The current state of affairs for psychology in the public system, as summarised recently by a colleague for the PM’s consideration.

The Right Honourable Jacinda Ardern

Prime Minister of New Zealand

We are writing to you as a group of concerned psychologists employed by DHBs across different services regarding the ongoing psychologist strike and lack of resolution thereof. Mental health has received considerable media coverage in recent times and we are concerned that despite the public statements that this area is a priority, we are unable to obtain any satisfactory solution to our issues, and our concerns are met with an apparent indifference.

Psychologists have intensive, scientific training and relevant experience to help address the mental health crisis, yet we struggle to remove barriers to performing to optimum levels in the DHB context in order to be able to do all we are capable of doing in helping our whanau. We are seeking your help in order for DHBs to provide us with:

- Adequate staffing levels to start meeting demand and facilitate safe working conditions
- Appropriate remuneration to make psychology positions in DHBs attractive, allowing better recruitment and retention
- Sufficient access to training and supervision to stay up to date with evidence based treatments, practice safely and prevent burnout.
- Ensure psychology remains an effective and valued component of our complex health systems

The conditions and remuneration in the DHB’s has not kept pace with other organisations and the private sector, with the result that many psychologists have left DHB employ. Mental Health services have not increased for years while the population has grown. There is an inadequate number of psychologists available in the DHBs to meet the demand, with some estimating that New Zealand in general will need a further 1000 psychologists to satisfy this demand[1]. Furthermore we are carrying a high percentage of vacancies due to recruitment and retention issues. Vacancy rates for psychologists in DHBs nationwide are 34%[2]. In Counties Manukau 67% of the psychologist workforce has left in the last two years[3], and this is an area where there is significant need and the impact of a growing population have been felt.

The impact of this on remaining psychologists is serious, morale is low, and many are experiencing, or in danger of experiencing, burnout. Service users are not able to access the timely and optimal care that they need, and new graduate or more junior psychologists in the DHBs are lacking adequate support and supervision as their more experienced colleagues resign. DHBs are the primary training ground for psychologists, and without the support of experienced psychologists, this cannot continue.

Psychologists in DHB employ are at the front line dealing with the most vulnerable people with complex mental health difficulties, who are often suicidal or self-harming in their distress. These are the people, our whanau, who, without treatment, have a high probability of becoming part of New Zealand’s suicide statistics. Psychologists are the profession best able to provide the treatment needed, and we have evidence based therapies available. Unfortunately as things stand access is extremely limited with no realistic prospect of improvement. Vulnerable people have to wait up to a year or even more for access to the treatment they need - and some are dying by suicide while waiting. Others are not even getting in the door. This often also leads to the “over-medicalization” of psychiatric treatment, with our Psychiatrist colleagues often having little other choice than to use medications as a temporary “fix” for problems needing psychological intervention. This is not acceptable and we hope you will stand by your promises and intent to reduce New Zealand’s rate of suicides and improved mental health.

The increased funding allocation in the last budget is a good start. Some funding is already going into developing mental health supports in primary care, however our clients and those on our waitlists cannot access the services they need in primary care. We are often tasked with looking after those whanau described in the He Ara Oranga Report as the “missing middle”, as well as those whanau with significant enduring mental health difficulties. Primary care intervention is great, but will not adequately address the needs of these vulnerable groups. Data supporting this has previously been documented[4]. We don’t need to reinvent the wheel to address the mental health crisis; we just need to “build a bigger bus” to allow everyone to get on and not get left behind.

Psychologists have significantly more to offer than what we can currently do given the restrictions experienced in DHBs. What psychologists provide is not only about talking and listening sensitively, we provide specialist assessment and intensive therapy drawing on a range of evidence-based psychological approaches that we tailor to meet the needs of individuals and their whanau. We liaise with and supervise other clinicians to provide optimal treatment. Clinical, Health and General psychologists have an average of 8 years training, including how to conduct and critique scientific research and develop and evaluate programs. As such we are well positioned to assist with service development to increase community access and develop programmes that deliver results. Unfortunately, with limited numbers of psychologists in DHBs, we are often unable to make a contribution in this area, and decisions about mental health provision are primarily made by managers with little or no psychological training .

Also, there are limited career paths or opportunities beyond direct clinical work for psychologists within DHBs. Psychologists are excluded from clinical governance or most higher level leadership positions within many DHBs. This leaves many senior and consultant psychologists unable to progress or to contribute to the broader management of mental health. This is another reason for experienced psychologists leaving, which in turn leaves new graduates without appropriate supervision. The extremely important, holistic voice demanded by our whanau[5] and represented by psychologists, is lost within the dominant medical model within these systems. Psychology also has a role to play in where the “bus” is going, a voice that is currently largely lacking and/or ignored.

We want to be utilised more effectively and broadly within DHBs to enable better recovery rates for our whanau. Psychologist here and overseas have made significant contributions to address social justice issues related to mental health[6], to develop approaches to be more culturally responsive, approach mental health problems in creative ways[7], and address some of the most complex presentations where medications are of little benefit[8]. The He Ara Oranga report recommended that psychological intervention take centre stage based on consumer feedback. We are asking for this to happen.

We are writing to make you and our service users aware of the what we believe is an evolving crisis that needs to be urgently addressed in the interests of providing optimal care for some of our most vulnerable community members, and a safe, best-practice work environment for psychologists and their fellow mental health clinicians. Psychological intervention is not a “nice-to-have” in addressing mental health, it is an absolutely essential scientific and best practice treatment for many mental health conditions[9]

[1] Health Central https://healthcentral.nz/new-zealand-needs-extra-1000-psychologists-estimates-taskforce/
[2] As found by DHBs and reported to the APEX bargaining team.
[3] Information released to APEX under the Official Information Act: https://apex.org.nz/news/dhb-psychologists-strike-begins-today/
[4] Please see document by Associate Professor Ian Lambie: https://apex.org.nz/wp-content/uploads/2019/10/Evidence-based-secondary-treatment-to-reduce-suicide-in-NZ-20-Sept-2019.pdf
[5] Consumer perspectives in the He Ara Oranga Report https://mentalhealth.inquiry.govt.nz/inquiry-report/he-ara-oranga/
[6] E.g., the work of Prof David Clark in the United Kingdom, in developing the Increased Access to Talking Therapies (IAPT) program enabling many service users to access talking therapies not otherwise available.
[7] Psychologists such as David Barlow, Peter Norton and James Bennet-Levy
[8] E.g. Marsha Linehan’s work on chronic suicidality
[9] See for example the National Institute for Health and Care (NICE) guidelines https://www.nice.org.uk/

Instagram Highlights - Part 2

The Psychologists' Strike, explained

Disgraceland Podcast - Norwegian Black Metal

Another unexpected loss

On a permo

The state of gun violence in the US, explained in 18 charts

Bad thoughts

Francine Christophe

Sword and Scale - Josh Powell

To This Day

Sylvie Reuter

"You almost made me mad"

He's still got it

Man With Issues

Madness in the Fast Lane