How many deaths would it take to get the system right?
Auckland, September 2, 2018
New Zealand’s suicide statistics released last week provide sobering and alarming reading.
I cannot stop thinking about the 668 people who took their own lives in the past year and the families, friends and communities deeply affected.
Men accounted for the largest number of suicides at 475 (71%), while the number of women who committed suicide was 193 (29%). Of these, 20% were young people in the 10-24 age group and 21% were Maori.
Anil Thapliyal (Photo by Lorenzo Thapliyal)
Prime Minister Jacinda Ardern rightly summed it up as a ‘tragedy,’ emphasising the need to improve access to care.
I agree with her that “we need to do more,” and if we must get it right then going by successful international trends, the Digital Mental Health or more commonly referred to as eMental Health has to play an integral part of holistic response to this crisis post mental health enquiry report.
Time and time again we continue to fix the same broken system by tweaking around the edges. We need a paradigm shift in our thinking: where the mental health service user is genuinely at the centre of service design.
Crazy Mental Health services
Mental Health service users across New Zealand receive and consume information differently from the way we used to in the past.
We take small things for granted (Internet Banking, Google, Trade Me, Email, Texting and Social Media) that connect us to services, information, friends and families but our mental health services continue to stagnate.
There is no overarching cohesive innovation framework for New Zealand.
We have failed to deliver effective and efficient mental health services commensurate with the changing times.
Noted below are some examples of brilliant developments happening internationally in the eMental Health domain.
Australia established eMental Health Strategy for Australia (June 2012) http://www.health.gov.au/internet/main/publishing.nsf/content/mental-pubs-e-emstrat
Mental Health Commission of Canada published eMental Health in Canada: Transforming the Mental Health System Using Technology (2014) https://www.mentalhealthcommission.ca/sites/default/files/MHCC_E-Mental_Health-Briefing_Document_ENG_0.pdf
National Mental Health Commission (NMHC) of Australia commissioned a pan-Australia eMental Health Review (June 2014) (https://www.researchgate.net/publication/283010660_NMHC_Advice-on-Innovative-Technologies-in-eMental-Health)
Improving timely access
An article appearing as ‘World Psychiatric Association Position Statement on eMental Health’ (eMental Health as a Response) August 2017 focuses on the role of technology aided solutions in improving timely access to information, engagement with the right services, treatment interventions and social supports as a complimentary adjunct to face to face treatment services or standalone self-help and self-management treatment support.
Chart from World Psychiatric Association Action Plan 2017-2020 Action Plan
Absence of an eMental Health Strategy in New Zealand has resulted in incoherent provision of mental health services. This is further exacerbated by the ineffective and cumbersome procurement processes strewn across the Ministry of Health, District Health Board and Primary Health landscape often duplicating services.
The state of Mental Health services also suffers from a lack of integration and interoperability between disparate services and IT vendor systems.
As a system, we do not know what the left hand and right hand are doing, let alone having a mental health service which consumers can easily navigate on their own.
Many people with mental distress are not able to access professional support or treatment in critical moments of their life. Due to regional, professional or resource limitations, access to care can be difficult.
In both rural and remote areas, as well as inner city neighbourhoods, the time between the onset of symptoms and getting professional help is taking far too long.
It is time that Primary and Secondary mental health have an embedded eMental Health component (e.g. build on the Ministry of Health’s existing investment in the National Telehealth Service).
Adequate investment in this area is long overdue.
Enhanced integration and coordination between primary and secondary care need to be addressed with the understanding that eMental Health services are not silver bullets capable of replacing face to face clinical services.
They can however certainly play a much more effective role within the mental health ecosystem. While we are deliberating on these issues, someone, somewhere in New Zealand is in dire need of quality services.
Urgent next steps
We need to put a sense of urgency to expedite the next steps.
As a nation we can do far better by embracing newer ways and means of engaging with the mental health service users. To that effect, it is important for New Zealand to consider establishing (a) A strategy for eMental Health (b) A Ministerial Advisory Group on eMental Health to examine the role of digital technology and (c) A dynamic eMental Health Programme of work at the Health Ministry.
In New Zealand, we pride ourselves on our ‘Number Eight Wire’ approach, representing the best of Kiwi ingenuity and resourcefulness, a can-do attitude and the ability to think laterally to solve a problem.
It is now time to implement this attitude and thinking.
This is not so much about the fiscal envelope alone, it demands strong leadership and most importantly political support to get it right.
If you are worried about your or someone’s mental health or that of your own, the best place to get help is your GP or local mental health provider.
However, if you or someone else is in danger or endangering others, please call 111.
If you need to talk to someone, the following free helplines round-the-clock: (a) Depression Helpline: 0800-111757 (b) Lowdown Text 5626 (c) Call or text 1737
Anil Thapliyal is the eMental Health Lead and Adjunct Professor at the Centre for eHealth, Auckland University of Technology. He is also President, eMental Health International Collaborative and a Member of the eMental Health Section of the World Psychiatric Association. He organises and attends several international conferences each year in London, Europe, Canada and the United States of America. He is an avid reader and strong supporter of Indian Newslink.
How many deaths would it take to get the system right?