A brush with death title image.

CONTENT WARNING: This feature covers topics including severe mental distress, addiction, self-harm and suicide. Please take care while reading, and reach out to one of the contact numbers below if it triggers any distress.

Illustration of a profile of Cameron looking down and dejected and his mother, Tania, looking stoic and straight to camera

Tania has been struggling for years to get her son Cameron into appropriate treatment since he was first diagnosed with ADHD as a teenager.

Tania has been struggling for years to get her son Cameron into appropriate treatment since he was first diagnosed with ADHD as a teenager.

Tania has lost count of how many sleepless nights she has spent worrying that her son, Cameron, would die of a drug overdose or take his own life.

Over the phone he would talk openly about suicide, telling Tania he didn’t want to go on. Often Cameron was holed up in his house, refusing to open the door to anyone, and there was nothing Tania could do to intervene.

At home in Lower Hutt, sitting at her dining room table, Tania (who requested her surname not be used) tells the complex story of Cameron’s mental illness and addiction struggle. It starts more than 20 years ago when Cameron was diagnosed with ADHD and today involves her caring for her mokopuna - Cameron's children. A catalogue of everything she has done over two decades to get him help would fill a book. On the table in front of her sits steaming cups of tea, banana bread and sausage rolls she has specially prepared for this occasion.

Tania (Ngāti Tūwharetoa) remembers making calls to Te Haika, a contact centre for people with mental health or addiction needs across the Wellington region, to ask for help when Cameron was suicidal. Staff said there was nothing they could do if Cameron didn’t want to willingly engage with a member of their crisis resolution team, and she should call police.

When she did that, officers said they were willing to do a welfare check, but had no powers to remove Cameron from his home against his will. Tania could only wait by the phone, hoping to hear Cameron was OK and dreading the opposite.

Karla Bergquist, a director at Te Haika (which falls under the Capital & Coast DHB), says the centre cannot respond to emergencies. Anyone concerned for someone else’s safety should call 111. “Once emergency services have attended, the person can be transported to ED for assessment by our Crisis Resolution Services, or police will contact Te Haika to complete a mental health assessment and make a plan for response,” she says.

Cameron was diagnosed with ADHD at 11. Soon he started selling his prescription medication to mates for cash. Drug and alcohol abuse followed, then a diagnosis of bipolar disorder. He got sober for a while, but relapsed and fell into depression. The cycle has repeated itself ever since, leaving Cameron unable to look after his children.

Tania holding her granddaughter, photo taken from behind.

Tania’s son’s mental health and addiction issues have resulted in her caring for his children. She shares the responsibilities with her mokopuna’s other grandparents.

Tania’s son’s mental health and addiction issues have resulted in her caring for his children. She shares the responsibilities with her mokopuna’s other grandparents.

Tania has been caring for her mokopuna for nearly four years. She shares childcare duties with their other grandparents. She loves her “babies” more than anything, but it has been hard. “It has been so rewarding caring for my mokopuna, but on the other hand I am left worried sick about everything that is going on in Cam’s life.”

Cameron’s interaction with mental health services over the years has been largely unsuccessful, Tania says. She tells Stuff about multiple visits to the emergency room where Cameron was made to lie on a bed for hours, only to be discharged the following morning without being seen by a mental health clinician. He has consistently been deemed “not sick enough” to be admitted to a psychiatric ward, but not offered any other treatment. The exception was Rangiatea, a 16-week mental health programme run at a marae in Hamilton. Cameron was accepted into the course in his mid-teens, and enjoyed it so much he completed it twice. “[It] had every component he had missed out on in his learning,” Tania says. “They embraced him in manaakitanga, they nurtured him, and he was able to engage with people who understood him.”

Tania sitting against a wall looking directly at the camera

Tania has been struggling for years to get her son into appropriate mental health treatment and addiction treatment since he was first diagnosed with ADHD as a teenager.

Tania has been struggling for years to get her son into appropriate mental health treatment and addiction treatment since he was first diagnosed with ADHD as a teenager.

Tania believes culturally appropriate services are vital for Māori and Pasifika patients, especially younger ones. It gives them a sense of belonging that is desperately needed for recovery. “A feeling of isolation is very common for those struggling with mental illness,” she says. “Mental health and addiction services are missing a vital ‘anytime of the day, open-door in familiar surroundings’ approach.

“When people ask for help, there should be someone available to sit down and talk to them and hear their story, instead of them being given a stack of forms to fill out and then being told, ‘Oh no, sorry, you don’t fit the criteria according to the Mental Health Act’.”

Bergquist denies mental health services at Te Haika are limited by specific referral criteria, saying it is “guided by the person’s mental health needs, their ability to participate in daily activity, and their level of risk to themselves and others”.

“Our dedicated team of clinicians work incredibly hard to ensure that every referral and every person seeking support, is provided the right support, guidance and advice,” she says.

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Tania sitting at a table with a coffee cup, looking out the window.

Tania says the two-decade long battle to help Cameron has also taken a toll on her own mental health.

Tania says the two-decade long battle to help Cameron has also taken a toll on her own mental health.

Over the past year, Cameron’s health has started to improve. He has been clean of methamphetamine and moderated his cannabis use. He has gained weight. But the journey has been long. Cameron was often unwilling to engage with services, Tania says, but instead of simply being kicked out, he should have been listened to, talked to and encouraged to accept help.

She has met “awesome, great workers” along the way and is thankful to every doctor and nurse who has helped her son over the years.

The process seems bureaucratic and singularly reliant on the patient’s willingness to follow a Western doctrine of repair and recovery. TANIA

Her mental health has also suffered, but she has had to stay strong and keep it together for her family. “Families and grandparents need support too. We shouldn’t be left to do this on our own.”

Through it all, perhaps the most troubling element for Tania was watching her son fall through the cracks. He was not considered serious enough for immediate treatment, but languished waiting for less-intensive services.

Clinical psychologist Dr Marthinus Bekker says limited resources and overwhelming demand mean the most serious cases are given priority. Even when a patient is accepted into treatment, they are referred to clinicians who already have massive caseloads.

Dr Marthinus Bekker on the challenges of the mental health system

Clinical psychologist Dr Marthinus Bekker says a wait list of six months or longer tends to be true for many mental health services throughout New Zealand.

Clinical psychologist Dr Marthinus Bekker says a wait list of six months or longer tends to be true for many mental health services throughout New Zealand.

Bekker worked for a DHB for more than five years. He was passionate about his work, but resigned this year to move into an academic role. “It had become increasingly frustrating just how difficult it was to do that work in that environment.”

The waitlist at the DHB where Bekker worked always ran to well over 100 people. The number of people on waitlists differs from one DHB to the next, but a wait time of six months or longer tends to be true across many services throughout New Zealand, he says.

Those that need immediate help will usually still be able to get it. CLINICAL PSYCHOLOGIST MARTHINUS BEKKER

Because the most serious cases are given priority, clinicians are not just dealing with a lot of cases, but also with the most complex cases. They’re also not able to see all of their patients every week, Bekker says. “Sure, an appointment with a patient lasts an hour, but then you’ve got 30 cases. You need time to read notes, to prepare for appointments, to consider the best treatment options, to write the notes and to fill out all the required forms that the DHB dictates need to be filled out. Then you’ve got a multidisciplinary team meeting that goes for two to three hours every week, we have to do mandated supervision, and somewhere in there we still have to fit in professional development. And lunch, which mostly just doesn’t happen.”

Most clinicians are passionate about helping people, but the inevitable burnout leads to an exodus of skilled and experienced clinicians, he says. “I had been there for just over five years and during that time, almost all the clinicians I had worked with when I started had left.”

Many managers arrive with “a hiss and a roar”, determined to turn things around, but the cycle just repeats as the fundamental supply of clinicians and demand of clients doesn’t improve, Bekker says. “I would see colleagues, often young, enthusiastic, amazing people come in and within a few months be overwhelmed and in tears and struggling. And then leave.”

Clinical psychologist Dr Marthinus Bekker says because the most serious cases are given priority, clinicians are dealing with very complex cases on top of a massive workload.

Clinical psychologist Dr Marthinus Bekker says because the most serious cases are given priority, clinicians are dealing with very complex cases on top of a massive workload.

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Illustration of Hattie Plant, young woman with long reddish-brown hair.

Hattie Plant struggled with eating disorders since she was 12 years old, and was diagnosed with anorexia nervosa last year.

Hattie Plant struggled with eating disorders since she was 12 years old, and was diagnosed with anorexia nervosa last year.

Some nights 23-year-old Hattie Plant would be too scared to go to sleep. Her already feeble pulse was dangerously low. Going to sleep would only slow it further. What if she didn’t wake up?

Hattie had struggled with bulimia since she was 12. She recovered, only to be diagnosed with anorexia nervosa last year. By then she was already seriously ill, eating almost nothing, and walking long distances to try to lose weight.

Collectively, eating disorders have the highest death rates among all mental illnesses. Of those, anorexia is the deadliest. Research has shown that those with the condition are five times more likely to die than their peers.

Research has shown the suicide rate for women with an eating disorder is 58 times greater than for those without. That’s on top of medical issues like heart problems, impaired kidney function and decreased lung capacity due to muscle wasting.

Despite Hattie’s dire condition, it took her an entire year to get into treatment. In that time, she teetered on the edge - eating so little that it quelled the anorexia monster in her mind, but just enough to avoid hospitalisation - especially when her GP warned this was imminent.

“When my blood pressure dropped or my heart rate slowed down to a dangerous level, I would make sure I picked up just enough weight to get out of the ‘hospital zone’,” Hattie says. “I really didn’t want to go to the hospital.”

She recalls one appointment when her GP recorded her blood pressure as 70/28 (a healthy blood pressure is about 120/80) and her heart rate as 42 (normal is 60 to 100). “My GP said it was the lowest blood pressure he had ever seen on a person who was still walking around.”

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Hattie: A year of teetering on the edge

Hattie has been diagnosed with anorexia nervosa, but still had to wait a full year before she could get into treatment.

Hattie has been diagnosed with anorexia nervosa, but still had to wait a full year before she could get into treatment.

Through it all, Hattie had almost no energy. It was like “walking through treacle”, she says. She fainted frequently. Once, when she was a bridesmaid at a friend’s wedding, a chair had to be put behind her at the altar in case she got light-headed.

It was not Hattie’s first brush with death. In 2019, while suffering from bulimia and severe depression, she attempted suicide. She called an eating disorder service. The only option was months away and for group therapy. Hattie didn’t want group therapy. “I knew that would make me worse as I would be comparing myself with everyone there.”

Hattie looking to the side, her hair visible in the mirror behind her.

Hattie struggled with eating disorders since she was 12 years old, and was diagnosed with anorexia nervosa last year.

Hattie struggled with eating disorders since she was 12 years old, and was diagnosed with anorexia nervosa last year.

After moving from Auckland back to Wellington and being diagnosed with anorexia, her GP referred her to the Central Region Eating Disorder Services (CREDS). Three months later she had an hour-long appointment with a psychologist who confirmed her anxiety and anorexia diagnosis. Hattie was officially on the waiting list.

She was told the wait would be six to nine months, longer than usual because she needed a specialist service for eating disorders. While she waited, Hattie was referred to a dietician to improve her eating habits, but her health continued to deteriorate. “[Anorexia] takes over your brain so much, you can’t really respond to anything, she says. “I couldn’t take the dietician seriously, I really desperately needed a therapist to help me.”

“I don’t blame the dietician, she is not supposed to be a therapist. But because she sees patients while they are waiting for treatment, she ends up having to be their therapist even though that is not her job.”

Hattie finally started seeing a psychologist in October this year. The wait time had ended up running to 12 months.

Hattie sitting on a couch and looking to her right out the window.

After Hattie was assessed by a psychologist with the Central Region Eating Disorder Services in Wellington, she waited a whole year before there was a spot for her to start psychological treatment.

After Hattie was assessed by a psychologist with the Central Region Eating Disorder Services in Wellington, she waited a whole year before there was a spot for her to start psychological treatment.

Hattie says she finds the mental health system “super hard to navigate”. She has to constantly advocate for herself to get the help she needs. “There’s all this public messaging saying ‘it is OK not to be OK, reach out and talk to someone’, but when you do and you get told you can only get help in a year, that doesn’t feel like very accurate messaging.”

Hattie fits the stereotype of “the type of person” who develops eating disorders - young, white, female and slim. She believes those who aren’t - men, older people, non-Pākehā, bigger people - are likely to face even more barriers than she did. Some have even approached her to share their struggles “When you don’t fit into that stereotype, it is much harder to get people to believe you when you say you need help.”

More frontline services are needed to help people before they end up in hospital or need prolonged treatment, she says.

How about we don’t wait until people are at risk of literally dying before we help them.” HATTIE

Stuff asked the Capital & Coast and Hutt Valley DHB for comment on the wait times at the CREDS, but was told a request would need to be filed under the Official Information Act. The wait time is at least 20 working days.

CHAPTER THREE: BREAKING THE LAW

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Research and words Mariné Lourens
Visual journalists Chris McKeen and Alden Williams
Design and illustration Kathryn George
Development Sungmi Kim
Editors Nicole Mathewson and Michael Wright

This project was created with financial support provided by a nib Health Journalism Scholarship.

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