Parked in the forecourt

Last night, before I went to bed, I put some wholegrain oats and sultanas into a pot with water to soak overnight. to make porridge for my breakfast this morning. It wasn't until I woke this morning that I remembered that the Directorate Leadership Team were having an end of year breakfast together. So I stayed in bed for an extra three quarters of an hour. And left the oats in the pot for tomorrow morning.

The cafe we went to is "Mojo" in Newmarket, a little further from home than is the hospital. I gave myself a half hour to cycle there, took just 20 minutes, and was therefore well and truly the first to arrive. Lots of customers were coming and going, and although they don't take bookings, the staff pushed two tables together and put a reserved sign on it when I said that I would be joined by eight colleagues. Guessing rather than counting up, and was exactly right (if I was included in the count). 

They roast their own coffee and it was very nice, complementing well the open omelette I chose. A very relaxing place for breakfast and then back to the office and meetings and sorting things out.

The Ministry has circulated a summary of submissions on aspects of the Mental Health Act to those of us who have the same role as I do in Auckland for their DHB; a statutory role in the administration of the Act, and responsibility for overseeing appropriate care. Submissions closed nine months ago, and just now are they telling us what the submitters are concerned about.

It seems that the greatest conformity in the submissions, was unhappiness that there is insufficient attention paid to "social reasons for mental illness". That was contrasted with the medical model. My problem with this is that identifying a diagnostic category, and therefore an appropriate treatment can be life saving; it can improve quality of life immensely; it can restore a sense of self that is otherwise lost in the turmoil of psychosis or uncontrollable mood changes. Social structures, good and bad, have massive influence on outcome, and it therefore becomes not either/or but how much of each.

We are facing yet another Government Enquiry into Mental Health services. Why they cannot look back over even just the time I have been in this field, and see that not one of the previous enquiries has achieved the worthy aims leading to having the enquiry. If the voices of the patients could really be listened to, and then responded to we might get somewhere. When services are based on "managing risk" not on treating illness and distress, no amount of investigation will change anything.

A few years ago, there was a spate of suicides of young mainly Maori in Northland. A youth who knew one or more of those who had died, thought about it, decided what was causing such despair and initiated talk and action amongst his community. Authorities went north from Wellington and discouraged publicity despite that the community's actions were resulting in significant improvement in how their young people were feeling and behaving. And succeeding at school. The initiatives were not supported with the resource required, and there is a fear that the previous situation is returning. 

Meanwhile a meaningless and vacuous conflict between the impacts of inequity, lack of opportunity, alienation, unemployment, cultural disregard to the extent of institutional racism, and the effects of actual mental illness occupies the attention of the policy makers. Dealing with the important social factors is no more, nor no less, important than treating any illness a person has. 

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