Last week I was interviewed for a piece TV3 journalist Kim Vinnell did on the state of our Mental Health services.  You can see video of the interview here: http://www.3news.co.nz/tvshows/story/mental-health-looking-at-the-bigger-picture-2015120918

TV3 were also good enough to let me post a guest blog.  To see the original post see: http://www.3news.co.nz/tvshows/story/opinion-the-right-prescription-2015121016

Opinion: The right prescription

Ask most people what the first thing someone should do if they’re depressed, or anxious and most will likely say: see your GP.

Likewise, most people would think the first treatment you’re likely to get offered would be medication, specifically anti-depressants.  At least in New Zealand, you’d be right.  But you might be surprised to know not only is this not good practice, it may also be unhelpful.

The two big mental health research and good practice agencies in the world, the National Institute of Clinical Excellence in the UK (or “NICE” which is a great acronym), and the American Psychological Association in the USA ( the “APA”) are clear that the first line treatment for depression and anxiety, especially in the mild to moderate range, should be talk therapy.

Not only that, but there is also a lot of studies that show that most of the anti-depressant medications aren’t very effective for mild to moderate range depression and anxiety, and certainly not as helpful as talking with a psychotherapist or clinical psychologist.  Not only that but when therapy is combined with medication for severe depression, both in combination are more effective than either on their own.

This is why people like me get so fired up about the lack of funded and affordable talk therapy options available in New Zealand right now.

It’s great we’re starting to break down the stigma so we can start to talk openly about how many people struggle with mental illness.  We now also need to be having a public conversation about what effective treatment looks like, and demanding it be appropriately funded, just like any other proven health treatment.

This is my recent column in the New Zealand Herald, which is published in the digital “Premium” edition every Thursday…

Angry about the measles outbreak? Good. Just be careful where you target it, writes Kyle MacDonald.

Vaccinations. As a parent I quickly learned it was something to avoid discussing with other parents. Sort of like the old maxim “never talk about sex, money or politics in polite company.”

I was never very good at avoiding uncomfortable issues though, call it a professional hazard.

However, like other impolite topics, vaccination provokes strong emotions, and clearly plenty of people are very upset about the fact close to 1000 people are reported as being infected with measles in the Auckland area.

We need to understand these reactions, because we need to talk about vaccinations.

So if you’re angry about the measles outbreak, good. Just be careful where you target that anger: you might be wrong about where the problem lies.

Recent NZ data suggests less than 25 per cent of those not vaccinated are a result of anti-vaccination views.

What about the rest?

Our declining vaccination levels are most marked in Māori and in those living in poverty. Our public health system has been failing to effectively reach, communicate with and make it easy for parents who care, but are struggling with day to day life, to immunise.

Now wait, I hear you say, 25 per cent is still significant. It is, and of course it’s entirely possible these two interact: those struggling to engage with health services are being further discouraged by the misinformation they encounter online about the harms of vaccines.

The World Health Organisation (WHO) has also ranked “vaccine hesitancy” one of its top 10 global health threats in 2019. Increasingly, it would seem, this is with good reason.

But at least in New Zealand the more urgent problem is (unsurprisingly) the same as it is for most health services: access. And that is actually easier to solve.

Getting people to change their beliefs is hard, and takes time. Yelling at them, in real life or on Facebook, doesn’t work. It is human nature to hold onto our beliefs more strongly when we feel we are being attacked.

It’s too easy to sit in judgement and refuse to try and understand that for some, keeping a roof over their families heads and food on the table – let alone school fees and clothes – takes all the energy that one – or if you’re lucky two – parents have.

Then try and find time to take time off for doctors appointments (even if they are free, they’re not free if you have to take leave – assuming you can get it).

Now try financially punishing these same families, and see how that helps people engage more actively with the health system.

Dr. Nikki Turner, head of the Immunisation Advisory Centre explained this succinctly when she said that what has changed for many New Zealand families is that we don’t tend to have an ongoing, trusting relationship with a health professional – usually a GP, – like we used to.

Instead, we turn to Doctor Google.

So by all means get angry. But channel that anger into demanding better funding for public health, outreach for those who aren’t actively engaged in the “system” and better information for all.

(Click here to read the article on the NZ Herald…)

This is my recent column in the New Zealand Herald, which is published in the digital “Premium” edition every Thursday…

Psychotherapist Kyle MacDonald on why he’s chosen not to take out health insurance.

When it comes to the politics of health, it seems impossible to separate it from money, whether it be the recent debate about funding cancer drugs, doctors’ salaries, the cost of hospital renovations or the financial performance of our District Health Boards.

But should it be?

In the lead in to the last election there was a rare televised debate between the Health Minister Jonathan Coleman, and then Labour Health spokesperson, David Clarke. The interviewer asked them both, at the end of the interview if they had health insurance, and both said yes.

I recall being deeply disappointed by this.

At an individual level, having health insurance is a rational choice to make – at the same time as it undermines the very basis of our public health system – a system meant to cater to us all equally.

Fortunately we are a long way from the corporatised disaster that is the American health system, but nonetheless the existence of the need for health insurance, and with it privatised health care, is the thin end of the wedge that enables discrimination between those that can afford to access health care, when and where it is needed, and those that can’t.

Now of course, at this point I run the risk of being labelled a complete hypocrite, as my income is largely due to the privatised mental health system. But, as I’ve detailed elsewhere , that is the reality of mental health care in New Zealand, and I wish it wasn’t – as do many of my colleagues.

It is also that time of year, where talk of the District Health Board budget’s come up in the news once more, and it frustrates me so deeply that we have the same conversation every year – that DHB’s are “in deficit” and need to work harder to stay within their budgets.

DHB’s are not “in deficit”. They are underfunded, because our health system is underfunded. If they blow their budget providing health care to the people they serve, then they need to be given more money to ensure they can provide those services. It is that simple.

I see the ongoing issue with framing this as a problem of budget management as political sleight of hand: it points towards the problem being the way that District Health Boards manage their finances, as opposed to the real problem: how successive governments consistently underfund health.

You might argue with the simplicity of this, but you can’t argue with the ethics. If we have the ability to treat a health condition, we should. Money should never come into it. Your personal financial situation should never determine your ability to access health care, for you or your family.

Access to good quality health care is a human right, not a financial decision.

And yet, a large portion of the electorate will continue to vote for tax cuts. No doubt many of the same people will still happily pay a premium on health insurance to protect their own health needs, yet complain abut paying – relatively – much less into the funding pool that pays for our national health system: via taxes.

And in case you’re wondering, I don’t have health insurance. Never have, and never will. For me that isn’t a financial decision, it’s an ethical one.

(Click here to read the article on the NZ Herald…)

This is my recent column in the New Zealand Herald, which is published in the digital “Premium” edition every Thursday…

“Transformational” has become a loaded word with this government. It has been turned from an election promise into a sneering accusation in the mouths of the opposition, writes Kyle MacDonald.

How does the Wellbeing Budget measure up, in terms of mental health?

Transformational might be a stretch, as with mental health we are just getting started. What is clear is when you look past the numbers – an impressive $1.9 billion dollars allocated for mental health and addictions – this is a road map for transforming how mental health support is funded and delivered in New Zealand.

In fact, you can go further and make the argument that it is redefining how we treat mental health.

In health we talk about “primary” services: largely, GP practices, where individuals can directly access the service, and secondary services, where the level of care is more acute, or you need to be referred by a clinician for services. Hospitals, largely.

Since the last major review of mental health in the late 90s, dubbed the “Mason Report”, mental health services have largely been the focus of secondary services, via the District Health Boards (DHBs). Primary, or community services, which have been a patchwork of charitable services such as Youthline, Lifeline and others, or private practice. There have been some attempts to fund access to psychological support via GPs, but these haven’t been nationally – or even regionally – consistent. NGOs have, over the last decade grown in the gap, but with short contracts and competition for funding they have done the best with what little they have been able to get.

The Wellbeing Budget has turned this on its head, by committing nearly half a billion dollars to primary mental health care over the next five years. In doing so, they have provided much needed direction and commitment. It will also enable people to commit to train, or retrain, as we will need to grow the workforce to provide services at this level. By 2023/ 2024 it’s projected this will allow around 325,000 Kiwis to access free, easily accessible mental health support.

By placing the service in “primary” health care – GP’s clinics, community services and Kaupapa Māori providers – hopefully it will be much clearer how to access help, and where to go to get it.

Some of course have expressed concern about the level of DHB funding, and it’s not clear yet how much is “enough”, at least with regards to DHB mental health services. But the good news is we are now explicitly talking about a “ring-fence” – meaning a specific amount of money that has to be allocated to mental health services by DHBs as part of their funding.

There is of course more money for suicide prevention – although we are still without a plan – and attempts to address the pressures on staff responding to acute mental distress in emergency departments and increased funding across the board for addiction services.

And of course, more access to support earlier should, at least in theory, take pressure off acute mental health services.

So is $1.9 billion impressive? Yes.

Is it transformational? That remains to be seen.

But at last we now have a plan. And more importantly a clear commitment to listen to the needs and concerns of advocates, professionals, clients and the public.

Let’s hope in five years time we all can look back and see that this is where the transformation started.

 (Click here to read the article via the NZ Herald…)

This was a one off opinion piece I wrote in response to the release of the Government Inquiry into Mental Health and Addiction, published in the NZ Herald Wednesday the 5th of December.

Yesterday He Ara Oranga: Report of the Government Inquiry into Mental Health and Addiction was released, the culmination of over 5200 submissions, and 26 public meetings into the state of Mental Health and Addictions treatment in New Zealand.

The report focuses on the need to expand access to treatment, along with a wholesale change to the way that mental health and wellbeing is treated in New Zealand. This includes taking a whole of Government approach to wellbeing, and establishing a Mental Health and Wellbeing Commission. It also makes clear that our approach needs to put “people at the centre” of any approach.

It’s hugely encouraging to see the review panel so clearly put people, and their whānau, at the heart of this report, recognise much of the system needs to change, and that there is a clear and urgent need for greatly expanded services to cater to those with so called “mild to moderate” mental health difficulties.

There is clear recognition in the report that our current services are inadequate, and their focus too narrow to capture the needs of a growing number suffering psychological distress and addiction in our communities. Additional funding and new services, especially at the community level, are recommended to address this need.

It is further recommended that the Mental Health Act and the way we administer compulsory treatment be repealed, and replaced with an approach that minimises coercive treatment, along with decriminalising addiction and treating drug use as a health, not a criminal matter. A clear target for suicide reduction is also recommended.

I believe this as an opportunity to radically reshape how we talk about, how we treat, and how as a nation we respond to psychological distress.

It’s now time for the Government to deliver what we can truly call a People’s Mental Health System.

If you enjoyed this article please make sure you click here to view the the original article in the NZ Herald.  The Herald measures the popularity of columns based on how many people view them.  So by viewing the orginal article you’ll be telling the Herald you like my column!

This is my column this week in the New Zealand Herald, which is published in the digital edition every Thursday…

Psychotherapy doesn’t exactly have a glowing history when it comes to mothers. Perhaps it’s because many of the founding fathers of my discipline were, well, fathers.

Or maybe it was just the times, being as most of the central theories and research, including attachment theory, was initially carved out in the early to mid-twentieth century.

However, I have a simpler explanation. I think it is so easy to blame mothers because, by and large, they’re there. When we think about our childhood, – there they are.

It’s like the old joke. The teenager, in a hormonal rage, turns to their father and screams “it’s all your fault!” Dad looks at them with a confused look and says “How can it be my fault, I was never here?”

From Freud to attachment theory, mothers then naturally become the focus.

It is undeniably true however that children need to attach to someone consistent. But more widely whether it be in the past, in other cultures, or in the Prime Ministers residence for that matter, fathers can and do step into that primary role.

In fact, children are quite capable of forming attachment relationships with many different adults, from an early age. Grandparents, wider whānau, and yes, even Early Childhood Educators.

However, it’s always struck me that while we “value” ECE, and as such are prepared to pay for it, why do we not pay mothers who do choose to stay at home and provide full-time care for their children?

To reduce the conversation down to whether daycare itself is good, or bad, is to simplify something to the point of meaninglessness. No matter what child-care a family might choose, it needs to be consistent, to be high quality and allow attachments to form and hold the child.

But most importantly for families, mothers, fathers and children, their needs to be a range of choices.

Increasingly – and especially in our larger cities – economic reality means most families don’t have a choice. And sadly, parents who may want to choose to be stay-at-home parents, or join parent lead ECE options like Playcentre can’t.

In fact, MSD requires mothers to utilise daycare once the child is three so they can be work available.

Only the privileged middle class still get to choose how to raise their kids.

So perhaps, if we really want to change our culture of attacking, shaming or otherwise critically focusing on mothers we should choose to value them. And how we value things in a capitalist society is to pay for them.

Of course, it would really be funding attached to the child. If mum or dad chose to stay home and parent, they get paid, you can use it to subsidise a nanny, or if you send your child to daycare, they get the money instead.

Parenting in ways that suit your families needs, and according to your own values, shouldn’t be a financial decision, because while you can’t buy love, maybe you can value it.

If you enjoyed this article please make sure you click here to view the the original article in the NZ Herald.  The Herald measures the popularity of columns based on how many people view them.  So by viewing the orginal article you’ll be telling the Herald you like my column!

This is my column this week in the New Zealand Herald, which is published in the digital edition every Thursday…

Odds are, if you’re of a certain age, somewhere in your brain the words “stranger danger” are etched as a dark warning.

Images of dirty old men, strangers with sweets and trench coats dominate what we wrongly assume to pose a danger to our children.

Of course, we now know that this portrayal is, at worst completely wrong, at best a statistical anomaly.

Around 85-90 per cent of sexual abuse is by someone known to the child – family, extended family, neighbours, teachers, sports coaches and the clergy. This is where the danger lies.

So how do we protect our children? How do we teach them to be safe in the world, to protect themselves from sexual abuse without traumatising them in the first place?

Where we start is by helping kids – from the age of about three and up – understand that their body is theirs and that they get to decide who can touch them, hug them and be close to them.

Sex doesn’t even need to come up, although teaching them about “private parts” and the right names for such things is a good idea.

It comes down to boundaries and consent and as parents, building and continuing to build, a safe relationship that encourages openness, and hopefully leaves kids knowing that they can talk to us about anything.

Fortunately, there is a course in Auckland, offered by Auckland Sexual Abuse Help that has been effectively teaching such things in pre-schools for 25 years.

But, despite all the deserved credit the ACC has been getting recently for standing by their commitment to fund sexual abuse counselling – even in the face of recent increases in demand – they have strangely decided to question the funding for the HELP run “We Can Keep Safe” Course – and in doing so put the programme’s future in jeopardy.

Remember those terrible “man slips over in the shower” and “woman falls through glass coffee table” ads a few years back? Part of the ACC’s mandate is prevention.

Surely we have a moral obligation to do as much as we can to try and help our kids navigate the world they find themselves in, especially given New Zealand’s child abuse record.

This isn’t about victim blaming, it’s about empowering kids to make better decisions about how to treat their own, and others’ boundaries with respect. Lessons that will hopefully last a lifetime

How much does it cost to keep our kids safe? About a $100 per child, for a six-week course. Less than one session of therapy.

Come on ACC. Cough up. And I don’t even care if you do it because the numbers stack up.

We can keep our kids safe, we just need your help.

If you enjoyed this article please make sure you click here to view the the original article in the NZ Herald.  The Herald measures the popularity of columns based on how many people view them.  So by viewing the orginal article you’ll be telling the Herald you like my column!