Hard News by Russell Brown

Very good episode on Media Take. One technical issue. There seems to be a small lack of synchrony between the video and audio that I found quite distracting.

http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=11804781

Is the government running down services to encourage privatisation in the mental health sector?

(The photograph in the herald article is quite odd, is Steven Joyces' body shrinking or is his head expanding?)

Very good episode on Media Take. One technical issue. There seems to be a small lack of synchrony between the video and audio that I found quite distracting.

Sorry about that. There have been problems with the new technical specs we have to supply to.

Is the government running down services to encourage privatisation in the mental health sector?

The "social bonds" model has huge ideological appeal to many governments, but it's distinctly unproven.

I can see it could work somewhere where outcomes are discrete and measurable – building low-cost housing, for example – but it seems dangerously experimental to try and save money by playing with it in the field of individual mental health. There are really strong incentives to "create" outcomes for short-term gain.

Big businesses that do govt social work tend to take the easy cases, fix the easy stuff and then the govt is left still having to deal with the hard cases and hard stuff that didn't get fixed. For people with little problems, who might have fallen off the government waiting list, it all seem good but for everyone else it just turns into double handling with high stress.

Big businesses that do govt social work

was never going to be a long lasting solution. And you cant accuse business people of being interested in the long term.
" Make a buck and move on" is more likely to be their motto in recent years.

Which has seen govts buy into a flawed business philosophy that has only come into vogue within their echo chamber in recent times.

The faults were so obvious to start with, to actually think in would work even in the short term would have needed heroic amounts of cognitive dissonance.
I mean heroicily idiotic. Cause they are still dishing up the same shit

The madness in the privatisation process of mental health services as mentioned is not just the the cherry picking for quick profitable outcomes but the flow on effects for other services who will be supporting the private profit, services like casualty departments of hospitals, shelters the police and justice services.

The 1992 Mental Health Act needs to be urgently reviewed. It was partially a response to the first Mason Report (1988), reports of abuse in the 'bins' and the system itself, and the deinstitutionalisation process then underway. The second Mason Inquiry and Report in the mid 1990s showed it was not the answer even then. Today it is all powerful, overrides our Bill of Rights Act and international rights Conventions, and is way out of date.

By the way Social Bonds are NZ Government contracts for social service provision with private providers and investors who only get a return on their investment when they have reached the targets specified in the contract. New Zealand’s first recently signed social bond aims to get 1700 unemployed people with mental health conditions into work over 5 years. An Australian company will deliver the service to eligible people living in the South Auckland region.

However, it can also be seen as privatisation and undermining of current services. And the contractor could just target easier cases in order to meet narrow targets.

Today it is all powerful, overrides our Bill of Rights Act and international rights Conventions, and is way out of date.

In what ways?

Out of date in its use of term 'mental disorder' and other terms and assumptions, its processes for monitoring and complaints, lack of consumer voice, and lots of other ways.

In what ways do you feel the expression mental disorder to be problematic?

In terms of the initial implemention of the mental health act it's intended to not presuppose a diagnosis but rather a broader loss of mental stability that could be caused by a range of circumstances.

Because it has no meaning in terms of DSM or ICD. It has been used to incarcerated people with autism by clinicians with little knowledge or understanding of autism, its presentation or how to interact with autistic people. Autism is not a mental disorder. That's just one group of people who have had their human rights removed because of the MH Act - there are likely others.

Mental disorder isn’t intended to be a diagnosis, it’s intended to be a description of a mental state that for some reason has shifted from some one’s baseline. A diagnosis may result after the assessment period.

But that isn’t sufficient to lead to the MHA being enacted, there has to be risk to the person and or to others. So someone who’s severely depressed – has a mental disorder – but who poses no risk to themselves or others cannot be placed under the MHA. And no clinician would consider putting them under the act unless there was a risk such as suicidal ideation with a plan.

It’s not possible to put someone under the act just because they are on the autism spectrum. But people on the autism spectrum can also have mental disorders such as depression or psychosis and they would come under the act or not just as some one who wasn’t on the spectrum.

It’s true that being under the act means having some rights taken away. But this happens in a small proportion of mental health related situations and only when there is risk. And that balance of risk vs rights is constantly being assessed by clinicians.

A minority group? (In much the same way as being left-handed is not typical, but neither is it a "disorder" -- and if someone decides to label me as having a "disorder" on that basis because I have "drifted from your norm", then my reply is very much unprintable.)

For those clinicians and others unfamiliar with autism, a meltdown can look very much like psychosis with a possible risk of harm to self or others. For those skilled at interacting with people with autism there are ways of changing the behaviour by avoiding the stressful situations which can cause meltdowns (such as sudden change, sensory overload etc). We have examples of people with autism being caught under the Mental Health Act because 'experts' did not recognise or know how to deal with a meltdown or other common autism behaviours in response to stress or anxiety. Sometimes they are stuck under the Act for years.

For those clinicians and others unfamiliar with

... traditional masculinity, expression of the permitted emotion (anger) can look very much like a psychotic episode.

Where does the act draw the line between "minority" and the rest, and what exactly defines "mental disorder"?

Neil, I admire your faith in the Act and the system, and maybe it works like that most of the time. But there are numerous examples when rights are removed for a long time, without sound basis or even clinical evidence. I've previously written about Ashley Peacock who has been held under the MH Act for years (and I don't want to go there now as we might finally have some progress and I don't want to jeopardise anything) but he was denied the right to dental treatment for several years on the mistaken assumption he was too 'dangerous' to be treated. Finally after he had several rotten and abscessed teeth removed under general anaesthetic and without incident, his behaviour and health dramatically improved.

Ashley Peacock is autistic and he has a psychotic disorder. He is one of the very rare, very complex cases where there are no good alternatives. His risks are on-going and unlikely to diminish.

Autism is quite distinct from psychosis and they can happen independly or they can happen together. I have met a number of autistic people who also have a psychosis and the autism in most case does not complicate things to any degree. But for some very small number the combination does make treatment decisions very difficult.

I think there is a conversation to be had over risk vs rights. If society would accept more risk then treatment in some cases could be less restrictive. Acute units are locked to mitigate the risk of self harm and harm to others that is posed by a small number of people.

But whenever someone from an acute unit commits suicide there are demands for more restrictions. If no one could get leave from a unit then there would be less risk.

Being locked up in the mental health system can increase the mental distress of autistic people. So even if someone with autism goes into the system because of misinterpreted meltdowns, which may be in response to stress, sensory overload or even experiences (common for autistic kids) such as bullying, being in the system can make them sick. It can be very boring and they are restricted from accessing those things which calm them such as the bush, beach or animals.

The People's Review is released at 3pm today. I'll post it here as soon as the embargo expires.

In my experience people with autism who have been admitted to an inpatient unit have been admitted because something else is going on rather than just the features of autism.

And I haven't notice that they do any worse from being in an inpatient setting where it is a non ideal environment for everyone.

Are you referring to cases where people with autism and no other complicating factor are admitted to an inpatient unit because of a lack of alternative settings?

One thing that concerns me about calls for a review of mental health is an over emphasis on resources - spending more money will solve all the problems - at the expense of more complex more dilemmas.

Eg suicide - every suicide is a tragedy but in terms of how well mental health services are going it's hard to measure the success - all the instances where suicide is prevented - but easy to measure the failure. And inpatient units are now terrified of letting anyone have leave off the unit for fear of the consequences. It's a difficult balancing act.

But one of the big issues is an issue of resources: adequate social housing. In patient units and respite services in Auckland find it hard to move people back into the community due to lack of accomodation resulting in difficulties admitting those requiring an inpatient setting.

I agree that lack of quality social housing with appropriate community support is a major issue. Poverty and the punitive attitudes of Work and Income don't help either.