Earlier in this chapter, we noted that many of the social determinants of mental health and addiction challenges (such as family violence, housing and employment) are not unique to the mental health and addiction system. Key interventions support the achievement of a broad range of wellbeing objectives across the social sector.
While we identified a need for a more coordinated, whole-of-government approach to addressing the complex, underlying drivers of wider wellbeing, we also stressed the need to look to solutions and support outside government – to families and whānau, communities and wider society.
However, some interventions target mental health and wellbeing specifically. These interventions include measures to counter mental health and addiction stigma and discrimination, reduce bullying in schools, foster (mentally) healthy workplaces, promote mindfulness and self-care, and build resilience in individuals and communities, especially in children and young people (both at school and in the home environment). Such interventions are important because for many people in our communities, the stigma of mental health acts as a barrier to seeking help. We also heard calls for more resources to help individuals and communities recognise or respond to mental distress or substance abuse in themselves or others.
Mental health promotion in schools
24–7 YouthWork started with one school in Christchurch in the early 1990s and now covers 71 local schools nationally. 24–7 YouthWork is a secular programme that encourages local churches to partner with local schools to fund 180 youth workers to support students across Aotearoa. The youth workers, who are often close in age to the students and outside the authority structure of the school, run activities to help students bond and feel a sense of belonging. They also offer a more informal way for young people to raise concerns and seek help. When it comes to mental health challenges, youth workers are able to do warm handovers for students to school counsellors and other supporters. There are several stories where students might not have been picked up by other methods. Youth workers typically serve for three to five years and also connect in regional clusters so can do handovers for students to new schools in the area, helping to make young people more comfortable with their new environments.
St John’s College and Whatever It Takes Trust
St John’s College and Whatever It Takes Trust (WIT) are based in Napier. Students and staff of St John’s College have used their business enterprise class as a vehicle to connect with WIT clients. In their class, students designed an early warning tool to detect flooding and donated all profits from the products sold to WIT. Nine students and school staff regularly visit clients at WIT. The regular contact has enabled some of the young men to open up about the challenges they face. St John’s shows the opportunity schools and other organisations have to form relationships with people who face mental health and addiction challenges. It also illustrates practical ways to be connected in the community and what a future of community care could be – the community providing care and support for people in distress and facing challenges.
In the next section we discuss issues around mental health promotion and the prevention of mental distress.
As with general wellbeing, promotion and prevention activities for mental health and wellbeing are dispersed across and delivered by multiple central government organisations. A broad range of community and NGO initiatives are also available. We have highlighted some of these initiatives below.
The Health Promotion Agency undertakes research and health promotion activities. This includes two major national mental health campaigns (Like Minds, Like Mine and the National Depression Initiative), as well as responsible alcohol use campaigns (for example, ‘Say Yeah, Nah’ and ‘Don’t Know? Don’t Drink’). Like Minds, Like Mine aims to counter the stigma and discrimination associated with mental illness or distress. It combines community action, a national media campaign, and research and evaluation to bring about social change. Surveys of public attitudes demonstrate that, as a result of the campaign, attitudes towards people with mental illness in the target group of 15- to 44-year-olds have improved significantly, especially among Māori, Pacific peoples and young people.171
The All Right? campaign was established in 2013 by the Mental Health Foundation, Canterbury District Health Board and Healthy Christchurch after the Canterbury earthquakes in 2010 and 2011. All Right? provides basic positive psychological interventions and communications focused on emotional literacy and intelligence, empathy, character strengths and self-care.
WorkSafe’s GoodYarn programme aims to help rural people recognise and respond to stress and mental illness. This programme has been expanded into an award-winning national initiative for dairy farmers led by DairyNZ, with workshops conducted across the country. Another rural initiative is Farmstrong, a web-based, prevention-focused initiative founded by FMG Insurance and the Mental Health Foundation. Farmstrong’s emphasis is on building resilience and healthy thinking skills to handle stress. Its website (www.farmstrong.co.nz) contains practical tips and evidence-based strategies to improve mental health and wellbeing.
SPARX is an award-winning computerised, interactive fantasy game based on cognitive behavioural training that the University of Auckland developed. SPARX teaches young people the skills they need to help combat depression and anxiety. It is supported by trial evidence for use with many ethnic groups, has been adapted for use by Rainbow young people, and is effective in reducing depressive symptoms and emotional distress.172
The growing amount of activity in this space is heartening, and it is encouraging to see mental health and wellbeing acknowledged and fostered beyond the health sector. However, as with initiatives to improve wider social wellbeing, strategic leadership and coordination for mental health promotion and prevention are absent. As a country, we have ended up with an approach of ‘letting a thousand flowers bloom’ and relying on enthusiastic and committed individuals and organisations. This approach is not sustainable or effective in the long run – and is not adequate to get ahead of the rising tide of mental health and addiction problems New Zealand is facing.
In addition, despite a proliferation of resources from government, academic institutions, mental health organisations and community groups, people do not know where to look for resources or how to determine what resources are most appropriate for their needs. Some organisations have resources to implement programmes, but struggle to identify which programmes are the most effective or are evidence-informed.
This issue has been highlighted in schools, where governance is devolved to local boards of trustees. A plethora of different programmes cover topics such as resilience, wellbeing, deliberate self-harm, anxiety and depression, bullying and suicide. Many providers fund and deliver these programmes to schools (including commercial entities, government and NGOs, charities and interest groups). In spite of this large volume of activity, resourcing and delivery varies across schools. Information is lacking about whether the programmes offered are sound and fit for purpose (particularly with regards to suicide prevention) and whether they are having a positive impact.
There are also significant gaps and untapped opportunities for mental health promotion and prevention, all of which would benefit from more funding and investment. For example, while many submitters praised national campaigns such as Like Minds, Like Mine for shifting thinking about mental health, more targeted destigmatisation and mental health promotion programmes are needed for marginalised groups.
Opportunities also exist for greater integration of promotion and prevention activities in people’s day-to-day lives. For example, data from WorkSafe New Zealand indicates that experience of work-related stress or mental illness is increasing year on year.173 Thus, workplaces have a critical role to play in promoting mental health and wellbeing. Workplaces can help develop core standards for mental health and wellbeing in the workplace or prevention programmes to reduce workplace bullying or stress among employees.174 Families and whānau also play a vital role in promoting wellbeing (as discussed in chapter 8).
Finally, the potential of emerging digital technologies (for example, e-coaching, e-screening, e-therapy, e-navigation and other e-mental health programmes) is yet to be fully realised, despite a growing body of evidence suggesting their effectiveness. The Government’s social sector science advisors have advised that, in an environment where funding is tight but with massive unmet need, e-mental health presents a potentially major and cost-effective tool. If effectively delivered, e-mental health can help people before their mental health needs escalate, improve the reach and accessibility of mental health supports and services (particularly in rural or isolated areas), and alleviate pressures in workforce capacity.175
We consider that greater central leadership, including oversight of quality, is needed for mental health promotion and prevention activity. With this infrastructure in place, we would support significantly more investment in this area, including customised responses at a local level.
Clear leadership and increased oversight would prevent clusters of disparate, fragmented initiatives. It would also facilitate a national roll out of initiatives with a strong evidence base that can be effectively scaled up. As we note in chapter 12, the new Mental Health and Wellbeing Commission has a critical role in setting direction and driving action and investment. This includes for mental health promotion and prevention, in close liaison with a range of sectors and the proposed social wellbeing agency.
Other proposed functions of the Commission include spreading information, innovation and best practice and promoting collaboration, communication and understanding about mental wellbeing. The Commission could do this by facilitating the development of a central information hub or online gateway (similar to the approach taken in Finland176), which provides a single electronic ‘door’ to online mental health resources. This hub could contain tools, resources and guidance about evidence-informed programmes and initiatives and guidance on design and evaluation, motivating engagement by celebrating and showcasing the diversity of approaches that have been successful. It could also provide links to resources hosted by other organisations, disseminate information and facilitate networking among those with common interests (for example, through events and seminars), and direct people to funding sources, supports and services that may help their initiative succeed.
We also see considerable benefits in developing regional hubs or mechanisms for sharing resources and ideas and empowering communities to lead the development of their own mental health promotion initiatives and customise national resources and tools to their local contexts. Schools and other community organisations stand to benefit from being connected to people who have similar interests and objectives, so they can exchange ideas, information and lessons.
It is a global challenge for learning environments, communities, whānau and workplaces to have the time and all the skills required to be able to determine what programmes, resources and interventions are safe and effective. In the United Kingdom, the mental health campaign Heads Together funded a website called Mentally Healthy Schools and coordinated a team to assess over 3,000 resources going into schools to support principals, teachers and boards to know what resources work and are safe. In New Zealand, we have a range of programmes including Health Promoting Schools, Mentally Healthy Schools and the Rethink programme. However, implementation is variable and resourcing issues and a lack of consolidation across education and health agencies have impacted on the ability of early childhood centres and schools to implement wellbeing and resilience programmes.
It is important to build a strong evidence base of safe and effective mental health promotion and prevention interventions and fund accordingly. Particular consideration needs to be given to areas where greater investment should be provided and which are the most appropriate delivery agencies, including at national, regional or local levels. We see mental health promotion and prevention as a key area of oversight of the new Mental Health and Wellbeing Commission and recommend that it develops a targeted investment and quality assurance strategy for activity in this area.
Facilitate mental health promotion and prevention
171 Ministry of Health and Health Promotion Agency. 2014. Like Minds, Like Mine National Plan 2014–2019: Programme to increase social inclusion and reduce stigma and discrimination for people with experience of mental illness. Wellington: Ministry of Health. www.likeminds.org.nz/assets/National-Plans/like-minds-like-mine-national-plan-2014-2019-may14.pdf.(external link)
173 Nielsen Co. 2017. Health and Safety Attitudes and Behaviours in the New Zealand Workforce: A survey of workers and employers. 2016 cross-sector report. Wellington: WorkSafe New Zealand. https://worksafe.govt.nz/data-and-research/research/attitudes-and-behaviours-survey-2016/.(external link)
174 Work-related health, including mental health, is a priority in the Government’s Health and Safety at Work Strategy 2018–2028. Other jurisdictions, such as Canada, have recognised the benefit of developing a voluntary national code of practice for work-related mental health aspects – a cohesive framework of voluntary guidelines, tools and resources – to raise awareness and support workplace stakeholders to adopt good practices for work-related mental health. WorkSafe, New Zealand’s health and safety regulator, is well placed to lead or support this cross-sectoral and cross-regulatory work.
175 Social Sector Science Advisors. 2018. Towards an Evidence-Informed Plan of Action for Mental Health and Addiction in New Zealand: A response by the social sector science advisors to the request of the Government Inquiry into Mental Health and Addiction. Wellington: Social Sector Science Advisors.