We need a coordinated national crisis response system

At Te Hiringa Mahara, the Mental Health and Wellbeing Commission, we recently completed a report monitoring crisis responses across Aotearoa New Zealand over the past five years. We looked at what is working well, what is not working so well and, most importantly, the experiences of people accessing crisis support.

We spoke with many people and examined a large amount of data. From that work, we defined what we believe a good crisis response system could look like for Aotearoa. We also made recommendations about what is needed to establish a cohesive, coordinated national system.

Good services are not reaching everyone

There is a great deal of good work happening across the country. We found strong initiatives and services, including peer-led acute alternatives and kaupapa Māori services. The problem is that these services are not available to everybody. Access often depends on living in the particular part of New Zealand where an initiative has been established. We looked at how other countries approach crisis response and completed a literature scan. That work reinforced our recommendation for a nationally coordinated system. At present, we have a range of different services that are fragmented and varied. We need to connect them so people know where to seek help, how to reach out during a crisis and how to receive the support they need.

Connecting what already exists

Many initiatives have been funded locally, but the missing element has been system-level planning about how everything connects. Across the country, people are given different phone numbers to call. Twenty-four-hour, seven-day telephone support is not available everywhere. Establishing that access was one of our shorter-term recommendations.

We also need much clearer pathways through primary care. This was another area we identified as requiring attention.

There have been promising developments in acute alternatives, including peer-led services, peer support in emergency departments and the rollout of crisis cafés. Co-response teams bringing police and mental health professionals together are another part of the emerging response.

I want us to maintain that momentum. These services need to continue expanding until everybody can access them, rather than remaining isolated initiatives available only within particular communities.

Designing for every population

Our central message is that we need a networked, coordinated system. People must understand how to reach out for help and know which telephone number to call. We must also ensure that every population can access the support being developed.

Rural New Zealanders face real barriers. Particular population groups are also finding it more difficult to obtain the support they need. A national system must recognise those differences. Coordination should not mean assuming everybody has the same circumstances or can reach services in the same way. It should mean connecting support so it is clear, accessible and capable of meeting the needs of all our communities.

Removing unnecessary age barriers

I have also been thinking about the needs of our ageing population. There is considerable attention on younger people, but much less discussion about mental health support for older adults.

One problem is that we place age barriers around many services. Some of the newer initiatives, including crisis cafés and peer support in emergency departments, are available only to people aged over 18. I recently visited a new service being established in Bondi, Sydney. It provides free and easily accessible mental health support without age restrictions. The service was described as being available from the cradle to the grave. It is designed for young people and families, through to people in older age groups.

That visit made me question why we impose age barriers. I see no reason why an accessible drop-in service of that kind could not also meet the needs of older people.

Closing the gaps between services

We also need to examine the distinction between mental health and aged care. It is not always clear which service is best placed to support an older person. The result is that some people fall through the gaps. As our population ages, this is likely to become a larger issue. We should not wait for those gaps to widen. We need a crisis response system that connects existing services, extends access to effective initiatives and gives people clear ways to seek help.