I recently talked with Marianne Elliott of ActionStation. Marianne is the Director of Story and Strategy for ActionStation, a financially and ideologically independent social justice organisation which works for results through collective action. Interested in “connected people” and the power of combined actions to facilitate change, ActionStation is multi-issue. It works by drawing connections between the different campaigns and the people who support them.
Marianne’s legal training has informed her background in human rights advocacy. As an advocate she has worked both in New Zealand and abroad including conflict zones such as Afghanistan and the Gaza Strip. These experiences have contributed to her dedication to ActionStation’s philosophy; that of empathetic values based on respect and dignity for all. ActionStation’s ongoing work supports the development of new conversations about certain issues where questions about how change happens are asked and answered.
One of ActionStation’s latest campaigns has been working for a People’s Review of the Mental Health System. Created on a narrative basis, Marianne was interested in developing stories as advocacy tools. She is a strong believer that human rights are story driven and that through the telling of individual experiences powerful change can happen. That is what the People’s Review of the Mental Health System is based upon; the telling of individual stories of lived experience of mental distress and extreme states, as a prompt to action at a governmental level. Regarding data, it is important to note here that the data gathered is qualitative and based on narrative process rather than that of quantitative statistical data.
People were often unsure about the sharing of personal stories of lived experience and trauma so the anonymity option meant stories were gathered from people who might not have otherwise contributed including those in the defence force, police and fire services. These contributors included both those with lived experience and those who have had experience of working with people in crisis. Having the option available for anonymity in story submission was important particularly for people working in the system – it had to be anonymous or jobs could be compromised. Interestingly, these stories from sector workers were like those from people accessing services. A consistent picture of the sector was therefore created. Even though there was the option to use a variety of media in submissions, most people wrote text and the report is reflective of this. The slightly distanced nature of text based content was probably appealing due to the privacy of the medium.
The content of the stories has raised further issues to do with privacy and concern on a personal basis in the context of mental health. Many have highlighted tensions where families desire information but where there also needs to be values and practices that uphold the rights of privacy for the individual and their desire for independence. It is a balancing act that a system in strife is ill equipped to keep in equilibrium.
That current system is one where mental health workers are recognising that services are often failing to meet the needs of the communities they serve. Additionally, there are a range of behind the scenes challenges that put a huge amount of strain on providers and mental health workers due to a lack of resources. The diverse voices gathered in the narrative approach to the project has helped to articulate this imbalance of resourcing. Addressing funding is not all that is needed. Within the review, it is important to consider and reflect on the oversight mechanisms of the sector such as those that prompted the loss of the Mental Health Commission in June 2012.
There are also social dynamics at play such as power imbalances and frameworks and philosophies that need review in relation to questions such as what is characterised as a mental health condition. With these frameworks in mind other equally important issues are raised based on an embedded view where the capacity of those who experience mental distress to contribute to society, be community members and be citizens, is questioned by current paradigms.
Also involved with the Peoples Review of the Mental Health System are Mike King and Kyle MacDonald. Mike is a mental health advocate, comedian and a television personality. The attention and profile his involvement has brought has been extremely useful to the campaign. The way Mike forges connections with people, in particular young Māori men, has been invaluable. Kyle is a private sector psychotherapist who is familiar with narrative structures in his work and who is prepared to ask sometimes difficult questions. His networks were useful and Kyle has direct empathy through professional experience with those working in the public mental health sector.
The process of collating the report involved readings of the gathered stories by several different people, from which overall impressions were recorded. “Diagnostic” labels were dropped as a point of definition and instead nineteen thematic keywords were compiled. These keywords were allocated both with software and manually by two individuals, for consistency of assessment. Then specific stories were chosen to illustrate the themes. The result was a forty pages long in its initial draft and has now been refined to the ten page report that has been released to the public and the media.
There are three main results hoped to be achieved through a governmental response to the report. Firstly, a review of funding to the mental health sector, secondly, restoration of an independent Commission as a monitoring body, thirdly a review of the systematic issues in the mental health system and fourthly a national education programme about mental health. The report was released on Wednesday 19 April alongside an open letter outlining the reports key findings. It will be presented to the Ministry of Health on May 9th before the budget is announced. You can read the report and sign the open letter at www.peoplesmentalhealthreport.org.nz
Looking more closely at the hope for reviewing funding to the sector, it is important to consider not only resourcing contexts but also the societal climate. A range of social and economic factors are placing people under stress. This stress can contribute to experience of mental distress by individuals in Aotearoa/New Zealand. As examples think of the rising cost of living and housing, and how this is informed by wage inequality and insecure working conditions. Therefore, in the wider view, the Peoples Review of the Mental Health System is about healing as a nation as well as on an individual basis. There is systemic change that needs to be made for health at all levels of society. And with this change I hope that in time, it will mean a different story gets told.