Justin Hughes believes in inter-generational trauma. The transformation of mental health services hasn’t been a straightforward journey, but Hughes is doing his part to better it. Katie Kenny and Laura Walters ask what the future of care should look like.
Justin Hughes' mother was affected deeply by her father’s suicide. In turn, the 27-year-old was affected by his mother’s suicide attempts. Something — he’s not sure exactly what — lived inside his grandfather, and lives in his mother, and in him. It’s been a constant concern since he was a boy.
Both his parents have experienced depression. When his mother was at her worst, in and out of the hospital, Hughes worried he had lost her — if not to suicide, then to her illness.
“I could see it coming,” Hughes says. “It felt like no one else was seeing what I was seeing. Then, when it happened, I thought, 'I saw this, why did nobody do anything? What could we have done to prevent this?”
It took a long time before he realised the answer is often: nothing.
“There’s only so much you can do. You can support someone through but you can’t make decisions for them. Sometimes you just have to watch them fall, and be there to pick them up again.”
Despite this, around the country are innovative examples of what the future of mental health could look like: groundbreaking research, employment opportunities, and world-first public health campaigns.
In the basement of a building across from Dunedin’s public hospital is a sterile room with a large comfy chair and IV equipment. Professor Paul Glue is helping conduct the world’s largest controlled trial testing ketamine as an antidepressant. Yes, ketamine — the horse tranquilizer, the powerful anaesthetic, the illicit narcotic. Also the most promising thing to happen to treatment-resistant depression in a long time.
The history of psychopharmacology is more indebted to serendipity than most areas of medicine. Between the late 1940s and late 1950s, effective drug treatments were discovered for bipolar affective disorder, depression, schizophrenia, and anxiety. Having largely been discovered by mistake, however, they lacked a theory that accounted for why they worked — or, in many cases, didn’t. Since then, there have been few advances.
“We’re still hoping for good fortune to strike,” says Glue, a psychiatrist in Otago University’s department of Psychological Medicine.
Two or three times daily, Glue gets emails from people saying they’re chronically depressed and desperate to get involved in a clinical trial. “It’s pretty heart-breaking stuff.”
Private ketamine clinics have popped up all over the United States, United Kingdom, and parts of Australia, but not yet here. Money isn’t a barrier; an ampial of 200mg costs about $10, plus a few cents for a syringe, cotton wool, a needle, and clinic time required as the drug has to be given under supervision. But ketamine worries drug companies — it’s been around for almost 60 years, so there’s little patent protection and as a result, it's not a lucrative option for big pharma.
Upstairs, in Glue’s office, his phone is ringing. He’s on call this afternoon, and a doctor is asking for his advice on a difficult patient. Pushing his glasses up his nose, Glue reassures the doctor, saying he’ll be there soon. Non-compliance isn’t unusual in his line of work.
“It would be nice to have some sort of scanning or imaging or genetic or biochemical test for a number of different disorders. We don’t have that. We diagnose most people by asking what’s going on inside their head. That’s terrible."
Still, he says, there have been big changes. Conditions previously thought of as incurable are now very manageable.
“It’s different from cancer, in a way. People are happy for you to take a bit of the tumour away. And then you look at genetic markers and say, we’re going to use this treatment as opposed to this one because of what your tumour looks like. And, it would be fabulous to have the same thing for psychiatry. Just, it’s on the to-do list.”
Twenty years ago, Dr Shyamala Nada-Raja of Dunedin’s School of Medicine was a young researcher attending a conference on suicide prevention in Adelaide. Suddenly, the afternoon session was overrun by suicide survivors and their families. Nada-Raja sat up in her seat as the survivors spoke of their disappointment with the academic community.
“It made a real impression on a lot of us who were there,” she says. “I was just starting out in the field and I thought, OK we read all these papers and all that, but have we actually spoken to the people who have gone through it?
“I think now it’s almost mandatory to do that kind of work. At the end of the day, the research has to go back and help that group and if they don’t understand what you’re doing, what’s the point?”
That question has shaped her career. Now, she specialises in figuring out how to use new media to help suicide prevention and improve wellbeing and resilience. But technology is an enabler of face-to-face connection, she says, not a substitute. And it's the content that matters, not the tool.
"It comes down to connections, relationships, we have to get those right."
Research shows social isolation increases the risk of suicidal behaviour. Therefore, in trialling e-therapies, her team tries to build a sense of community. That on its own has shown to make a big difference in people’s lives. In fact, altruism was the top reason people wanted to take part in the study in the first place: not to heal themselves, but to ease others’ suffering.
Justin Hughes doesn’t dwell on what he describes as his “sob story”. At high school he didn’t talk to many people about his parents’ divorce, or his mother being in and out of the hospital. A mental illness is different from a physical illness, he explains, in that it’s not necessarily getting better or getting worse — it’s just ongoing. Growing up, he wanted to escape that.
“It’s one of those things where it’s hard to admit even to yourself how much these things have hurt you, knowing at the same time it’s no one's fault.
“I don’t blame my mum for anything.”
Talking about his personal experience with depression and anxiety, he says: “I have comfortably come to terms with it as something I’ll deal with for the rest of my life.”
He’s had to learn how to talk about his experiences in a way that’s helpful without succumbing to negativity. In a way that allows him to hold down jobs and work towards a master’s degree. He’s willing to share, he says, because “one thing people who go through this hate the most is that feeling of being misunderstood”.
In one breath Hughes will tell you he had eggs for breakfast, and in the next he’ll tell you his mother tried to kill herself.
“That’s probably the hardest thing to ever actually say because those words mean a huge amount: yes, my mum tried to kill herself. You’re stating facts. It’s like saying the sky is blue. But I can’t describe the story behind those words. What does the sky mean to you, or anyone?”
“I just hope that as a society, as individuals, we can learn to see beyond the everyday.”
When was the last time you asked someone how they were, and meant it? When was the last time someone asked you how you were, and you were honest?
“Now, with my friends, even when I’m going through other stuff, I say, what’s going on? How are things? That’s the hard thing — really stopping and talking to people.”
Where to get help
Need to talk? 1737: free call or text 1737 any time for support from a trained counsellor
Lifeline: 0800 543 354
Youthline: 0800 376 633 free text 234 or email talk@youthline.co.nz
Samaritans: 0800 726 666
Healthline: 0800 611 116
Depression helpline: 0800 111 757 or free text 4202 or www.depression.org.nz
The Lowdown: www.thelowdown.co.nz or free text 5626
SPARX.org.nz: online e-therapy tool
OUTline NZ: 0800 688 5463 for confidential telephone support for the LGBTQI+ family, as well as their friends and families
Note: all helplines are available 24/7. For further information about supports available to you, contact the Mental Health Foundation's free resource and information service (09 623 4812 or info@mentalhealth.org.nz) during business hours.
This project was made possible by funding from the Frozen Funds Charitable Trust, through the Mental Health Foundation.
Words: Katie Kenny and Laura Walters
Illustration and layout: Jemma Cheer
Visuals editor: Alex Liu
Copy editor: Joanne Butcher