The Office of the Auditor-General recently released a report “Mental Health: Effectiveness of the planning to discharge people from hospital”. You can access this report here.
The report does not make clear why the audit focused on discharge planning, yet it is clear that a number of good people dedicated a great deal of time and energy to compiling the report. The report states that the Office did not interview service users, ex-service users or people with lived experience of mental health crises and/or conditions because “we did not wish to potentially cause unnecessary distress”.
To focus solely on discharge planning is a confusing thing to do. To not establish or question starting assumptions makes this report another attempt at papering over the fundamental cracks in our mental health system. We all would have benefitted from an audit of any, or all, of the following questions:
- What is the current state of the national electronic health record project and what is needed to get it operational?
- How is the national mental health budget allocated, including a DHB to DHB comparison?
- What are the life courses of people who use DHB based mental health services?
- What are the benefits people have gained from using DHB based mental health services?
- What are the benefits people have gained by not using DHB based mental health services?
- How does our mental health system understand and address the social determinants of mental health crises and conditions?
The final four questions would have required engagement with people who have experienced mental health crises and/or conditions. The Office seems to have reached the erroneous conclusion that we are people who must be talked about but not talked with. This belief is not only untrue it is also deeply discriminatory. It is not possible to audit our mental health system without engaging us in designing, conducting and providing data for such an audit.
This report in its introduction sets out that it is based on six incorrect assumptions:
- There is such a thing as ‘mental illness’
- There is such a thing as ‘serious mental illness’
- That 15,000 people “needed to stay in an inpatient unit during 2015”
- That people admitted to inpatient units “are in greatest need of support”
- That providing this support is “difficult and demanding”
- That our mental health system can “effectively” support people admitted to inpatient units
If this report project had been started by engaging with all the diverse people in our community the report writers would have learnt that mental health and wellbeing is not a measureable “investment with significant payback”. Such an approach to our mental health system will never provide an adequate picture of people’s experiences. People are in pain and people are dying. People we know, people we care about, people we hear about and people we may never meet. They are our community and we believe their voices are the ones that need to be heard. That some people may find it difficult to hear the pain and outrage of our community will not make these experiences go away. We know what we need, and we’re more than happy to talk about it.
If the Office had asked us we could have helped them to understand that taking a distressed person from everything that is familiar to them, and isolating them from everything that is of comfort, is one of the most damaging things our mental health system does to people. Inpatient units operating under our current mental health system cannot “effectively” support people. They control and contain people because of never proven theories of broken brains. There is a lot of research showing that inpatient units cause harm, and in some cases fatal harm. The key points of the United Nations Convention on the Rights of Persons with Disabilities relating to inpatient units are set out in this summary by the Office of the UN Human Rights High Commissioner. This would have been a good starting document to discuss.
What this report has done is impose another set of un-meetable systemic standards on the people who work in mental health services. It has also consigned people who experience mental health crises and/or conditions to either not being “seriously ill” enough to receive support or so “difficult and demanding” that they embody every prejudiced belief about our community that has ever been held in this country. We need change, and we need all the good people at the Office of the Auditor-General to engage with us in working out the right questions to ask.
There is benefit in this report, and that is to give us another opportunity to speak our truths and to once again ask that our voices are listened to about our experiences.
Nothing about us without us.