Is there any hope of change in New Zealand’s ‘‘two tier’’ health and mental health system, wonders Marianne Quinn.
My GP has a Lotto fantasy. It goes like this: overnight, she has the means to establish a fund from which her patients can get the surgery they need, and which their low income means they are unable to fund themselves. That's it. Overnight, the means to assist people ``out of pain'', diminished functional capacity, further deterioration leading to more pain, etc etc.
This fantasy is both sweet and also a stark reminder that for many years now, New Zealand has been operating a ``two tier'' health system - one where if you can afford to pay, you get surgery in a timely manner, and if you can't, you join a queue and wait. And wait. And wait.
The new Government brings hope, a precious commodity. Expectations are raised and people - especially vulnerable - dare to hope for better.
Incoming Health Minister David Clark is right when he says there's a lot to repair.
While it's one thing to have a hip that needs replacing and you need to turn to a system to help you, it's quite another if you have a life that needs fixing and you have to rely on our existing services for help.
Nowhere is this more apparent than being young and needing to access counselling. This new Government is promising ``free counselling for the under-25s''. Sounds wonderful - again, hope stirs. Maybe this time, it means what it says - could it be true?
I believe David Clark is listening. I'm hopeful that Carmel Sepuloni, new Minister of Social Development, is too. In the way of these things, ``health'' is in one bucket, and the means to access that ``health'' is in another, currently separated by a bewilderingly inconsistent set of regulations and an over-worked, demoralised undertrained workforce whose role it is to apply these regulations.
Currently, the under-25s can access counselling via ``Disability Allowance''. Briefly, to qualify, the person needs to have had a health condition for at least six months that is causing a significant negative impact on their life. The initial application is signed by their GP and also by a counsellor who has space to see them. Note: two signatures to get off ``first base''.
Step two: submit application. Options: online, delivered, or taken to your nearest Winz/Study Link office. Frequently, forms get lost (gentle reminder: do keep a copy). Who you talk to may have little or no understanding of the process and you might get conflicting advice and have to make lots of calls or visits. Try not to be put off by this.
People with anxiety may struggle with crowded places and managing queues. But online forms can get lost, calls are answered by offices around the country; there is no accountability or consistency, and, often, no evident humanity.
I try to tell myself that those administering these regulations are doing so to the best of their ability; that there's no intention to be obstructive or cruel, even if that's the effect.
And this is still going on. We have a new Government but these same procedures are being followed. My outrage at this isn't new. I'm giving voice to it now because there's some indication that someone is listening and we might get some change.
However, it is fanciful to imagine that those same workers who have spent years declining applications made on solid grounds, supported by both a GP and counsellor, are suddenly going to be transformed into agents who will positively facilitate access to counselling. They need to be told by their bosses that their work is to facilitate, not obfuscate. That they have an important positive role to play in assisting the mental health of young New Zealanders. And their department needs funding to train or retrain these people (a new kind of Kiwi host course?) or offer them suitable deployment elsewhere, somewhere far removed from mental health.
Right now, we have hope: let's not lose it.
Marianne Quinn is a Dunedin clinical psychologist and psychotherapist.
