Thursday, September 30, 2021

Mental health gets the standard Labour treatment

Labour governments typically have two standard responses to a political problem, or even the mere perception of one. They either throw vast amounts of money at it, or they create an unwieldy, centralised bureaucracy to give the impression something is being done. Sometimes it’s both, since these solutions often overlap.

We’ve already seen several examples of both approaches under this government and it’s not even one-third of the way through its term. In health and education, Labour is re-inventing the wheel by setting up potentially cumbersome bureaucracies that will strip away all pretence of local representation – and in the former case, create a co-governance structure that will give Maori power vastly disproportionate to their numbers. Reform of local government is still to come, and we can expect it to follow a similar path.

Even more egregious is Labour’s proposed Three Waters upheaval – a project so flawed and obnoxious that even the mayors of Auckland and Christchurch, both former Labour cabinet ministers, have declared their opposition.  

Another former Labour minister, Richard Prebble, succinctly describes Three Waters as the biggest robbery in our history. “The government is taking over $35.7 billion of ratepayers’ water assets and leaving the ratepayers with the debt,” Prebble writes in the New Zealand Herald.

Once again a centralised, opaque governance structure will be created that will give grossly disproportionate power to unelected Maori, sweep away local representation and discard generations of local knowledge, investment and experience.

Arguably the most offensive aspect of Three Waters is its audacious dishonesty. Rather than solving a problem, the government has invented one. The entire exercise has been sold to the public on the basis of a one-off incident – Havelock North’s 2016 water crisis, when four people died and thousands fell ill as a result of contaminated groundwater.

Using that isolated event as its primary justification, Labour has insulted our intelligence by spending millions on an infantile advertising campaign aimed at scaring us into believing the entire country’s water infrastructure is in such a parlous state that only the imposition of a new layer of remote, unaccountable bureaucracy can save us. In fact most councils manage their water safely and effectively without help from the Big State, still less any need for a dodgy Scottish governance model.

Another striking example of textbook Labour kneejerk-ism is Health Minister Andrew Little’s action plan (I use that term sardonically) for mental health.

It bears all the familiar hallmarks of Labour box-ticking: a Maori name, Kia Manawanui (apparently it means “have patience”, which seems apposite given how long the mentally ill may have to wait for anything to happen); a blizzard of empty buzzwords (two examples: “joined-up investment” and “a digital eco-system of support”); a 10-year plan (Stalin and Mao were fond of visionary plans too); and the creation of yet another new bureaucracy, in this instance an "external oversight group” headed by a dependable Labour favourite in the person of Professor Judy McGregor.

All this is intended to create the illusion of decisive, meaningful action, but it’s merely the announcement of a plan that has yet to be formulated. It contains nothing substantive or concrete – not even any goals or targets (they’ll come later, presumably).  It will provide work for lots of highly paid consultants and hangers-on but do nothing in the short term to help people suffering from mental illness. In short, it’s a disgrace and a travesty.

It’s not as if the government hasn’t had plenty of time already to assess the problem. It commissioned a mental health inquiry (another thing Labour’s good at) that produced a doorstop of a report in 2018, and it has budgeted for $1.9 billion to sort things out – money that it doesn’t seem to know how to spend. Responsible governments decide what needs to be done then work out what it’s likely to cost. But this one appears to work backwards, plucking a sum out of the air then wondering what to do with it.

In the meantime, Little continues to huff and puff over National’s supposed neglect of mental health (which may have been a fair criticism in 2018, but voters allow governments only one term to blame the previous lot; after that the excuse just doesn’t cut it) and wrings his hands in frustration at his inability to get anything done. Pardon me, but isn’t he supposed to be in charge?

And now, after all that, it seems we’re being told that what’s needed is more talk, more planning and ... oh yes, a layer of "oversight". If words and reports were all it took to solve the problem, New Zealand would be the most mentally robust nation on the planet.

Someone who has monitored the deepening crisis in mental crisis over many years is Andy Espersen of Nelson, a regular commenter on this blog who spent his entire working life in psychiatric hospitals. Following the announcement of Labour’s mental health “plan” he wrote the following letter to Little, part of which I reproduce here with his permission:

Dear Andrew Little.

Your government uncritically followed He Ara Oranga [the 2018 inquiry into mental health and addiction] by almost immediately accepting 38 of its 40 recommendations –  practically rubber-stamping them. You simply did not leave enough time to properly investigate, understand and weigh up the recommendations.

This inquiry was set up exclusively to solve the following New Zealand mental health problems:

 1. The increased number of suicides among clients of our mental health services.

2. The obvious shortage of fully serviced, psychiatric in-patient beds.

3. The number of atrocious murders of innocent people by known mental health patients.

4. The chaotic and dangerous state of affairs in our acute mental health units where both staff and patients are regularly assaulted by insane patients.

5. The never-ending complaints from carers (usually parents) of schizophrenic sufferers re lack of realistic support for them.

6. The problem with our many single, homeless people now slumped in our streets – of whom at least 70% are suffering from schizophrenia. 

7. The fact that whereas before 1992 we did not have one single schizophrenic sufferer in prison (it was actually illegal to imprison a schizophrenic person) – we now have ca. 2000 mentally ill prisoners (20% of our total prison population!). Tony Bouchier, then President of the NZ Criminal Bar Association, in an RNZ interview on Feb. 18th 2016, stated, “One of the main reasons the prison muster is so high is that our prisons are our proxy for our mental health institutions which we no longer have. And everybody in criminal law will tell you this, from judges through to defence counsel, if there was another way to deal with these people through proper mental health legislation our muster would be a lot smaller”.

Those were the reasons for setting up the Paterson Inquiry. Jonathan Coleman (former  Minister of Health) resisted an inquiry into mental health, dryly observing :”We know the problems – why set up an inquiry?”. Those were the problems Dr Coleman and all other people working with the mentally ill then knew as facts.

Nevertheless, in came your Labour party –  up came Ron Paterson [the inquiry chair] – and out came He Ara Oranga.

My proofs for your being ill advised by your public service employees consist of the following facts :

 1. Nowhere in the 219 pages report will you find any reference to any of the above mentioned 7 stark, accepted mental health problems, except suicide.

2. Nowhere in its 219 pages will you find any mention of the treatment of mental illnesses -  schizophrenia, human insanity, dementia, endogenous depressions  or any of the neuroses. You won't even find the words for those conditions mentioned (except schizophrenia once, in passing,  in chapter 1, page 33).

3. Nowhere in the 219 pages will you find any reference to the most drastic changes happening to New Zealand's philosophy of treating mental illness in 150 years, namely the enactment of the 1992 Mental Health Act -  which you are now blithely revoking and replacing. As none of the 7 problems mentioned above existed prior to 1992, one can hardly avoid suspecting that those changes might be a factor behind those problems!

4. All you get from the report is an incredibly vague treatise on something the commission calls   “mental well-being” -  which has nothing whatsoever  to do with mental illness. We are advised that we shall all attain that state of  eternal bliss when we have enough mental health personnel  to reach 20% of our population rather than the miserable 3.7% as at present!

5. The report lacks any practical suggestions how to initiate working towards this eventual utopia. It is all just fine words and sentiments  – all politically correct. There is nothing to hang your hat on – as is  amply proved by the fact that nobody has yet  figured out how to even begin to spend the $1.9 billion so generously promised by Labour!!   And by the way,  we who are passionately concerned about mental health were jubilant when Labour came out with that fantastic budget.

It beggars belief that your Mental Health Directorate advised you to follow the recommendations from He Ara Oranga  - ignoring  the facts shown above.

So far I have only criticised  -  which is easy.    I wish to finish on a positive note: How then should we proceed to repeal and replace the 1992 Act?  In 1991 British social historian Waltroud Ernst wrote a paper on 19th century psychiatry in New Zealand.  Our first mental health legislation was The Lunatics Ordinance 1846.   Ernst wrote that it aimed to “provide safe custody and the prevention of offences by persons dangerously insane and for the care and maintenance of persons of unsound minds”. This brief synopsis  shows the foundation for the building of all our designated,  psychiatric hospitals  for 150 years - together with our whole philosophy of our treatment of all our mental illnesses. 1. It authorised society to contain acutely psychotic persons and charitably protect them from their own actions over which they have no control. 2. It gave all mentally ill persons the right to remain as a wards of the state under protection for the rest of their lives, if they so desired.

We enjoyed this mental hospital based system for 150 years – and everybody, including the mentally ill, were very satisfied and content.  I here must stress that other groups of people who eventually became patients in our mental hospitals (e.g. the intellectually disabled and the epileptics) were never happy here. This system was destroyed for ideological reasons only by the enactment of the 1992 Act – and its consequential closure of our charitable, residential institutions.

Our ten-year mental health plan should be simply to revert to the charitable philosophy of yesteryear. And would it not be good if  the whole of parliament would agree to that plan?

I have been in touch with Shane Reti  [deputy leader of the Opposition] and happen to know  that he sympathises with my views – he is an old time medical doctor who spent part of his training working in mental hospitals but, of course, like you he is thwarted by the convictions of our present mental health ideologues.  It would be ideal if you and he  could get together to talk about all this.  And why not include Brooke van Velden [ACT deputy leader]?  Please, please – do try to work towards a multi-party solution to the mental health issue.   It is ironic (and saddening)  that Judith Collins and Jacinda Ardern both claim to have mental health as a priority  but don't get together to work something out.

You politicians are supposed to be running the show – not your advisors.  It is the same with all this Covid nonsense. Here you are legislating and issuing decrees  – all terribly destructive  to New Zealanders, with long-lasting,  devastating effects both economically and psychologically.  And meekly excusing it  by saying that  you are following expert advice. But you are not obliged to follow “expert advice”.   Your job is exclusively to do the best, the most humane, the most charitable, the most rational for your fellow New Zealanders who have honoured you and elected you to govern –  and if that runs counter to scientific, epidemiological opinions, so be it. 

Yours sincerely,

Andy Espersen


Richard said...

I note the annual suicide stats have been withheld for a couple of months.
Usually published in August, the coroners' website now says they will be published...well, today actually.
'The Chief Coroner releases national provisional suicide statistics each year to help suicide prevention efforts and initiatives undertaken by other agencies. The provisional suspected self-inflicted death statistics for the 2020/2021 period are expected to be released in late September.'
I wonder what the delay could be.
I'm keeping an eye on the website. This Govt has a long history of quietly changing deadlines and stats surreptitiously.

Terry M said...

A government of obfuscation.hyperbole,ambition but absolutely no ability. With a Minister of Health with no medical knowledge,a Minister of Justice with no knowledge of law,a Minister of Imigration who was a journalist,a Minister of Corrections who goes awol during the Waikeria prison riot, the Minister of children not mentioning sending in the heavies to try to influence the judiciary in a custody case,the whole mismanagement of the covid vaccinations program which should have been completed months ago all led by the Minister of Propaganda. Hang on. Forgot the Minister of Local Government stealing water assets from councils and giving them to iwi. But wait. Here comes he Puapua. I think they are doing a damn good job of committing political suicide. The damage in the meantime could be catstrophic.

Phil said...

Richard, It will be a political disaster for the Government if there has been a massive spike in suicides. I don't trust them either.

Unknown said...

I really do not know where to begin, as there is nothing to add, to perfectly laid out facts. Well written.

Odysseus said...

You presume "goals and targets" will be formulated for the new mental health bureaucracy? We should be so lucky. Surely you recall that among Labour's first acts in 2018 were the abolition of targets for health and education? Labour thrives on obfuscation and unaccountability, Stalinist planning and new bureaucracies with bizarre te reo names. They are grossly incompetent but they pay the media to sing their praises and New Zealanders seem to lap it up like demented lemmings.

Unknown said...

Another great piece Karl. I always look forward to your pragmatic opinion.Helen Clark, as Minister of Health in 1992, was responsible for the doing-away of secure mental institutions, effectively casting dangerous and vulnerable people out onto the streets. Prisons and dementia units (and underground carparks, bridges, bush reserves...) have shouldered a problem they were never designed for. Nice one, Helen. Yet successive govts have done NOTHING to fix this disgrace.
BTW suicide rates are being withheld in USA too.

Doug Longmire said...

Excellent article Karl and Andy. Describing the appalling mismanagement by this administration.

Andy Espersen said...

Increased suicide rates these days are most probably caused by lockdowns.

Russell Parkinson said...

Ive got 30 plus years as a subdivision engineer and project manager under my belt. That has included numerous water discharge and water rights applications under the RMA. The 3 waters boundaries are aligned with Iwi boundaries, not local authority boundaries.

While local authorities have their failing they are still the best bodies to look after the 3 waters. Regional authorities currently allocate water rights consents.

In my view this is not just an asset grab but an attempt to take control of water rights and have them controlled by iwi. It is undoubtedly highly undemocratic. In facts its sneaky and dishonest. Mahuta should go.

Terry M said...

"Helen Clark, as Minister of Health in 1992, was responsible for the doing-away of secure mental institutions, effectively casting dangerous and vulnerable people out onto the streets."
Probably to avoid becomming a member. Then ended up at UNO. Karma.