.eu-west-2.amazonaws.
com/nhsbn-static/Other/2019/International-MH-report-
31-October-2019.pdf
OECD. (2017). Teenage suicides (15-19 years old). https://
www.oecd.org/els/family/CO_4_4_Teenage-Suicide.pdf
Quinn, R. (2021, July 13). Psychologists unable to take
new clients fear “tsunami” of mental health problems.
Radio New Zealand. https://www.rnz.co.nz/news/
national/446766/psychologists-unable-to-take-new-
clients-fear-tsunami-of-mental-health-problems
The Department of Corrections. (2017). Change lives
shape futures: Investing in better mental health for
offenders. http://www.corrections.govt.nz/__data/assets/
pdf_file/0006/894228/Corrections_Womens_Strategy_
August_2017_web.pdf
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