CHAPTER FIVE: CONCLUSION
5.1 Overview of Thesis
The number of young people experiencing a form of mental distress, locally and internationally is steadily rising (Government Inquiry into Mental Health and Addiction, 2018; Ministry of Health, 2021; Unicef, 2021; WHO, 2021). Concerns regarding the mental health systems response, specifically here in Aotearoa New Zealand, inspired and informed this research thesis. International and local responses to the increasing number of referrals have been critically analysed by many academic scholars, and it has been widely determined that systems are inadequately meeting the needs of young people. Literature highlights prominent issues preventing care such as insufficient resources, specifically funding and
staffing (Baker et al., 2019; Cranage & Foster, 2022; Dawson et al., 2020; Government Inquiry into Mental Health and Addiction, 2018; Huxley et al., 2005; McMillan, 2002;
Oxtoby, 2023; Parish, 2018; Rimmer, 2021; Sprinks, 2016; Triliva et al., 2020; World Health Organisation, 2020); increasingly large waitlists (Adams, 2023; Brown et al., 2002; Government Inquiry into Mental Health and Addiction, 2018; Mulraney et al., 2020; Puton et al., 2022; Sacco et al., 2022; Westin et al., 2014) and a need for more patient centered care (Jørgensen & Rendtorff, 2018; Lempp et al., 2018; Paton et al., 2021; Triliva et al., 2020). Within Aotearoa New Zealand the mental health systems response has become a ‘hot topic’ addressed by various media outlets (Almeida, 2023; Hendry-Tennent, 2022; NZ Herald, 2023; RNZ, 2023; Roberts, 2023; Trigger, 2023), government reports (Cross-Party Mental health and Addiction Wellbeing Group, 2023; Government Inquiry into Mental Health and Addiction, 2018; Ministry of Health, 2021; Te Hiringa Hauora, 2020) and concerned fuelled community
discussions.
When reviewing the literature, many challenges within the mental health system were illuminated, and their impact on young people seeking care was carefully
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depicted. However, I believed that there was a significant gap within this field of research and this thesis intended to begin resolving that knowledge gap. An
extensive pool of literature discussed the challenges within the mental health system from a clinical perspective, with many articles originating from mental health
nursing, psychiatry, psychology, and social work specialisms, each utilising the perspectives of mental health professionals and previous or current patients (Baker et al., 2019; Brooker & Coid, 2019; Cranage & Foster, 2022; Gulland, 2016; Lacobucci, 2022; McMillan, 2002; Mojtabai & Olfson, 2020; Mulraney et al., 2020; Rimmer, 2021;
Sacco et al., 2022; Triliva et al., 2020; Westin et al., 2014). There were also various articles that addressed mental health concerns, or provided relevant insight, from a sociological perspective, drawing significantly on feminist theory (Cohen &
Hartmann, 2023; Marecek & Gavey, 2013; Payne, 1991), critical disability studies (Brady & Franklin, 2023; Mac Carthaigh, 2020; McLaughlin et al., 2016), the
potentiality of mental illness as a socially constructed phenomenon (Bowers, 1998;
Cohen, 2016) and the implications of neoliberalism within healthcare settings (Barnett & Bagshaw, 2020; Brown et al., 2022; Cohen, 2019; Dawson et al., 2020;
McGregor, 2008; Moncrieff, 2018; Rizq, 2014; Zeira, 2022). However, very few articles paired the clinical perspectives and utilisation of professional voice with the
sociological perspective. Furthermore, there were no articles that utilised these two perspectives in collaboration, while also presenting a unique Aotearoa New
Zealand-informed viewpoint. Therefore, to resolve this knowledge gap, this research thesis, intended to explore current challenges within the Aotearoa New Zealand mental health system, utilising the perspectives of mental health professionals, while drawing significantly on sociological frameworks of understanding.
Findings from this research depicted challenges within the Aotearoa New Zealand Mental Health system that professionals felt were preventing them from providing quality care to young people. Analysis identified that these challenges could be linked to phenomena such as neoliberalism, its associated models of operation, and
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individualistic thinking. This research suggests that ideologies associated with neoliberalism and individualism, specifically a focus on efficiency and profit margins, may be implicated in the current situation of insufficient resourcing; the reliance on crisis management and long waiting lists; the pressure to quickly
discharge young people rather than form continuous therapeutic relationships and professionals subsequent inability to explore therapeutic approaches that lie outside of standardised biomedical models. While some of these challenges, specifically the reliance on crisis management can be understood, due to the increasing number of complex mental health referrals, as outlined in the literature review, participants and Brown et al., (2022) draw connections between crisis management and the system's reliance on profit margins and efficiency. The reliance on the biomedical model, echoes similar claims to those above, due to the standardised, efficient nature of biomedicine (Nelson, 2019).
Staff burnout and the impact of caring for others without adequate support was also an identified concern, further illuminating issues such as diminished staff morale and subsequent challenges with staff retention, this was also reflected in previous research (Devilly et al., 2009; Figley, 2002). Research findings suggest that the lack of therapeutic relationships, which are considered a key ingredient to supporting
young people (Hartley et al., 2022; Horwitz, 1974, as cited in Noyce & Simpson, 2018;
Matos & Dimaggio, 2023), made professionals feel like the system was doing more harm than good by reinforcing insecure attachment styles (Lim et al., 2012) and negatively impacting the fragility of a young person who felt they had not been prioritized or adequately cared for.
The later section of the research focussed on what approaches could be beneficial for the system moving forward. Findings identified alternative approaches to mental health care which drew significantly on relational ideologies and phenomena such as collaboration, therapeutic relationships, patient-centred care, and holism. These alternative, relational approaches directly challenge the individualistic, neoliberal
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ideologies that appear to be dominant within the mental health system's current model of operation. Findings from this section of the research encourage practices that foster therapeutic relationships (Duncan et al., 2022; Hartley et al., 2022); an increase in interprofessional collaboration, and care plans that incorporate holism (Garrett et al., 2019; Settipani et al., 2019; Thomas & Hargett, 1999); an increase in Kaupapa Māori informed practices (Beutow & Coster, 2001; Levey & Waitoki, 2016;
Taskforce on Whānau-Centered Initiatives, 2010; Te Ara, 2016); approaches that move away from the diagnostic model and its perpetuation of discourses of personal tragedy (Brady & Franklin, 2023; Garland-Thompson, 1997; Mac Carthaigh, 2020;
McLaughlin et al., 2016) and an increase in mental health care systems that are integrated and based on collaborative care models (Cross-Party Mental Health and Addiction Wellbeing Group, 2023) such as youth one stop shops.
The findings in this research suggest that neoliberalism, traditionally understood as a political or economic business strategy, is influencing the Aotearoa New Zealand health system (Dawson et al., 2020; Gane, 2014; Sparke, 2016). Applying a
sociological lens, a perspective that critically analyses systemic issues successfully (McManus et al., 2019; Pescosolido, 2010; Rodriguez et al., 2019), demonstrates how individualism and neoliberalism, specifically the standarised and efficient
approaches to mental health, alongside the dominant western biomedical model, are significantly contributing to the issues currently presenting within the Aotearoa New Zealand Mental Health system. Comparatively, relational, community- focused, and flexible approaches to mental health, are presented as beneficial and encouraged. This research outlines why a critical analysis of approaches based on individualism and neoliberalism, in comparison to relational, community-focused approaches is significant when attempting to understand the root causes behind the inadequacies of the mental health system. An analysis of the impact that
neoliberalism is currently having, followed by a presentation of alternative
approaches, that can also be further understood through sociological frameworks
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such as feminist ethics of care and the understandings shared by disability scholars, illuminates processes through which the mental health system can transform, to better service our communities, specifically young people struggling with mental health concerns.