Heather Casey, Chair of the Mental Health and Addiction Services SLA

There are many priority areas I could focus on within this article; the social determinants of health, the First 1000 Days, people-centred services, population health, health promotion and building healthy communities to name just a few – all of them important concepts.

However, I will start with my recent experience.

I was passing through an emergency department in an unnamed hospital just last week and heard the expression ‘they are one of yours directed to the local mental health team.

I cringed and thought if ‘Mental Health is everybody’s business’ is going to be a reality, we need to be thinking and talking as a health system about addressing how stigma and discrimination is a barrier to many people seeking help.

My experiences to date indicate that everyone is an expert on approaches to psychological wellbeing.  What this often means is that the mental health sector is perceived as responsible for ‘curing’ everyone or, more often than not, to blame for not resolving matters.

We do not have a cure for every physical ailment, why would mental health and addiction be any different?

Mental health, or mental ill-health, is as broad a term as physical health or physical ill-health.  Mental illness is an umbrella term that covers many categories of illness and also shapes how we structure our services – either age-related, based on diagnosis or similarity of presentation.  This is similar to all health services – older people’s health, paediatrics, surgery, general medicine, etc.

As with all health services, there is a continuum between mental health and mental illness.  Health promotion and health education activities at one end of the continuum and specialist, secondary and tertiary services at the other.

If mental health is truly going to be everybody’s business, then people need to be able to talk about their lived experience. Those who present with mental health and addiction issues are not separate or different from ourselves, they are our sons, daughters, brothers and sisters, neighbours and work colleagues.

People often talk about feeling ashamed or judged and therefore hiding behind a mask. If they don’t feel comfortable talking about their experiences, they may not seek help.

The challenge I would like to put out there as Chair of the South Island Mental Health and Addictions Alliance, is for all involved in health and support agencies to reflect on their own attitudes and behaviours.

Ask yourself…do you believe that mental health and addiction issues only happen to other people? Have you ever said ‘they are one of yours’? Think about the language you use in and out of work; are you ‘othering’? The language we use is important, it helps to shape our own and others’ attitudes and behaviours.

Of course this is nothing new – but has our health system changed accordingly?

If we are to succeed as a South Island region to offer whole-of-system, joined-up, and/or integrated health services, then successfully addressing stigma and discrimination within ourselves and our system is the first step. People need to feel comfortable about accessing services to fully engage in relationships with people providing those health and support services.

The Mental Health Inquiry is a great opportunity for us to raise the profile of mental health and addictions. The Inquiry has brought mental health issues into every New Zealanders’ world – we all need to embrace this opportunity to engage and contribute on what is going well, as well as what is not.

The conversations that will surround the Inquiry and keep it front and centre for our community will be ongoing for the next several months – and the trick is for us to springboard from these discussions to a place where discrimination and stigma around mental health and addiction are a thing of the past.

Heather Casey is chair of Mental Health and Addiction Services for the South Island Alliance (SIA) and nursing director for mental health for the Southern District Health Board. This opinion was originally published as a guest editorial for SIA – the collaboration between the five South Island DHBs.

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  1. Heather Casey cringed when she heard that remark. Her ideology refuses to accept that a very sharp line can indeed be drawn between the psychoses and all other mental illnesses. Heather Casey states, “there is a continuum between mental health and mental illness”. No, there is not. Never once in her long, politically correct discourse does she mention the word schizophrenia – although for 100,000 years this was the only known “mental illness”. When governments built asylums all over the western world this was the only illness contemplated – not even the depression was thought of as an illness.
    And as for stigma, it is not at all appreciated today that this is sharply on the increase – ironically because we are now again forcing our insane population to live untreated and unsupervised among us in our industrialised cities. During the 150 years we had residential institutions New Zealanders had come to understand and accept insanity. We had learnt that schizophrenia is a knowable illness with a predictable prognosis – nothing to fear or worry about. There was a friendly, humorous attitude to our “nuthouses”. The hundreds of families living around those places never locked their doors, day or night, though thousands of insane people lived there in open wards. With “half-way houses” scattered in all our suburban areas we are now returning to the primitive, prejudiced attitudes of the middle ages. Families around them fear and hate them (and sometimes for good reasons). We are in witch-hunting territory again – I hate and fear it.


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