Up Front by Emma Hart

It works: End of story. 

I often think, it’s a strange job, being a therapist.  From a certain point of view all I do is have conversations with people.  I also often feel deeply privileged.  Just like the stories courageously told here, I get trusted with some of the most intimate details of people's lives in the hope that talking might help.  But it is a very particular type of conversation, which I and my colleagues trained many years to be able to have. 

And actually it’s no mystery.  

What is a mystery is how a Chief Medical Director at one of the nations largest insurance companies, Sovereign, can remove cover for counselling and therapy from their policies, on the basis their isn’t really any evidence it works.  This is a bold statement especially when they are happy to keep funding medication, which they claim does “work.”  

The American Psychological Association (APA) in the USA made one of its strongest statements to date last year, in a release titled “Research Shows Psychotherapy Is Effective But Underutilized.” 

“While medication is appropriate in some instances, research shows that a combination of medication and psychotherapy is often most effective in treating depression and anxiety. It should also be noted that the effects produced by psychotherapy, including those for different age groups and across a spectrum of mental and physical health disorders, are often comparable to or better than the effects produced by drug treatments for the same disorders without the potential for harmful side effects that drugs often carry.”

Furthermore, the frontline medication treatment of SSRIs or “Selective Serotonin Inhibitors” are currently at best questionably effective for mild to moderate depression. 

This isn’t new information.  The National Institute for Clinical Excellence (the beautifully acronym-ed “NICE”) have said since 2005 that the frontline treatment for mild to moderate depression should be psychotherapy.  

So let’s be clear; this isn’t an ideological or even a political argument.  Therapy and counselling are not some wacky alternative treatment that should be a luxury for those who can afford it, or “believe in it”.  Belief has very little to do with it. 

But money does.  Frontline generic SSRIs costs less than twenty cents a day.  Therapy comparably can cost between $80 to $150 per session. 

Doing nothing also costs nothing, but it would be hard for even Sovereign to argue that is a treatment option.  

But no surprise the National Government has. 

The review of the Family Court is poised to remove all funding for couples counselling, a service that anecdotally was highly effective (and empirically supported), however Judith Collins sees no evidence it works and WINZ are also reportedly tightening up the access of funding via disability top ups for counselling costs. 

So while it is now OK for us to talk about mental health and even for All Blacks to be depressed, as a nation we can no longer afford to help. 

That’s not depressing.  It’s heartless.

Kyle MacDonald is a psychotherapist and blogger at www.psychotherapy.org.nz.  He is a regular contributor to the Wallace Chapman Sunday morning show on Radio Live and Chair of Public Issues for the New Zealand Association of Psychotherapists.

I very much wanted to blog about this issue, but I felt I couldn't without betraying too much personal information that wasn't mine. I put out a plea for guest posts, and Judith was good enough to volunteer. Please treat her with the sensitivity for which our community is known. ~ Emma.

 Sunday's New Zealand Herald ran a story about cuts to the availability of talk therapies in both the private and public sectors. This seems utterly wrong-headed to me.

Several years ago, after my daughter was born, I got a bit depressed. Ok, maybe it was more than a bit. I got catastrophically depressed. I was unwell enough that I don't remember much of what happened very well, but this is what I can remember, with a bit of help from the people that helped care for me.

I stopped functioning. So I was taken to the doctor (I had to be taken, because I wasn't functional enough to take myself anywhere). He wrote me a prescription for citalopram. I took it religiously for six weeks, before going back and telling him it wasn't helping, that I was still fundamentally unable to get up off the couch. I was suicidal, I wanted everything to just stop existing. So he packed me off to the hospital mental health team.

I don't remember the crisis team that treated me. I don't remember which drugs they added to my regimen - I remember than I was on two or three at least. What I do remember was that they sent me to the Acute Day Programme. This was a step down from being an inpatient in the mental health unit, where you would attend a programme at the hospital every day from 9am to around 3pm. In the mornings were group therapy sessions, and in the afternoon were activities of various types.

I hated the group therapy, with a passion. I didn't want to open up to a bunch of strangers. But over the course of a few weeks of these daily sessions, I started to. And I started to find my reasons for

living again. I was helped up out of the pit and started to see the sunshine again.

I have always wondered if things would have been different if I had been able to talk to someone when I first started spiralling down. Maybe I wouldn't have gotten so very unwell. I will never know. Counselling was not available to me until I was very, very unwell.

I have been a mental health patient for more than ten years now, and one thing I have discovered is that SSRIs do not work for me. It's always been the front-line treatment, to write for whatever SSRI the doc of the moment preferred, and they simply do not touch the deep, black depression that I suffer. So the idea of just writing an anti-depressant prescription seems wrong-headed to me. The boast that I've seen is that they work 70% of the time. That means that 30% of people will continue to suffer, and they will have to play medication roulette until they find something that works. Having the option of both medication and talk therapy running concurrently would seem to me to make so much more sense. But counselling is expensive, and many antidepressants are cheap - fluoxetine (Prozac) is three cents per pill, as is citalopram (Celexa). Three to six cents a day seems very attractive when compared to the hundred-plus dollars it costs for each counselling session.

Sovereign are planning to cut counselling sessions for their clients, because it's too expensive. If they were saying that chemotherapy was too expensive, and that they wouldn't pay for it for cancer patients, people would be screaming. Chemotherapy, radiotherapy, and surgery are all parts of a treatment plan, and taking one away because it was too expensive is compromising people's care, and increasing the

chance that they will not recover. It's exactly the same with mental health treatment plans - all options need to be open, and the best one selected for a patient's needs.

These issues come from a fundamental misunderstanding of mental illness. People, medications are not magic bullets. They don't just make everything better. Mental illness is complex, and requires some combination of medication, self-help, and talk therapy to recover. Talk therapy is slow and expensive, and it's not as sexy as a magic potion that solves everything, but it can be the basis of life-long wellness, as people learn better ways of thinking and dealing with what life throws at them. Taking that option, and those tools, away from people is wrong.

Judith Fursdon blogs at Drop Bear Exterminator. 

Hey guess what? It's my turn to write the "This Herald Editorial is Batshit" column. In my defence, this Herald on Sunday editorial is batshit. I nearly didn't write a column. I was just going to upload a clip of me reading it aloud in my Outraged of 1870 voice. Imagine Stephen Fry wearing pearls and a twin-set. 

Oddly, the first two paragraphs lay out a very good case for why there should be sex in Young Adult fiction: 

Children are exposed to a great deal of explicit sexual material these days. As they come through puberty and beyond, they are liable to come across so much of it on the internet that those who would like to bring a better influence to bear might despair.

They should not give up. There are more weapons in the fight than heavy-handed bans and censorship that never worked, even before pornography was as pervasive as it is now. The best weapon is a book.

You'd never guess, from that opening, that this was a piece that was going to go on to describe an award-winning book (which, it appears, the columnist has not read) as "a waste of time" simply because it includes sex. No other objection to the book is raised. Sexual content has automatically made it bad. 

Anyway, let's take a brief break from trying to read "It is not prudish or patronising to maintain a certain standard, it is re-assuring them that quality exists and people they respect can recognise it" aloud without laughing, and address the question. Should there be sex in Young Adult fiction? 

Of course there should. What the fuck is wrong with you? 

The book in question, Ted Dawe's Into the River, was in a category for readers aged 14-18. Any discussion of the 'innocence of children' is as irrelevant as Bob McCoskrie's opinion. Most avid readers in that age bracket will be reading adult fiction as well as Young Adult. Also, most of them will be aware that sex exists. 

The vast majority of teenagers are sexual beings. For stories intended to be for and about them to contain no sex is a case of Your Defaults are not Apolitical. This isn't about jamming inappropriate material in where it doesn't belong. It's about addressing the weird obvious gap where it would naturally be. (Also, it's never been the default for YA. Tomorrow When the War Began is twenty years old. Where did your copy fall open?) Teenagers want depictions of sex. They actively seek them out. 

And "So Morally-Panicked They Could Barely Type" has a point. Teenagers have access to a lot of shitty depictions of sex. What better counter-balance to that than well-written depictions of sex in Young Adult novels? Where better to genuinely show the awkwardness and angst and fear of adolescent sex than where you can have an internal narrative? (As Carrie Mesrobian says, "Stay in the cringey spot.") You could even have, and I know this is a bit radical, depictions of sex that show clear consent as natural. You could show boys having genuine emotions and feeling hurt and being afraid of being rejected or not knowing what to do. 

Including sex also allows the inclusion of issues of sexuality and gender identity. My teenage years were the 1980s, and I can't remember ever once reading a book with an LGBT character. Never. 

Last year, when my daughter was fifteen, I lent her my copies of Jacqueline Carey's Kushiel books. Well, I gave her the Naamah books and meant to talk to her before she got to the ones with the explicit BDSM content, but she read them too quickly for that. I was more than happy to do this, because these books depict a world where sex is a positive, varied thing. Same-sex relationships and kink relationships are treated with the same degree of focus and respect as opposite-sex and vanilla relationships. Consent is clear. Casual sex is had honestly and freely. The underlying theme is "Love as thou wilt". All this is not in spite of the explicit content, but because of it. Why wouldn't I want my kids to see those things as possible?

So Lianne Dalziel has finally declared that yes, she is running for mayor. There'll be plenty of time to talk about the mayoral race later. The other thing this means is that there'll be a by-election in Christchurch East. What I want to do at this point is just have a quiet, general word with the Labour Party about Not Fucking This Up. 

It's been clear for a while that you'll need new candidates in East and also in Christchurch Central. I'm mostly going to pretend that I haven't heard any rumours about who those candidates might be, except for this one, because it was in the paper. Now, it may be that it's about as soundly based as that time The Press suggested that perhaps Bob Parker wasn't going to to run for mayor again, but just in case it's not, what the hell were you guys smoking? You're thinking about standing Clayton Cosgrove in Christchurch East, instead of him fighting to regain Waimakariri? I mean, I guess it would be an efficient way of showing both electorates exactly the same degree of respect, but really? This is Christchurch. Even moving someone in from North Canterbury is considered carpet-bagging here. 

Look, I don't know if you noticed (no, seriously, I don't know if you noticed) but we had an earthquake. Everything changed. That's the only issue there is here. We feel abandoned and betrayed. We feel like we're fighting a war, and Campbell Live are the only people who know it's happening. That might not be a fair appraisal, but it's how we feel. 

This is not the time to be taking us for granted. Yeah, we really hate those other fuckers, and yeah, those are traditionally safe Labour seats, but you know what happens if you don't engage us with your candidates? No, we don't vote National. We just don't vote at all. That's what happened in Christchurch Central. It didn't swing to National. Wagner won the seat with 1079 fewer votes than she got when she lost it the time before. In particular, if you want us to turn out for a by-election? You need us to be actively on your side. Or rather, you need to be actively on our side. 

You need to stand people we feel are down here in the trenches fighting with us. And when I say "us", I particularly mean women. All "shoulds" aside, it's the women in eastern and central Christchurch who are particularly carrying the emotional burdens of what's happened to us. Even if we work, we're more socially expected to look after our families, mentally and physically. We're the ones walking our children through the pissing rain for forty minutes to get to their "new" school, and trying to make them feel okay about it. A quarter of our teenage daughters exhibit symptoms of PTSD, and you know what? We kind of feel like that's our fault. We are tired and angry and sad. 

James Dann is right: this by-election is a chance for our issues to make the news night after night. We need you to stand someone who knows how we feel. Your candidates should be people who marched with us, who fought with us even when nobody else was paying any attention. I would love it if at least one of the candidates you chose, for Central or East, actually was one of us: the exhausted scary fucked-off mothers of Christchurch.

One of the ways I can tell I'm getting old is that sometimes, when my Social Media Posse are raising hell on an issue, I find myself thinking, "Man, it's way more complicated than that." The case of Kaitlyn Hunt is one of those times. 

You might think I'd be utterly unambivalent about this. Here's an eighteen year old girl facing a felony prosecution for 'lewd and lascivious battery' for having sex with her fourteen year old girlfriend. Isn't this clearly homophobia? 

No. Kaitlyn's girlfriend's parents might have pushed the prosecution because they're homophobic, or they might have done exactly the same thing if their kid had been sleeping with an eighteen year old boy. We don't know. The prosecution would still have been taken if the older teenager had been male. We know this, because it happens. There have been many cases in the States of boys facing felony prosecution, and the rest of their lives on Sex Offender Registers, for having consensual sex with their younger girlfriends. Homophobia is probably a factor, but it's way more complicated than that. 

There are also clearly people who find this relationship less problematic because it's not heterosexual, not more. Some people have a much easier time thinking of a theoretical eighteen year old boy as a manipulative abusive predator than they do a girl. That's problematic too, because it's based on a sexist assumption that the male is always the one pushing for sex. 

Here's the question that should be really hard to answer: is it wrong for an eighteen year old to have sex with a fourteen year old? Mulling this question led me to an even curlier one: should there be an age of consent? 

Our age of consent is about right, yeah? Sixteen; seems about right. Not fifteen, that's too young – unless you're Swedish. And fourteen is definitely too young. Germany and Italy have that dead wrong. Thirteen is ridiculous. That's only for creepy third-world countries, like Spain. 

There are countries, and states in the States, where it's only legal to have sex with someone under eighteen if you're married to them. A fifteen or sixteen year old can't possibly consent to something as significant and life-altering as casual sex, but marriage? No problem. In the Cook Islands and Samoa there is no age of consent for boys. In Canada – Canada! – the age of consent is orifice-dependent. 

Any age of consent is deeply problematic. It's a bright line. It says that today someone cannot possibly consent to sex, but tomorrow they can. It creates a situation where two people can have sex they both want, and both be guilty of a crime. 

One of the ways some jurisdictions have tried to deal with the injustice this can cause is the "Romeo and Juliet" exception that might have saved Kaitlyn Hunt had she been a little younger. This offers mitigation, or negates the offence, if the couple are 'close in age'. How close is close enough varies. 

What Romeo and Juliet laws try to convey is that a relationship is okay if the couple are peers. When I was fourteen, my boyfriend was seventeen. Nobody who knew us thought that was a problem. We were clearly peers. Equals. The fact that our age difference crossed the age of consent did not create an unhealthy power dynamic. 

So Romeo and Juliet laws are clearly a good idea, right? I mean, as long as you don't do it like Kansas. There's still a bright line, though. To quote from Connecticut's law: 

A 15-year-old born on 1 January can consent to a 18-year-old born on 1 February. This is just under a 3-year age difference. A 15-year-old born on 1 February cannot consent to an 18-year-old born on 1 January.

Can age of consent law be done well at all, when age is the only signifier of maturity and power dynamic we can use? What's its purpose? A hundred and fifty years ago or so, the age of consent was about three years below the average age of menarche. Now, it's about three years above that. Is it about protecting children from paedophiles, or teenagers from mistakes? Can we have an informed debate about it in a society that's still scared of teenage girls having protected consensual sex in ongoing relationships? 

Kaitlyn Hunt's girlfriend's parents say they had no choice but to involve the police. They'd asked their daughter not to see her. They'd told Kaitlyn to stay away from their daughter. Anyone who's had, met or been a teenager will be gob-smacked to hear that didn't work. They had no choice. What I can't fathom is what they thought they were protecting their daughter from that would be worse than what they're putting her through.