In December 2018 an inquiry into the state of mental health and addiction in New-Zealand resulted in He Ara Oranga – the report of the Government Inquiry into Mental Health and Addiction. The report, delivered to the Minister of Health, described an underserved and unacknowledged population – the missing middle. This label refers to those who are in distress, would certainly not meet the definition of ‘mental flourishing’, yet do also not meet the criteria necessary to qualify for mental health support.
The aim of the report was to address current gaps in the system and expand access to mental health services. It was to do this by bringing forward a list of recommendations. A total of 40 recommendations were outlined, of which 38 were accepted by the government. For a summary of the recommendations, both accepted and rejected, view our February 2019 article He ara oranga overview: The report of the government inquiry into mental health and addiction.
We were pleased to see, among the many recommendations accepted, the following two:
Recommendation 12: Commit to a staged funding path to give effect to the recommendations to improve access and choice, including:
expanding access to services for significantly more people with mild to moderate and moderate to severe mental health and addiction needs.
more options for talk therapies, alcohol and other drug services and culturally aligned services.
designing and implementing improvements to create more people-centred and integrated services, with significantly increased access and choice.
Recommendation 10: Agree that the work to support expanded access and choice will include reviewing and establishing workforce development and worker wellbeing priorities.
Unfortunately it is not clear how exactly this is being achieved, or how the Wellbeing budget has been allocated in support of these recommendations.
The 2019 Wellbeing Budget – the first ever in New Zealand – incorporated priorities based on these recommendations, however in 2020, with much of government focus and resource being directed to managing the COVID-19 pandemic, priorities have shifted.
One of five priority areas of the 2020 budget is Physical and Mental Wellbeing - Supporting improved health outcomes for all New Zealanders. However, again, it is not clear how this is going to be achieved. These are sentiments recently echoed by Mark Wilson, Senior Public Relations & Media Engagement Officer of the Mental Health Foundation.
“The MHF remains concerned that the Budget is lacking in some key areas, including:
No resourcing or implementation plan for the recommendations of He Ara Oranga – without a plan we are concerned that progress will stall and drift.
…There continues to be a need for greater focus on peer support and lifting the voice of people with lived experience of mental distress and suicidal thoughts and feelings.
The details of any re prioritisation of spending that may affect mental health and suicide prevention.
While we are pleased to note initiatives focused on providing mental health crisis and suicide prevention support, and an increase in available telehealth and digital mental health services such as 1713, what seems missing is the obvious (at least to our admittedly biased eyes) area of focus – workplace mental health, a great contributor to population wellbeing.
In other words, a targeted effort to increase mental health awareness, education, de-stigmatisation, and support for the functional missing middle. A current New-Zealand employment rate of 70% means the greater majority of the population spend a significant portion of their day working. Work environments subject people to all forms of stressors and psychosocial hazards which pose a very real risk to mental wellbeing, but they also provide a perfect platform to build mental wellbeing and mental health literacy.
It is now well know that according to The Health and Safety at Work Act 2015, the need to address psychosocial hazards at work and reduce psychological harm for all workers is a legal requirement. The Health and Safety at Work Strategy 2018-2028 cites mental health as a priority under the goal of limiting harm, although admittedly, it is quite evasive on the ins-and-outs of this priority.
What does the research say?
The WorkSafe funded annual 2019 NZ Workplace Barometer survey measures, among other things, psychosocial safety climate (PSC) and its relationship to employee health and wellbeing.
PSC is described as an important precursor of stress-related illness (Dollard & Bakker, 2010) and is a key indicator and predictor of worker engagement and psychological health.
Psychosocial hazards can result in negative outcomes such as work-related stress, burnout, depression, and its effect can build up over time. Consider this in our ongoing stress and uncertainty heavy environment.
These psychosocial hazards and risks can incur a considerable costs to organisations. A 2014 European Union report estimated that psychosocial hazards cost as much as €25.4 billion per year (European Agency for Safety and Health at Work (EU-OSHA), 2014). In the United Kingdom, work-related stress, depression or anxiety are responsible for 44% of cases of work-related ill health and 57% of working days lost in 2017/18 (HSE, 2018). From our experience working and surveying within many New-Zealand organisations, work often plays a starring role when it comes to sources of stress.
Based on the recent New-Zealand sample, 44.4% of respondents reported scores that indicate a potential high psychosocial risk to these workers with associated negative outcomes such as depression.
The study found that, contributing further to distress, even more so than the effects of bullying, is job insecurity – a fact that should be noted by all employers in the current COVID-19 environment.
More than two thirds of respondents (69.6%) reported an absence from work during the last 12 months due to ‘physical or mental health’.
The most recent Southern Cross Society Workplace Wellness Report completed in 2019 showed that 23% of businesses has seen an increase in reported stress of employees, and cite this as a cause of absence. Workload was named as the most commonly work-related stressor.
COVID-19 has introduced financial burdens to organisations, and demands to be leaner than ever. With employers being financially unable at times to fill vacant positions, remaining employees are seen picking up the additional work responsibilities.
The study further noted that a typical employee’s absence costs an employer up to $1,000. The direct costs of absence amounted to $1.79 billion across the economy in 2018.
For those interested, results are tentatively available from the 23 week COVID-19 Health and Wellbeing Survey. What stood out most to us were the rates of reported loneliness and isolation, at 21% in the most recent week, which of course now many of us know is negatively associated with brain (think performance and memory), physical and mental health.
Pooled data from Mental health Monitor and Lifestyle Survey reported that almost one-third of people reported experiencing mental distress in their lifetime (31%) and 77% of people knew someone who experiences mental distress.
Of those respondents who were currently experiencing mental distress, just over one-third (36%) reported being discriminated against because of their mental distress.
The findings showed that familiarity with mental distress is associated with higher willingness to work with, live with, or live nearby people experiencing mental distress. These findings again reinforces the need to increase education and promotion around mental health and wellbeing, to both normalise the topic and increase engagement in support.
Beyond workplace wellbeing
Zooming out now to the broader New Zealand population the 2018/2019 New Zealand Health Survey reported that on average, 20% of New-Zealanders are affected by mood or anxiety disorders – that is approximately 778,000 people. Over 323,000 adults suffer from psychological distress, with this latest statistic having climbed steadily over the years. The rate of psychological distress for women is almost double that of males, and is also highest in the working population age bracket.
Provisional suicide rates in New-Zealand indicate a reduction in suicide, with rates being the lowest it has been since the 2016/2017 reporting period, a positive finding. The ratio of male to female suicide remains unchanged at 1:3, with males being much more likely to take their own life. Suicide rates are highest among 25-34 year olds, and drops off at retirement age (+65).
It is clear that while progress is being made toward addressing mental health in New-Zealand, there is still a long way to go. Mental health exists on a continuum - we are not either mentally healthy, or mentally ill, yet the words mental health still hold connotations to mental illness for many. The reality is that most of us at some stage in our lives will experience depression or severe psychological distress. Furthermore, it doesn’t need to reach those heights to affect us across multiple domains of life and health.
Understandably, we have yet to see the statistics of the true impact of 2020 on the wellbeing of our nation. One can easily conclude that the stress induced by this rollercoaster year will be felt for some time, and will continue to ripple through the recesses of all our lives.
Employers have immense power to influence the wellbeing of their people. Don’t wait for the wheels to fall off. When we act early, everyone wins.
Blog by Ance Strydom