More for our neighbours

I work in mental health, but the longer I do this work, the less I believe the system understands what people actually need.

I have spent decades inside it. I am a consultant, a credentialed mental health nurse, working across government and non-government spaces. I sit on boards, including the World Federation for Mental Health, where we promote global mental health and host World Mental Health Day each year. I chair the women’s mental health section. I work across the Oceania region. I collaborate with people from different countries, different systems, different realities.

And still, the same problem keeps repeating.

We are not doing enough. Not for our neighbours.

Not for people in Pacific Island nations facing social change and climate pressure with limited resources.
Not for the people already inside our systems, trying to navigate something that was never designed to hold the full complexity of their lives.

I see it everywhere. Fragmentation. Silos. Services divided into neat categories that do not reflect how people actually live.

We separate aged care from disability. We separate mental health from alcohol and other drugs. We separate physical health as if it exists somewhere else entirely. But no one lives like that. Every person is a mix. A shifting combination of needs, experiences, pressures, and histories.

The system insists on simplicity. People do not.

So we end up with something that does not work.

What I keep coming back to is something much more basic. Something we seem to have lost.

Kindness.

It sounds almost too simple, but I have seen how far it goes.

A young woman once told me she had been terrified to fly to a conference. She did it anyway. I spoke to her briefly, told her she was doing well. That was it. Months later, she told me that moment stayed with her. It helped her keep going. It helped her take the next step.

That is the scale of what we are overlooking.

We talk about systems, policy, reform. But we ignore the everyday human interactions that actually shape experience. Connection does not have to be complex. Sometimes it is just a conversation. A coffee. A simple acknowledgment that someone showed up.

We default to power. To hierarchy. To control.

We need to let that go. We need to accept something fundamental. Every person is different. Different backgrounds, cultures, beliefs, education, experiences. And every person has something to contribute. But we cannot access that if we continue to treat people as categories instead of individuals.

The shift I am seeing, and the one I believe matters most, is the rise of lived experience.

For too long, mental health has been dominated by clinical authority. I remember when conferences were filled almost entirely with psychiatrists. That was the lens. That was the voice.

Now, people with lived experience are standing up and saying something different. They are saying we need to work together. Not as separate groups, not as experts and subjects, but as collaborators.

That means letting go of “us and them.”

The benefits of lived expertise

It means recognising that knowledge does not only come from training. It comes from experience. It comes from people who have lived through the system and understand its gaps in ways data cannot capture.

I do not consider myself an expert. What I know, I have learned from people with lived experience. They have corrected me, challenged me, forced me to rethink what I thought I understood.

Every clinician should have mentors with lived experience. Not as a token gesture, but as a core part of how we practice. Because without that, we risk reinforcing the very systems that are failing people.

If we are serious about change, then the design of services must come from lived experience.

Not informed by it. Not consulted occasionally. Designed by it.

First Nations models of care

We also need to look more seriously at First Nations models of care. We ignore them, despite thousands of years of knowledge about how to care for people within community. Instead, we prioritise medical models that isolate the individual and prescribe solutions from the outside.

We have it backwards.

Community knows how to hold people. Family knows how to support. Care does not begin with diagnosis. It begins with connection.

We need to become wiser to that.

At the same time, we need to accept that change is slow. Systemic advocacy is not immediate. It is not visible in the short term. It requires persistence, collaboration, and patience.

I think of it as being a tugboat. Not the ship itself, not the captain, but one of many forces working to shift something much larger. You cannot turn a ship quickly. You nudge it, gradually, over time, with others alongside you.

That is what this work is.

It takes five to ten years at a minimum. Sometimes longer. Sometimes the outcomes will not be seen in my lifetime. That is the reality of it.

But that does not make it any less necessary.

If anything, it makes it more urgent.

Because the alternative is to continue as we are. Fragmented. Reactive. Disconnected from the people we are meant to support.

So I come back to something simple again.

The need to keep learning.

We cannot assume we understand everything. We need to challenge ourselves, to step into areas we do not know, to listen properly. Not to respond, not to defend, but to understand.

I have sat in rooms thinking I knew a subject, only to realise I understood almost nothing. That moment matters. That discomfort matters. It is where change begins.

Learning. Listening. Connecting.

It is not complicated. But it requires us to shift how we think about expertise, power, and care.

If we do not, the system will remain exactly as it is.

And that is no longer acceptable.

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The advocate for New Zealander's mental health