Sarah O’Connor and Andrea Bates on holistic mental wellbeing
On a lovely spring day, Sarah and Andrea told me about their peer-to-peer approach to mental health within the holistic Te Whare Tapa Whā framework of wellbeing, and how mental health conditions aren’t always as simple as something to be ‘fixed’ or gotten rid of.
Who are you, and what are you doing?
Sarah: We both worked in the mental health and Non Government Organisation (NGO) sector for some time, and we decided that we’d like to do things a little bit differently. We wanted to work more around projects that we were interested in doing, and look at health in a more holistic way — especially around Sir Mason Durie’s concept of the four walls of health; physical, emotional, spiritual, and whanau. It’s not just looking at one aspect that’s ‘wrong’ with you, but looking at all elements of your health as a whole person and how that feeds into your mental health, which is where we are focused.
Andrea: The current focus on the mental health comes from our own experience and our knowledge, but also because it’s an area where so much could be done. So much of the NGO sector is bound to contracts with very set outputs and very limited money, so that means there’s very little room for innovation. Instead of trying to create a behemoth that employs 50 million people from 9–5 every day, we wanted to think about what needs to be done, how do we get that done, and how do we work on that principle.
Tell me more about Wellbeing Wellington.
A: We started mid-last year, and we got all the documentation to become a trust signed off December last year. We have five trustees; fabulous people, who we’re really lucky to have. They’ve got a combination of really solid business, finance, and health experience, and all came from the same value set that we do. We bill ourselves as a values-based organisation which is all about learning. We’re very much of the principle that we know bits, and we try and do those bits as well as we can, but there’s others who know an awful lot that we don’t, so who do we need to involve as experts in their areas so that we can all work out how we address an issue. That fits with our values which come out of the mental health peer movement, but also values held by multiple cultures and organisations across our country. I do think it’s the way that our country is starting to develop how it works. You don’t have ‘an’ answer, you have multiple views and you work out what you’re going to do together. Anyone who’s dabbled in social enterprise knows that you need to have ideas, but you also need to know which ideas to push when. It’s very much about spending time with people, to listen and try to work out together what it is that’s important.
What are you working on at the moment?
We’ve got a few projects in development. We’re doing a few things that fit under the umbrella of Equally Well, which is a movement started by Te Pou, a mental health workforce development organisation who do a whole bunch of really interesting things. Equally Well is around people with mental health conditions and their physical health. The data’s all there. We know people with mental health conditions have worse physical health outcomes than the average person. We know that Maori are disproportionately represented in our mental health statistics and that correlates across to physical health outcomes. These are significant systemic problems, and they need to be addressed. We have a system that fails people with mental health conditions, and specifically, Maori and Pacific people with mental health conditions. So Te Pou have put together Equally Well which has every part of the mental health sector working together. Service users, NGO’s, GP’s, mental health nurses, psychiatrists, psychologists, the Ministry of Health — everyone is paying attention. It’s absolutely phenomenal. If you want to talk collective impact theory, there’s your example.
We’ve got a research project and a service pilot that we’re looking to run early next year which is around how we work with people prescribed these drugs. They’re incredibly serious drugs, they have major physical health impacts, and there’s an avalanche of research that says we need to seriously re-think how we’re using these drugs. On average, people with what they call serious mental health conditions die 25 years earlier than the average person in the population.
Wow. I had no idea.
The thing is people should know that. Because it makes you re-think how we address this issue. There’s a paper on Te Pou’s website that Helen Lockett put together, and it lays it all out. These are the numbers, this is what we need to pay attention to. What’s even better about Equally Well is that it’s spread outside mental health. You have people from all sorts of specialties paying attention and saying, no, hang on, people are people, and we don’t treat people like this. We’ve got a couple of small things running under there which we’re really thrilled about, and again, they’re collaborations, so project-based, bringing people in to work with them, but also working with other organisations. So that’s really exciting.
Are you seeing an appetite for trying new approaches with the pilot you have in development?
S: I think so. There’s so many people who are willing to collaborate and actually do things in a different way.
A: If you have the space to innovate, there’s all sorts of amazing things you can do. We thought that the most effective way that addresses issues around these drugs is to provide something that was wrapped around with peer support. Because, if you’ve just had a crisis, you’re more than likely taking quite a high dose of drugs. You have all those impacts, and the last thing you need is to be told to ‘go for a walk everyday and eat your greens.’
S: It can be quite patronising. It doesn’t feel like the person knows what you’re going through, which often they don’t. You need somebody to say, I’ve been in your situation and I know what that feels like.
People are increasingly acknowledging that there’s a lot of impact that’s happening from these medications and we can’t just put our head in the sand and ignore that it’s happening.
We need to acknowledge that physical health is equally as important as mental health. Sometimes when you get a mental health diagnosis that becomes the primary focus, and physical health falls away, but you can’t have one without the other.
A: So it fits beautifully in with Sir Mason Durie’s Te Whare Tapa Whā. Unless you can support the person to look after every part of themselves, one of the walls is going to crumble and it’ll fall over.
In the traditional view, if we look at the example of employment, you might think employment is having a job. No, employment is huge to identity, it’s huge to income, finance — therefore housing, care, heat, clothing, paying the doctor…so if we look at wellbeing from that lens, what sort of things can we do, that are not already being done?
What are the challenges of doing things differently?
S: The key thing is funding. What happens with a lot of the NGO sector is that a tender will come out, and different organisations will compete for that same piece of the pie, but because we’re not really trying to do that, we’re trying to find funding from different kinds of sources. It means you can look outside the square. It means you’re not constrained into one lot of budget. In a way, it gives you more room for flexibility. But it does mean that you really have to put your thinking caps on about who you’re going to approach. It’s a challenge for everyone.
A: The good thing is so many people in this region are on the same page, it’s just about lining up the right people at the right time and getting things moving. Which is a challenge. But it’s a worthwhile one because why replicate what’s already happening?
What were you both doing before Wellbeing Wellington?
A: When I left university, I worked as a lawyer, then I got into management, did an MBA, and ended up working in the mental health sector. So there’s work, there’s qualifications, and then there’s my own lived experience of having a mental health condition. It all just fit together really well, and it was time to do something different.
S: My background is in the social sciences. I got a degree in sociology, worked briefly in a government department, and then ended up working in the mental health sector in different roles. I started off doing administration, co-ordination, then I got into mental health research. I was a research assistant on a couple of projects that were several years long and really interesting, and one in particular sparked my interest in peer support. Then there’s my own experience of having a mental health condition.
Is that what most people refer to it as?
S: A lot of people talk about mental distress in the sector, as opposed to mental illness. The concept of mental illness is about having some kind of broken brain. As more and more research is coming out, we realise that it’s not what we believe and it’s not what many people believe.
A: The clinical academic sphere don’t particularly enjoy ‘mental distress’. So if we’re not going to use ‘mental illness’ because it’s not logical, and we’re not going to use issue/problem, then what do we use? ‘Condition’ is relatively neutral compared to ‘problem’ or ‘issue’. ‘Problem’ comes from the perspective that anything to do with mental distress is negative, wrong, and must be gotten rid of.
We have our ups and downs about our experiences, sometimes good, sometimes bad, but overall they’re part of who we are, so actually, we get to choose. And we can choose to have them — maybe not quite as they are all the time, but to have them.
S: So peer support is something that really sparked a connection with me. It’s about moving ahead, not being stuck in a situation. Acknowledging where you are, but moving ahead with a goal or where you want to be in life.
A: It’s always putting that positive frame on; where do we want to head, not what are we running away from. That’s what we’re all about. We know there are issues in our world, our society, and we could sit there and gripe about them forever quite happily, but complaining about it’s not going to change much. You hear so much negative stuff about the mental health sector, and it’s so unwarranted. There are so many absolutely amazing people doing the hard yards on a daily basis, but also thinking, planning, and strategizing. There is so much being done.
When have you felt really proud of what you’re doing?
S: The movie screening. Healing Voices is a documentary produced by Oryx Cohen (COO of the National Empowerment Center) and produced and directed by PJ Moynihan. It’s called Healing Voices which we take to be a little bit of a play on hearing voices. It spans five years of Oryx, Jen, and Dan’s life.
Each person was in a different stage of their life. Dan had been diagnosed with ADD as a young kid and gone through that whole system being treated with ritalin, and he was incredible. He was only 20-something, and he’d totally made sense of his own stuff. He hears voices — they were characters in his life. He had learned to deal with it, and it wasn’t a big thing. It was part of who he was, and he just explained it in a very easy going, quite hilarious way.
The overall message is that people have (mental health) experiences and they’ve been part of the human condition for thousands of years. How we address those experiences, shape, and frame them, either limits or catastrophises them. It talks about the other options; how else could we see them, how else could we treat them, what other supports we have to put in play. It covers the Hearing Voices Network and talks about peer respite, open dialogue, and the grassroots peer support community.
We’d heard about the movie, and got in touch with Oryx and asked if we could show the doco here. We purchased a license and did that in Wellington with Lighthouse Cuba and the reactions were really positive.
What are your plans for the future?
A: From the outset we thought fifty years into the future because we always wanted our model to be sustainable. I think a key thing about what we’re doing is, if we try something and we think it’s really good and it gets evaluated and it comes out well, there’s not a lot of point in us holding on to it. That’s not what we set ourselves up to be. We don’t want to be the people who create and own the knowledge to the exclusion or loss of the rest of the country. If it works, we’d much rather say to people in other areas or national providers, hey this thing went really well, do you want to take it on? Because then what we’re doing is providing value, we’re not actually feathering our own nest. Right from the outset that was fundamental for us.
What would be your advice to anyone else wanting to create some good in Wellington?
A: Get a good group of advisors, test your ideas and listen a lot.
S: Sometimes when you work in a certain field you talk to the same people, but it’s important to expand on what you know. Talk to different people, get new perspectives and fresh ideas. People are interested in this work and want to talk, so take a chance.
How can people contact you if they want to get involved?
Through our website, twitter, and email — we’re happy to talk to anyone who is interested.
