From Radio NZ’s Sunday Morning with Wallace Chapman, 7th October, 2018

Johann Hari has had his share of criticism – those who say he’s basically told people with depression to throw away their medication. But is that really what he’s done? Local psychotherapist Kyle MacDonald gives his take on Hari’s message and how NZ needs to improve its approach to mental health.


This article was orginally published on December 12, 2016 on the Spinoff website

What do you do when someone you’re close to on Facebook – or someone you hardly know at all – is talking about suicide or exhibiting signs of acute emotional distress? Kyle MacDonald talks to the head of Facebook’s ‘Compassion Team’ to find out how you can help.

We Kiwis love Facebook. As a nation we’re among the highest users in the world, with around 80{1b812f7ed7a77644fff58caf46676f6948311bf403a3d395b7a7f87010507f87} of New Zealanders visiting regularly. Facebook is the third most visited site in New Zealand after google.co.nz and google.com.

But does Facebook care about us as much as we care about it? Should it?

man sitting at the MacBook retina with site Facebook on the screen

You might be surprised to learn that within the organisational juggernaut that is Facebook there is something called a “Compassion Team”. Recently psychologist Dr. Jennifer Guadagno, the team’s head, was in New Zealand for the Netsafe Conference.

So what does the Compassion Team actually do?

“Our mission is to support people through sensitive life moments and enhance well-being,” says Dr Guadagno. “Our team is really focused on understanding those more difficult, sensitive life moments, how people are experiencing them, how they show up on Facebook and how we can support people through them.”

Sensitive life moments like relationship break-ups, bullying, self harm and experiencing suicidal ideation.

The thing is, the Compassion Team doesn’t rely on an algorithm. Facebook doesn’t use a line of code to figure out if people are emotionally distressed. They’re relying on all of us.

Facebook’s mental health support features are located within actions tab under the little drop down arrow on the top right of each post. Click on ‘report post”, select “I think it shouldn’t be on Facebook” and then “more options”. Once you’ve indicated that a post you’re concerned about contains self harm or suicide, you can choose what type of help to offer.

But whether it’s in real life or online, people often don’t know what to say.

“We did a lot of research with people in the lived experience community – people who have had past experiences with suicide ideation or attempts,” says Dr Guadagno.

“On both sides, we heard that same thing: people are worried about saying the wrong thing, not really sure how to go about it but want to do something.

“We suggest a text for them as a way to start the conversation, and they can edit that, add their own [words]. They can completely delete it and put what they want to put or just as it is as a way to start that conversation.”

It doesn’t end there. If you don’t want to reach out, you can anonymously flag the post and Facebook will let the person know someone is concerned. The user will also be sent links and locally relevant services, including helplines, that they can utilise. At times of acute risk, Facebook employees have even accessed local crisis services and sent urgent medical help.

Well intentioned? Without a doubt. Well researched? No question, as Jennifer herself said pretty much everything at Facebook is “data driven.”

But should we be relying on technology like this? Or should we be doing more here in New Zealand, given our relentlessly high suicide rate?

Mike King thinks so. In 2016 Mike spoke to over a 140,000 New Zealanders about emotional health as part of his suicide prevention work with the Key to Life Charitable Trust. From his point of view, there is little doubt we need to be utilising every tool we can.

“Arming people with tools to talk is one of the crucial mechanisms in this day and age. Not only for the person you’re trying to help, but also for the safety of the person trying to reach out. Really simple things, like not saying ‘What’s wrong?’ and instead saying ‘Are you OK?’ or ‘What’s going on?’ and reinforcing to people that you care.”

In many ways this is the point. We can debate whether Facebook cares enough, and while there is little doubt that this initiative is one that should be applauded, it isn’t up to Facebook to care.

Technology can’t replace real human connection – ultimately it’s up to each and every one of us to say something in whatever way we can, to show we care and to not let our friends suffer alone.

But anything that helps and encourages that has to be a good idea.

If you enjoyed this article please make sure you click here to view the the original article at the Spinoff…



Malakai Fekitoa is a great man for admitting anger issues

Malakai Fekitoa

This post first appeared as an opinion piece in the New Zealand Hearld.  Click here to see the original

There is little doubt Malakai Fekitoa is an explosive presence on the rugby field. As a lifelong Blues fan I’m still annoyed we lost him to the Highlanders.

His running is that rare combination of silky and elusive, and brute force, reminiscent of the great Walter Little.

However this week he has risen even further in my estimation, not just as a great rugby player, but a great man, because he spoke very publicly about his emotional struggles off the field via his Instagram account:


We have all read the stories of the bad behaviour of professional sportsmen. It usually involves alcohol and anger. It often leads to violence. But it isn’t the All Blacks we should be worried about.

New Zealand has some of the worst statistics in the world when it comes to domestic violence. Visit any Emergency Department in the country on a Saturday night to see the scale of the problem we have with young men inflicting violence on one another.

And too often the problem is misunderstood. We should never accept aggression and violence as OK, but similarly too few people understand that often anger and aggression for men is a sign of deeper struggles.

When we think of depression most of us think of the stereotypical “miserable” person, and for many this is their experience of depression, an emotional turmoil, unrelenting sadness, numbness and emotional pain. But there’s an old cliché in therapy: “women ‘act in’; men ‘act out'”.

What does this mean? Women tend to internalise their feelings, collapse into overwhelm and self attacks, self criticism, self hate and most extremely self harm.

Men tend to deal with their distress through action, frequently taking it out on others through irritability, anger and for some unbridled aggression.

I don’t know what Fekitoa is apologising for, and in many ways I’m glad we don’t as it means his very sincere message can’t be spun as an attempt to get out of trouble for something, but what is so important is he has made himself humble, vulnerable and been honest.

The path back from anger is simply to talk, just like Fekitoa is doing, to find ways to reach out and talk about the pain: the unhappiness and what fuels the anger. And for so many men this is the hardest task of all. We have too few role models for this.

So I have the utmost respect for what Fekitoa has done, and I hope he gets the help and support he needs. And hopefully it will prompt many more men to speak out, not lash out.

What depression isn’t


The tragic crash of Germanwings flight 4U9525 in the French Alps, killing 150 passengers and crew, seemingly caused by the deliberate actions of the Co-Pilot Andreas Lubitz, has caused a flurry of conjecture and misinformation about the role of mental illness in the events.  Jessica Williams and I discussed this, and what depression isn’t, on Radio Live this Easter Sunday.

“Madman in Cockpit”;”Andreas Lubitz receives treatment for depression”; these were the initial headlines across newspapers in the wake of the plane crash in the French Alps.  Not only is this kind of sensationalism about the supposed mental health status of Lubitz unhelpful, it also appears to be wrong.

The fact is Lubitz received treatment for depression in 2008, and seemingly not since.  It appears he may have had anti-depressant medication in his home, but it is unclear whether he was taking it, nor is that indicative of depression.  What is clear is that being depressed, even suicidally depressed, is no indication of homicidal tendencies, nor is it a predictor of “murder-sucide” as in this case.

Fact: “Depression” doesn’t make people violent.

In fact overall people with a mental health problem are more likely to be a victim of interpersonal violence than a perpetrator of it.  And being a young man from a lower socioeconomic group is the strongest “predictor” of violent behavior, independent of any mental illness.  Substance abuse is also a much stronger predictor of violence than mental illness, and even more so amongst those who are mentally ill.  (about 70{1b812f7ed7a77644fff58caf46676f6948311bf403a3d395b7a7f87010507f87} of violent acts committed by those with a mental health problem are by people who are intoxicated.)  (Click here for the whole article)

Once more it is easy to confuse correlation and causation, and in doing so, reinforce the stigma that people who are suffering with mental illness are “dangerous.”  The fact that Lubitz may have suffered from depression, and committed this horrendous act does not mean one caused the other

So if depression wasn’t to blame, what was?  Well there is little doubt that if he did indeed crash the plane he was seriously disturbed, and whilst this level of disturbance and violence may be rare, what are the signs?  What makes someone want to kill 150 people, and themselves?

“We know from the other (admittedly very rare) murder-suicide events, that these attacks are usually carried out by young men (young men are, in our society, much more likely to be aggressive), a sense of alienation and resentment against other people and society (often fuelled by very real prejudice and unjust social circumstances), a sense of disillusionment and hopelessness, and attraction towards notorious glamour – often, ironically, fuelled by the kinds of headlines that I and my colleagues in mental health resent. And of course ready access to lethal weapons.”  (Click here to read the whole article)

Furthermore, while murder suicide is extremely rare, this particular kind of incident, where the vicitims are not known by the person is particularly unusual…

“Paul Keedwell, a consultant psychiatrist at Cardiff University and a specialist in mood disorders, says that only about two or three people in every million each year carry out murder while committing suicide, and most of these cases are men who end up killing their wives or partners.”  (Click here for the whole article)

Sadly though, I believe one of the downsides of the increased discussion about emotional health, and depression in general, is that depression has become a term that can be to easily thrown about to explain behaviour we find hard to understand.

In doing so not only do these reports confuse and mis-inform, but they risk real harm to all those who struggle under the weight of the despair and monumental pain of depression, who sadly will only ever be a danger to themselves.

And while these sorts of headlines are only words, they are more harmful than “depressed” people ever will be.


Bah Humbug

Bah Humbug

Personally, I love Christmas but it hasn’t always been that way.  In part that’s due to seeing the effect that this time of year can have on the people I talk to.  Working for many years in the Mental Health system I also know how it can be a very busy time for those charged with responding to acute mental health crises.  But why is this?  Why do some people struggle to have a “Merry Christmas”?  Mark and I talked about this on Radio Live this Sunday morning.  (Click here to listen to the audio of the interview)

A recent study by the Samaritans in the UK suggests that nearly half of all men feel sad or depressed at Christmas time…

“Of the 140 interviewed, around 45 per cent say they feel more worried over the festive season than at any time of year, 37 per cent admit to feeling lonely and 30 per cent are stressed and anxious.

For many men, their sadness is increased by the expectation that everyone should have a good time, with 45 per cent complaining they feel pressure from others to be happy when they are not.”  (Click here for the whole article)

There is little question that it is a time of year that comes loaded with expectation, and if you are struggling financially, have conflicted relationships with your parents or family, or have recently lost someone close to you it can be hard to validate these feelings when everyone is telling you to have a “Merry Christmas”.  And the survey is even more important because in the UK, and similarly in NZ, men are more likely than women to take their life than women.

However other studies show the picture may be less clear cut.  Some claim there is no connection between Christmas and increased depression and suicide, pointing out that the suicide rate and admission rates tend to drop in December.  This is true, but the details are a bit more complex.  It seems that suicide and depression presentations drop during December overall but then take a sharp rise immediately following the holidays, as high as a 40{1b812f7ed7a77644fff58caf46676f6948311bf403a3d395b7a7f87010507f87} increase according to one Danish study.

This certainly makes sense to me, as I think what can commonly happen is people can hold on and “survive” the intense stress and distraction of the lead up to Christmas day and the holidays, even if they’re miserable, but once the day has passed and there is more space to think, then depression can come crashing down.

So what can you do to survive the holiday period, and Christmas day in particular, if this time of year tends to make you miserable?

  • Be mindful of “shoulds” and expectations.  As much as possible try to make the day, and the holidays, what you want and need.  Challenge the need to do the same thing every year just because “that’s what we’ve always done/ have to do”.
  • Talk to your partner, family, parents about how to make the days less stressful.  Do we need to have the big midday feast, do all the adults need to buy each other presents?
  • Talk about your feelings, with loved ones and friends.  If it’s been a tough year, take some time to process all that’s happened.
  • Watch how much you drink, alcohol is a depressant and can make our mood worse (even though it might feel like it helps at first).
  • If you’re taking time off try and stick to basic routines around sleep and exercise.  Don’t let yourself become inactive, this can lead to depression.
  • If you’re on your own, try and find some ways to be with people.  Accept invitations to “orphans Christmas” celebrations, attend a local Church service, or volunteer at the City Mission or other charities.  If you do want to just stay home and be on your own, find a way to fully accept that, and make it a day just for you.

So this year if you’re worried about yourself, or someone else, these good people are available to talk to.  Even on Christmas day…


Workplace burnout

We all have bad days at work but what is “workplace burnout” and how does it differ from just having a bad day?  Mark and I talked about this, Sunday morning on Radio Live this week. (Click here for audio of the interview)

Burnout is a growing area of study, at least partly because it seems to be on the rise.  In fact just yesterday organizations like the Employers and Manufacturers Association (EMA) have begun to ask if we need to an “anti-stress law” in New Zealand…

“Imagine a world where those stressful after-work calls, emails and texts were illegal.
The radical idea is sweeping parts of Europe with calls for an ‘anti-stress’ law in Germany, burnout legally recognised in Belgium and an email-banning labour agreement in France.
Many officials, including the German Employment Minister, believe smartphones and email are creating a dangerous culture where employees are constantly on call and unable to separate their private lives from work, leading to a rise in stress levels and mental illness.
Similar problems exist in the Pacific, with a Statistics NZ survey in 2012 showing one in five Kiwi workers struggle with work-related stress and one out of every 10 are unhappy with their work-life balance.”  (Click here for the whole article)

It’s easy to think of burnout as simply being a result of working too hard.  But the reality is a bit more complicated than that.  It seems clear that both personal and situation factors play a role, and that burnout can happen to the worker in the most menial of jobs, all the way through to CEO’s of large companies.

Researchers have identified six key causes of workplace burnout, and only one of them is over work:

  • Lack of Control over work tasks and role
  • Values Conflict between worker and organization
  • Insufficient Rewards, financial and otherwise
  • Work Overload
  • Unfairness of rules and work policies
  • Breakdown of Community and relationships between teams


And so what are the common signs of burnout?  Well helpfully there’s a list of those too

  • Exhaustion
  • Lack of Motivation
  • Frustration, Cynicism and Other Negative Emotions
  • Cognitive Problems
  • Slipping Job Performance
  • Interpersonal Problems at Home and at Work
  • Not Taking Care of Yourself
  • Being Preoccupied With Work … When You’re Not at Work
  • Generally Decreased Satisfaction
  • Health Problems


It can be hard to know what to do if you feel burnt out, especially if you work in an unsupportive workplace.  But many organizations have Employee Assistance Programmes, that fund anonymous counselling for staff.  And for some it can be as simple as taking a break from work, and refocussing on home and work outside of life.

However it can also be an oppurtunity to review how and why we work, and to learn some simple stress management techniques, and to better manage those professional beoundaries.  Because even though work and money are increasingly important in this day and age…

“No one ever said on their deathbed ‘I wish I’d spent more time at the office.’ ” — Harold Kushner”


What’s normal?

What is normal

In my line of work I’m often asked by people, is this normal?  Mostly I’ve tended to suggest that I may not be the best person to ask, and joke that being a therapist can give one a skewed sense of normal.  But increasingly, I don’t think it does.  I think it gives you a wider view of reality, a view unencumbered by the understandable denial and fear that tends to accompany discussions about “mental illness.”  Mark and I talked about this, and what “normal” actually looks like on the Radio Live Sunday morning show this week.  (Click here for audio of the interview)


“Normal: noun   1. the usual, typical, or expected state or condition.”

In New Zealand, we have one of the highest rates for anxiety, and one of the highest overall prevalence rates for mental illness in the world, of those surveyed.  In the latest national survey, and most reliable statistics, the “Te Rau Hinengaro: The New Zealand Mental Health Survey” from 2006:

  • 47{1b812f7ed7a77644fff58caf46676f6948311bf403a3d395b7a7f87010507f87} (nearly 1 in 2) New Zealanders will experience a mental illness and/ or an addiction in their lifetime
  • At any one time 20.7{1b812f7ed7a77644fff58caf46676f6948311bf403a3d395b7a7f87010507f87} (1 in 5) New Zealanders will have experienced a mental illness or an addiction in the last 12 months
  • Anxiety disorders are the most common mental illness, followed by mood disorders and substance abuse
  • The young and those who are socioeconomically disadvantaged are more likely than others to have experienced mental illness in the last 12 months
  • Women are more likely to experience anxiety, depression and eating disorders than men
  • Men are more likely to experience substance use disorders than women
  • Only the USA has higher levels of anxiety disorders than NZ of the 15 countries for whom data is available
  • Only the USA, Ukraine and France have higher rates of mood disorders
  • Only the USA and Ukraine have higher levels of substance abuse (Click here for a summary)


So what’s normal?

When we look at the big picture, it’s normal for young people to struggle more when it comes to managing their emotions.  It’s normal for people in poverty and in sub-standard living conditions to feel miserable and overwhelmed.  It’s normal for women to struggle with anxiety and their mood when things get tough, and for men to drink too much or use drugs when life gets on top of them.

But these figures also only capture the “extremes”: those who get diagnosed with a mental illness.  What that means that your symptoms must interfere with most, or all, areas of your life.  It doesn’t capture those who live with anxiety, who might have bad days and simply carry on, it doesn’t capture what it means to be human and struggle.  Because all mental illness, whether it be anxiety, mood disorders, difficulty eating when under pressure or being impulsive in ways that are harmful, is part of being human.  In that sense it’s very normal.

But it’s much easier to believe it’s “abnormal” to put “it” over there, and make it different.  In a way that’s normal too, it’s just not accurate or helpful.

Denial no answer – let’s talk

This piece appeared in the Sunday Star Times, Sunday the 2nd March, 2014.  Click here for the original article.

OPINION: In the week following the death of Charlotte Dawson, it seems everyone’s been talking about suicide.

Which is interesting, because the default position here in New Zealand, thanks to a coroner’s ruling in 2006, has largely been that we don’t talk about suicide in the public sphere for fear of triggering “copycat” deaths.

What’s also been surprising to me is how some very smart people have said and written some really dumb things about suicide and depression.

Commentators have pointed the blame for Dawson’s death at her childhood, adoption, sexual abuse, her fame, her age, social media bullying and her treatment by the media.

But people don’t kill themselves just because they get bullied, have been abused, are losing their home or their work.

And they certainly don’t kill themselves because they’re losing their looks, or because of the weight of the feminine beauty ideal bearing down on their shoulders.

Ultimately we will never know exactly why Dawson killed herself. But I’ve spent most of my working life talking to people who are actively suicidal, have tried to kill themselves or chronically feel that way.

The only consistent reason that people want to kill themselves is they can no longer stand the intense mental anguish they feel, believe it will never feel different and feel there is no other solution.

Suicidal depression has many causes, often as unique as the individual.

Some of the things I listed above may be a factor, but there is no one fundamental cause of depression and it’s deadly outcome, a sense of hopelessness.

To go looking for the cause is understandable for those left behind, but ultimately futile.

When people are in the grip of these emotions, their perspective is distorted, they can see no future and no hope, they are not in their “right mind”.

That’s why we have special laws that enable us as a society to detain people and treat them against their will when they are suicidal, people who want to end their life can no longer make good choices for themselves.

The number of deaths in New Zealand last year due to suicide was 541. That’s more than 10 people per week and 200 more deaths than those killed on the roads annually.

Yet we struggle to talk about it.

Chief coroner Neil Maclean recognised that in 2012 when he said “suicide needed to be brought out of the shadows” and that we should be free to report on it and talk about it in the media.

Although there is some, albeit quite weak, evidence for a reporting ban, what is clear is that preventing the reporting of suicides has made absolutely no difference to the suicide rate.

And we can’t measure how much of an impact not talking about it openly has had.

There is little doubt in my mind that to deny something, as we do as a culture and in the media with suicide, is to give it more power.

It also can leave people in general in the dark about how to talk to someone who is suicidal.

I know it makes people who feel that way more isolated and alone.

I don’t think for one moment we should rush to a conclusion.

But it’s a start that we’ve been able to talk about it.

Perhaps now we could also start having the right conversation.

– Kyle MacDonald is a psychotherapist and blogger. He is the New Zealand Association of Psychotherapists Council spokesman on public issues.

– © Fairfax NZ News