Hard News by Russell Brown

The addiction treatment part of the report appears to me to be the most coherent aspect with the clearest outline of a path forward.

It does however, as far as I can see, glide over the significant issues of how to deal with the small number of people who become extremely voilent on p and synthetics. Of course ultimately they should be offered treatment but in times of extreme crisis and risk there needs to be some form direct, immediate intervention which doesn’t sit well with other aspects of the report advocating less coercion.

I think this is part of a broader problem with this inquiry. Mental health is not one system – there are many parts which deal with vastly different situations and risks.

There may be a lot here in the area of community counseling of such issues as situational stress but the idea that there would be no compulsory treatment provisions misses the experience of the other far more acute areas where the greatest risk and vulnerability lie.

The report doesn’t offer much on some of the most important and difficult issues such as risk vs autonomy vs staff safety. They are dilemmas with no simple solutions.

On drugs it makes a lot of sense but for people involved in the most acute high risk areas there isn’t much here. The most obvious first step though would be more funding for existing acute services and more community accomodation for those coming out of acute settings. No need to wait to do that.

It does however, as far as I can see, glide over the significant issues of how to deal with the small number of people who become extremely voilent on p and synthetics. Of course ultimately they should be offered treatment but in times of extreme crisis and risk there needs to be some form direct, immediate intervention which doesn’t sit well with other aspects of the report advocating less coercion.

I don't see that it curbs any ability for the state to deal with violent acts, which are subject to criminal law.

The police can detain them but in what circumstances/environment and what is the role of mental health services. People at present can be placed under the act for a drug induced psychosis – if that option is no longer there what would be the alternative.

I’m not suggesting the current process doesn’t need improving necessarily but any alternative needs to reflect the risks.

People at present can be placed under the act for a drug induced psychosis

I don't think that excludes legal drugs, does it? If you're psychotic because of your Prozac you can still be coercively admitted, because it's about the psychosis and the danger it presents to the individual and the community, not the cause of the psychosis.

but any alternative needs to reflect the risks.

It would certainly be better if it did, but I don't see failing to improve in all ways on the current process as a blocker for some improvements to it. Otherwise incremental improvement would be impossible.

The recommendation is that the mental health act be done away with because it’s coercive. No mention of what could replace it is made and there is no discussion as to why coercive acts maybe be sometimes necessary.

That’s not a recipe for any positive improvement.

What could happen is that, as Russell has suggested, situations are dealt with by the criminal legal system rather than health.

There’s a lot in the report that’s of value but not so much where the crisis is being felt the most – by the most unwell.

situations are dealt with by the criminal legal system rather than health.

I can agree that some pathway should continue to exist for those clearly having potentially harmful psychosis* to be helped rapidly by mental health professionals rather than only the police.

*Or any other potentially dangerous mental health condition. Severe depression for example.

Many individuals, local government bodies, educational institutions and businesses can contribute to the goal of changing the drinking culture without any changes to the law.

No they can't. Like, what?

It's not culture, you change alcohol use and immediate violence numbers with price and hours and distance between outlets. Put the price up on RTDs and they just vanish. Put the price up on Vodka and people will prime with whatever's left cheaper. Put the pubs far enough apart and there's no fights between different pub patrons at closing time. Change hours and people will party at private residences instead of private businesses, pre-load for the party at the pub, or pre-load for the pub at the house, it's all just law, take your pick.

NZs "culture" of drinking has always followed the price, and the hours, and the distance between venues. Because it's not a culture, it's activities happening within the limits of the laws and entirely adapted to them.

People used to return the bottles you know, because the law at the time supported that, enforced company behaviour around reuse. Now the branded crap litters the sides of our country roads, broken glass fucking everywhere thanks very much. Because the laws that supported returns are long gone and company behaviour changes to maximise profit in the current set.

None of it is culture.

Cuz NyooZuld doesn’t have culture??
Nah, of course there are relevant social norms, e.g. about the acceptability of drinking with the purpose of getting utterly munted: social activities may be “within the limit of the law”, but they don’t have to be “testing the limit of the law and/or the body”. The levers you’ve mentioned haven’t had much influence on that despite many tinkerings with settings over the past century (witness the extreme case of the “6 o’clock swill” as a reaction to early closing). Other levers might be more relevant (e.g. “responsible host” laws), but still offer only small parts of the solution.

I can agree that some pathway should continue to exist for those clearly having potentially harmful psychosis* to be helped rapidly by mental health professionals rather than only the police.

In crisis situations where safety is of immediate primary importance establishing rapport and trust is often not possible.

I’m disappointed with the Minister of Police axing the extension of mental health education for police. I can see why the Police Association would push back on that - the Police already have a great many expectations foist upon them - but they will often be first responders to situations that turn out to have mental health as a significant component.

Wherever possible community mental health teams should lead but that’s not always possible but even when the police are in a support role it’s still important to have a reasonable understanding of mental health.

I notice there is often an everymans passive aggressive tone to your posts. Whats up bud? Your darkest fears getting the upper hand when you look out at the world?

The levers you’ve mentioned haven’t had much influence on that despite many tinkerings with settings over the past century (witness the extreme case of the “6 o’clock swill” as a reaction to early closing). Other levers might be more relevant (e.g. “responsible host” laws), but still offer only small parts of the solution.

Agreed. There's a case for saying that New Zealand's binge culture developed under the heaviest restrictions on availability. The 60s and 70s trend to giant suburban beer barns didn't help either.

I also wonder if, like a number of other stats, alcohol consumption over time in NZ is influenced by the baby boomer cohort.

https://teara.govt.nz/en/graph/40691/consumption-of-pure-alcohol-1960-2011

It's interesting that RTDs are the driver for a modest overall rise in consumption since 1999/2000 – which was, of course, the year that the drinking age was lowered.

Of course, this doesn't really show the most problematic drinking, including that leading to foetal alcohol syndrome, which is a massive, generational problem.

...foetal alcohol syndrome, which is a massive, generational problem.

Add to that P babies now coming into the health, education and welfare system and it’s going to place even more pressure on systems at breaking point.

I’m not sure the inquiry said much about how to plan for that. People with that sort of cognitive impairment are going to need specialist mental health care and support.

Pre-tertiary education is about to get a major shakeup with quite some alacrity all without millions spent on an inquiry.

It seems mental health is being treated yet again as a poor cousin. The rhetoric of crisis is not being met by any commitment to action and funding.

A pity NFZ has no interest in mental health. They get can get their interests funded.