Mental wellbeing after Covid: go early, go hard, go local

Every year, an estimated 20 percent of New Zealand’s population is affected by mental health challenges.

Due to Covid-19, that figure is tipped to significantly increase – and could reach as high as 40 percent of the population for a period of time, says Professor Richie Poulton, who is the lead author of a new report into mental wellbeing.

“With two out of five Kiwis potentially affected, the impact will be felt by everyone. We need to be prepared. Failure to do so could lead to considerable, but avoidable psychological damage and suffering. We can’t let that happen. We have a duty to protect and promote mental wellbeing for all New Zealanders,” he says.

Sir Peter Gluckman, Director of Koi Tū: The Centre for Informed Futures at the University of Auckland, which produced the report, says there needs to be a much greater focus on promoting mental wellbeing at a community level, particularly on preventive actions and measures designed to keep individuals, families and communities well.

Their comments come with the release of Protecting and Promoting Mental Wellbeing: Beyond Covid-19. Written by Professor Poulton, Sir Peter, Rochelle Menzies, Dr Anne Bardsley, Professor Tracey McIntosh and Dr Monique Faleafa on behalf of the Koi Tū mental health expert advisory group, the paper calls for mental health services to be fundamentally changed from an outdated, centralised system to a devolved community-led model that responds to the needs of community and iwi.

The paper pushes for faster implementation of key recommendations from the He Ara Oranga Mental Health and Addictions Inquiry report such as moving to a more community-based model of mental health-service delivery, and integrating support services into general practice and other community settings.

Professor Poulton – who heads the Dunedin Multidisciplinary Health and Research Development Unit at the University of Otago and is associate member of Koi Tū – says there is strong consensus among mental health professionals that it is time for a paradigm shift from mental illness towards mental wellbeing.

He says Covid-19 could have a devastating effect on already vulnerable sectors of society, straining a system already under pressure.

There is also a second, potentially large group of newly at-risk, children, adolescents, working-age adults, and older citizens, facing major unplanned disruption in their lives. They may not know how to seek help, their peers and family may not recognise their needs and they will have little experience of welfare and agency support.

“The new at-risk group have no playbook for this scenario and could respond in unpredictable or even catastrophic ways,” says Professor Poulton.

There is a growing need for easily accessible e-mental health support and treatments, but Sir Peter warns against untested ‘digital snake-oil’ services that could even do more harm. “These digital tools and services need to be evidence-based, validated and regulated. Ensuring they are safe and effective for all users needs to be an immediate Government priority.”

Co-author Professor Tracey McIntosh, co-head of the University of Auckland’s Te Wānanga o Waipapa (School of Māori Studies and Pacific Studies), says Māori and Pacific populations are high risk as intergenerational disadvantage and high levels of deprivation are already a reality.

“Culturally aligned psychosocial support and services are urgently needed, beginning with those communities that are currently under served and where the need is high. Exploring how te ao Māori perspectives can enhance and inform mainstream services should be prioritised,” she says.

Sir Peter says accurate, real-time data capturing of levels of psychological distress in the population is also paramount.

“Based on what we have seen previously, for example after the Christchurch earthquakes and from overseas disaster experiences, we must prepare for increasing levels of disillusionment and despair in the months ahead, as the true impact and magnitude of Covid-19 takes hold,” he says.

The advisory group includes Dr Sarah Hetrick, Professor Ian Lambie and Professor Stuart McNaughton from the University of Auckland and Laura Black, Dr David Codyre, Rangimarie Hunia, Dr Sarb Johal, Professor David Johnston, Dr Helen Lockett, and Professor Roger Mulder.