For people with intellectual disabilities across Otago and Southland, good mental healthcare is not an abstract policy issue.
It means being able to see someone who understands your communication, recognises when you are anxious, depressed or hearing voices and can offer the same hope of effective treatment that anyone else would expect.
For families, it may be a son whose distress suddenly escalates in ways those around him cannot explain, or a middle-aged sister with autism whose ageing parents lie awake wondering who will understand her when they no longer can.
It is support workers responding to crises in the early hours, disability providers struggling to maintain fragile placements and clinicians searching for specialist advice that may be many hours away.
The ombudsman's findings about Wakari Hospital's Ward 10a have understandably focused attention on the care provided within the unit.
They deserve careful consideration in their own right.
As with any report of this nature, it is important to distinguish the findings themselves from the wider commentary that has followed.
Above all, people with intellectual disabilities deserve care that is safe, therapeutic and respectful of their rights.
In the South Island, in common with many regions around the world, we have spent more than a century grappling with how best to support people with intellectual disabilities.
Some chapters of that history are uncomfortable.
Facilities such as Seacliff, Templeton, Braemar and Otekaike remind us of an era when disabled New Zealanders were separated from their communities and expected to live lives apart.
Yet that same history also produced important advances in research, clinical practice and disability rights.
Researchers at the University of Otago, the Donald Beasley Institute, disabled people, families and advocates have helped document institutional life in order to better understand the consequences of deinstitutionalisation and have reshaped thinking about disability, citizenship and belonging.
Alongside this scholarship, specialist intellectual disability mental health services developed in Christchurch and Dunedin have created expertise that has benefited people across the South Island for decades.
Most people with intellectual disability receive their mental healthcare through mainstream services and that is entirely appropriate.
Some, however, have needs that require additional specialist input.
Mental illness may be difficult to recognise in someone with intellectual disabilities when communication can be limited.
Symptoms can be mistaken for the person's disability, their behaviour or their physical illness.
Assessment and treatment often need to be adapted and mainstream teams may need specialist advice and support.
Providing the same care is not always equitable care.
People with intellectual disability may need reasonable adjustments and access to specialist expertise if they are to have the same opportunity for accurate diagnosis, effective treatment and recovery as everyone else.
Specialist intellectual disability mental health services support mainstream care by providing expertise when and where it is needed.
This expertise has never rested with one person.
It has depended on experienced multidisciplinary teams, specialist nursing, allied health, clinical leadership, teaching and opportunities to learn from one another over many years.
It benefits not only the people directly referred to specialist services, but also the wider health and disability system, which relies on specialist advice, education and clinical leadership.
The latest ombudsman’s report about Ward 10a should also prompt a broader conversation about how we care for people with intellectual disabilities who experience mental illness.
Safe inpatient care is only one part of the system.
Most people with intellectual disability live in the community, where good outcomes depend on skilled disability support, responsive crisis services and strong links between mainstream and specialist mental health services.
When those connections are weak, vulnerability does not disappear, it becomes less visible.
People may cycle through crisis, restrictive interventions and placement breakdown while care becomes fragmented, and no one service sees the whole picture.
The response should therefore be more ambitious than deciding the future of a single ward.
If the existing environment is no longer fit for purpose, it should be replaced.
But the specialist workforce, clinical expertise and partnerships that have developed around these services should be strengthened, not dispersed.
Specialist capability takes years to build and can be lost remarkably quickly.
Ultimately, this debate is about more than a building or a service.
It is about whether, when someone with an intellectual disability in Otago or Southland experiences severe mental illness, there will still be specialist clinicians in the South Island with the knowledge and experience to help.
That capability is difficult to build, easy to lose, and worth preserving and improving.
• Dr Diana Andrea Barron is a senior clinical lecturer, University of Otago.
