Long journey to recovery for Kiwi consumers: Recent developments in mental health policy and practice in New Zealand

Abstract

Mental health services worldwide are undergoing significant changes in philosophy and direction due to the rising influence of the consumer or service user movement. This paper explores some key developments in the history of social policy, legislative change and funding of mental health services in New Zealand, especially since the landmark 1996 Mason Report. The growth in consumer networks and consumer participation in the aftermath of this report at multiple levels of the mental health service system is examined, with a particular focus on the adoption of the recovery approach as the guiding principle for the nation's mental health strategy. Consumers and carers are now active in contributing to strategy, policy and service development, nationally and locally. Opportunities for advocacy, advice and input into the quality of service provision have increased for many people living with mental illness. However, although government policy and systems are designed to drive services towards consumer empowerment and the recovery approach, there is still a long way to go before a fuller paradigm shift and greater consumer participation are achieved for people living with mental illness in the New Zealand community.

Many of the developmental stages in mental health services outlined by Smith and Gridley (2006) in New South Wales and across Australia were happening simultaneously in Aotearoa: New Zealand. Today, traditional psychiatric hospitals such as Cherry Farm, Lake Alice, Tokanui, Sunnyside and Porirua no longer exist, and psychiatric units have been integrated into general hospitals and the general health system. This significant step in de-stigmatising mental illness has been accompanied since the mid-1990s by increasing changes in the relationship between mental health service consumers and providers.

Mental health consumers and their family or whanau members are exercising their voice, and assuming increasingly crucial roles in policy formulation as well as service design and delivery. This influence is, in turn, helping to shape changes in professional mental health thinking and practice. Today it is generally accepted that service consumers are to be seen as people who have something valid to say about the treatment and care they are given or have to receive, and the services and systems that deliver that care.

The first half of this paper provides an overview of key developments and pressures in New Zealand mental health policy and practice that laid the ground for the watershed 1996 Mason Report and the subsequent increased consumer participation. The second half focuses on the post-Mason Report era, particularly the expansion in consumer activism at multiple levels of the mental health service system, and the adoption of the recovery approach as the guiding principle for the nation's mental health system. We then identify some key challenges to a fuller paradigm shift and greater consumer participation for people living with mental illness in the New Zealand community in the 21st century. (A Table is available on request that summarises some of the major developments in policy, legislation and provision of services for people living with mental illness since early colonial New Zealand. Brunton (1997) offers a very rich and more localised account of the direct impact of these major developments for the West Coast, South Island mental health services since 1872.)

Acknowledgements

Grateful acknowledgment is given to the late and great Linda Simson, Manager of Step Ahead Trust, Christchurch, Kelley Allen of Otepoti CAMHS (Consumer Action on Mental Health) and Elizabeth Biddington of the Southern Consumer Network, Christchurch for some of their personal history of the consumer movement used in this article. Also, many thanks to Heather Gridley for her encouragement and support. We also acknowledge the useful information and helpful advice provided by the anonymous reviewers of this article.