On January 24, 2018, the Prime Minister, Jacinda Ardern, announced Labour’s promised government inquiry into mental health and addiction services and on November 28 the report, He Ara Oranga, was released.
The whole process was good news for mental health field but, I fear, it has and will be a mixed blessing for the addiction field.
While a nationwide review of the extent and quality of our responses to addiction is long overdue, alongside others working with in this field, placing the word “addiction” next to mental health sets off a very loud warning bell.
The challenges we face with addictions may on the surface appear to resemble those encountered in mental health: they both involve someone caught in an overpowering emotional vortex, they both impact severely on families, they both contribute significantly to our appalling suicide statistics and many people struggle with both mental health and addiction issues.
However, the similarities here are misleading; they mask some fundamental ways in which these two fields are different.
First, the most common forms of addiction, to alcohol, nicotine and gambling, owe much of their force to the legalized industries which package, advertise and promote their products; there is no equivalent to this in mental health.
Second, the consumption of addictive products are deeply embedded into our society. For example, the manner in which a society values and celebrates alcohol plays a big part in how problems emerge and what we do about them.
Third, while addictions have strong health impacts, they also have much broader social and societal impacts in terms of crime, violence, corruption, poverty and social disruption.
And finally, the treatment approaches between the two fields are based on very different ways of thinking about how people change. For example, while treatments for mental health tend to focus on ways of caring for and protecting people from harm, treatments for addiction place far more emphasis on strategies that promote self responsibility.
In my forty years of involvement with both fields, I have been dismayed to watch planning for addictions being repeatedly tacked onto and then wrapped up in what are essentially plans for what is required in mental health.
For example, the Mental Health Commission in its two previous Blueprints simply subsumed planning for addictions into their documents with very scant regard for its specific needs. Similarly, in hospital services, mental health leadership has repeatedly incorporated addiction services under a mental health umbrella, leading to regrettable losses in terms of treatment integrity and innovation.
The formation of the committee for the current inquiry assembled a group of people with experience and expertise around mental health. None of the committee have recognizable backgrounds with addictions.
Now, eighteen months after the release of the report, we have seen little in the way of change for addictions.
Their main addiction recommendation, to implement changes in the availability, pricing and promotion of alcohol, has been ignored. Addiction services remain poorly funded and lacking in adequate national organization and representation.
There also remains an issue with one of their core recommendations to establish a new “mental health and wellbeing commission”, where yet again the addiction field’s unique needs and challenges are subsumed under mental health.