Category Archives: Health

The pressures NGOs face

Yesterday I wrote a bit about NGOs providing essential social services. Today, I’m looking at the rest of the article I referenced there, on the funding issues that NGOs currently face. This government not only pushes essential social services off onto NGOs – it also underfunds them. Badly.

The author, Richard Wood, notes that even services which are ‘fully specified’ (which I think means fully funded for the services specified in their contracts, but it’s a piece of government jargon that Google wasn’t keen on giving up the definition of) are underfunded. If the government is short-changing the services which are supposed to be fully funded, how is it for partly-funded services? Pretty dire, would be my guess.

None of the funding for NGOs has been inflation adjusted since 2009, and even further back the inflation adjustment has not kept pace with actual inflation (which is about 30 percent in the last 12 years!). As the services struggle, and fall further and further behind, the government gets to look at them and tut-tut over their budgeting and fiscal responsibility. It’s rubbish.

At the same time as this government underfunding, philanthropists have signalled to the government that it’s not their job to fund essential social services, that these should rightly be funded by the government. So, with not enough government funding and little philanthropic money, core services are struggling badly.

Why on earth are essential and critical social services being treated like this? I suspect that it’s because the government doesn’t see them as essential or critical. They see them as a money pit that brings no tangible returns – despite the billions that mental and physical illness, criminal behaviour, homelessness and the like cost the economy annually.

We’re talking about social needs in economic terms again, and it’s wrong. It’s a people cost, and people are worth more than money. Perhaps the next government will see some sense.

NGOs providing essential social services

For reasons previously unknown to me, successive governments have farmed out the provision of critical social services to non-governmental organisations (NGOs). This always struck me as shifting the responsibility away from the government, and I never understood why. Recently, the New Zealand Herald ran an article that mentioned why the government has utilised NGOs.

An effective, properly funded social services sector is crucial for the support of vulnerable children and their families. Most of the social services we need to achieve Government priorities are services best delivered by NGOs. There are many good reasons for this.

From the client perspective, NGO services are more trusted, accessible and private. From the community perspective NGOs are better networked into the community, both at agency and front line worker levels, and more likely to collaborate with others in the community.

From the Government perspective, using NGOs allows it to control the money it invests in social services while reducing the need for the employment of public servants who are not only more highly paid but get annual pay rises.

I agree with the client perspective. It’s much easier to trust the Sallies or Relationships Aotearoa than the Ministry of Social Development. There’s less of a sense of impending screwing over looming in the near future. While this is true, I think some rehabilitation of the government’s persona that it presents to people is important, rather than pushing all the work onto NGOs in order to cover up that reputation sinkhole.

I’m not sure what to think about the community perspective. I guess they’re better networked. I feel though that it’s because they’ve put in the work that government departments don’t feel like doing.Government departments could actually do the work and make the contacts and have the same advantages that the NGOs have there if they really wanted to.

From the government perspective. Well. Controlling the money it invests in social services? That sounds very much to me like code for ‘under-funding services and then blaming them for any failures due to lack of cash flow’. Any time the government talks about controlling costs it means that someone is going to lose out, and that the government is going to do all they can to make it seem like it was the most responsible thing it could have done.

The reason all this has come up is that a big NGO, Relationships Aotearoa, has just closed down due to funding deficits. The government blames RA, while RA say that the government didn’t come to the table with anything realistic. Whatever the reasoning, the upshot is that a bunch of counselling, including court-ordered counselling, has abruptly ended. That means that a bunch of ex-violent criminals have just lost their counsellors, people essential for their transition into functional community life.

It also reduces the need to pay public servants, who are guaranteed a good wage. Shall we say it plainer, and tell people that they just want to be able to pay people minimum wage for providing some of the most important social services to the most vulnerable groups in the country? Even if it’s not minimum wage, they still want to pay far less than people are worth to work far harder than the government deserves from them.

So why NGOs? People trust them more, yeah, but mostly we don’t have to give them much money, and we can shift the blame when thing so wrong. I love our government.

Cold damp housing kills

A couple of days ago, I wrote about the death of Emma-Lita Bourne, who passed away from complications of pneumonia. Her cold, damp home was ruled to be a factor in her death. Today, news broke of the death of Soesa Tovo, a 37-year-old man from South Auckland, who died after a year of medical requests for the family to be moved from their cold and damp home He struggled with heart and lung issues, including a hospitalisation for bilateral pneumonia.

Over and over again, social workers associated with various health care organisations including the hospital that treated him for pneumonia and his local Primary Healthcare Organisation, wrote to Housing New Zealand to request that he, his wife, and their six children be moved. Their three-bedroom home was damp, mouldy, and so cold that the whole family slept in the lounge together – the only room in the house with carpet. The ceiling was insulated, but that was not nearly enough to make it a warm dry home.

Housing New Zealand homes are killing people. Many are in locations already known for being cold and damp anyway, and the houses need extra care to keep out the moisture and mould. But the government hasn’t been maintaining the houses, and they’re falling into disrepair. That sounds quite sterile – ‘disrepair’ – but it’s murderous. It’s literally killing people.

The school noticed the kids were sick all the time. The father was in and out of hospital. Yet Housing New Zealand did nothing at all to help this family. You can talk all you like about waiting lists and fairness and appreciating what you have, but I want to know why there was a family living in a home unfit for human habitation. They won’t be the only ones, either. We just don’t hear about the others until someone dies.

State housing was originally built to give workers strong, healthy homes so that they could be at their most productive. Today they’re storehouses of misery. We can do better! What we lack is the will to do better. This government gives precisely zero shits about the welfare of its poor people.

The kicker for the Tovo family is that, almost a year after Soesa died, they are still in that same small damp dump. Even the struggle of grief, added on to the list of illness and misery already catalogued, was not enough to get that family a better home.

What does it take to get help around here?

Help is everywhere

Today an article came out about a coroner’s decision that was released during the week regarding the death of a fifteen-month-old girl named Emma-Lita Bourne. She died of a brain haemorrhage related to the pneumonia she had been suffering during the time leading up to her death. The coroner ruled that her death was partly due to the inaction of Housing New Zealand, the government agency that is responsible for the national social housing stocks. The house was cold and damp, and contributed to her illness, according to the coroner.

I then made the mistake of reading the comments on the article. Many of them were well-considered and thought out, but one stood out. It reads “this is pathetic journalism. Help is everywhere for those who need it.”

I call bullshit.

If there was help everywhere for those that need it, we would have no suffering in the country, yet that is blatantly untrue. Food banks would never have to turn people away, or if they did, there would be a service that took up the slack instantly. There would be no cold, damp, leaking housing stock, because anyone that found themselves in such a place would apply for help and it would be given. Is that our reality?

People who say things like that have no idea what poverty is like, or their experience of poverty is atypical to the point of being alien to your average poor person. The hopelessness and powerlessness of having no good choices, no lifelines, no avenues of escape are not in any way familiar to them, and they are pontificating from a place of comfort into a world they just don’t understand.

I find it shameful that there are people that misunderstand the reality of poverty in this country so thoroughly that they think such things. But then I think, how on earth would you educate such people. I think that if I had no experience of being broke (and I was never in desperate poverty, just student poverty) I would likely not understand what it was like. But then, I have education and empathy – maybe I would be less ridiculous than this creature.

The resources available to people in deep poverty are sparse and inadequate. Stating that help is everywhere is just straight bullshit, spouted from a place of privilege. A place where there is money to turn the heater on, and the roof doesn’t let the rain in. The world of the really poor just isn’t like that. It’s about being cold and hungry and never really having enough of anything.

A report put out by the Ministry of Social Development on Friday pointed out that 200,000 children are in situations like Emma-Lita’s. How many of them become so unwell they end up dying because of their living conditions? It’s shocking that such a thing happens in a country as wealthy as this, with a strong history of social support. What has happened to us that we have let our social safety net develop so many gaping holes?

We can do better by our people living in poverty. We can actually spend money that is allocated for Housing New Zealand maintenance on that maintenance (because our Housing Minister is proud to state that only 60% of the maintenance budget is currently being spent, and it has been like that for several years). We can raise benefit levels to a point where people can afford the power to heat their homes, or we can subsidise power. A heat pump is no good when you can’t afford to run it. We can pay people enough to put food on their tables, and we can feed the kids at school to take some of the strain off people’s budgets.

We can do better, but this current government will not, because they don’t understand grinding poverty. Even those that had to rely on social security to get by did so in an era when such things were properly funded, and you could live well enough on benefit dollars, in properly funded state houses that were relatively new. It’s not an experience at all parallel to the ruins of the welfare state we find ourselves in now.

Help isn’t everywhere. It’s hiding away, it’s hard to access, and it’s out of reach for many people. Middle and upper class New Zealand need to stop deluding themselves about this.

Investing in mental health care

Investing in mental health care sounds like a great idea, right? Put more money into the mental health system, more people get care and logically more good outcomes ensue. Right?

Well, when this government heard ‘investing’ they went, ‘you know what, let’s get private investors to fund mental health initiatives using a bond scheme, where the investors get a return on their money if the scheme hits preselected targets’. And there went good ideas, flying out the window like so much smoke after a toaster fire.

Are. You. Kidding? When did it become a good idea to put mental health treatment in the hands of private investors who are prioritising a return on investment, not on actual positive outcomes for the patients involved? Sure, the key performance indicators (KPIs) might seem as though they demand good results for the clients, but we are not looking at a situation where people are looking towards client’s best interests.

The first scheme to be proposed under this new framework is one in which mental health patients are moved into work. The potential for abuse is huge – pushing people who aren’t ready into work that’s not suitable, employed by people with no understanding and ripe for abuse and failure. But it’s got to work for investors, so it’s going to work, dysfunctionally, checking boxes and playing with people’s mental health in return for a few dollars.

I don’t know how this is supposed to benefit anyone except the investors. It’s going to cost the government money. It’s not going to do any favours to the sick people involved. It’s not, as far as I can see, fiscally sensible. And it’s an experiment.

This is an experiment that has only been tried in the UK and the US, and those experiments are so new that we don’t know the outcomes yet. Sure, there’s some think-tank in New Zealand saying it’s a good idea, but it’s an unknown.

Should we be experimenting with social bonds on vulnerable mentally ill people? No, and no, and yet again no. Mental health care is already so bad, and this is not going to make it better. It’s a crazy capitalist experiment, one that we shouldn’t be trialling on people with enough serious challenges in their lives already

Tehe Th

Should parents be informed of their daughters’ abortions?

Or worse, should they have power of veto? The subject has been raised in New Zealand recently, and some of the things that are being said just utterly horrify me.

I was raised in a household where abortions were just absolutely off the table. So when I found myself pregnant at 16, it was never even an option. I carried my child, and I raised her. To be honest, I don’t really know what my parents would have wanted me to do – the strength of the religion that had been pounded into me meant that I went blindly forward with what I believed was God’s will, and damned if I was going to listen to anything that didn’t mesh with my ideas of right and wrong. I was the sort of person that I would be ashamed to raise – dogged and dogmatic and unthinking and narrow-minded. But that is then.

If I had elected to have an abortion, then I do not know if my father and stepmother, who were the only family I had around, would have approved. I strongly suspect that things would not have gone well for me had that been my choice (not that things went smoothly for me anyway, but that’s not the point). Mine is not a good example of what could go wrong for vulnerable pregnant girls, though. I was already responsible for myself, living out of home, and generally not supported by my family. Things were not going to get dramatically worse for me,

If I had been at home though, and relying on my very religious family, then them finding out about me making the hypothetical  decision to have an abortion could have landed me out of home. No, worse than that – if it was not already a done deal, I would have been pressured out of it, or outright forbidden to go through with it. My body was not my own, you see. It belonged to God and whoever God delegated his authority to. So in a religious setting, informing the parents is not a safe thing to do.

Parents like to think that they have a right to know what their teenage daughter does with her body. But they have to acknowledge that she has choices, and agency, and they cannot control her or dictate to her for the long-term, so letting go in the short term is necessary and healthy. Giving her knowledge, information, and power over her own body is the best thing they can do for their child.

One comment that just left me floored was “maybe the father of the baby should have a choice – he may want the baby” . . . I’m sorry, are you kidding me? It’s her body. Not his. Until he can be pregnant and give birth in her place, he doesn’t actually get a say in what she chooses to do unless she wants him to. Basic bodily autonomy 101 here, kids. It’s not the father’s choice. It’s not the parents’ choice. It’s up to the girl – and only the girl.

I have two daughters of my own, and one of them is just hitting puberty. I understand the impulse to control and to guard and to protect, but it’s impulse that does no one any justice. Build your relationship with your girl. Build trust and love and acceptance, so that she knows that if things go awry she can come to you. Let her know what you would do in such a situation – tell her up-front that you will support her in whatever way you see fit, whether that’s that you would support an abortion but not a baby or vice versa, or whether you would be there for her and do everything you can for her no matter what she chooses in a situation like that. Educate her so she knows how biology works, how to stay safe and healthy, and support her to get whatever contraceptives she needs.

Maybe I’m being idealistic, and maybe I’ll feel different about my girls as they grow, but I don’t think so. I want to trust them and empower them in a way that I never was, so they can make these sorts of decisions, about love and sex and abortion and parenthood and growing up, with their eyes wide open.

I was a teen mother. I also had an abortion when my daughter was less than a year old, because I couldn’t cope with two under two. I never told my husband that, because he was part of the religious tradition that condemned such things – but I did what was right for my physical and mental health. I have walked both roads, and I would hold my child’s hand down whichever one they chose, if it came to that.

Mental health in Christchurch

An article came out today, telling me some things that I thought everyone must know about post-earthquake Canterbury, and some things that I didn’t know, things that make me both angry and sad.

Mental health issues have become more prevalent in Christchurch since the quakes, something that is entirely expected, at least from where I stand. People who have been through a major traumatic event, like a huge earthquake, are more likely to have PTSD relating to the event, but are also more likely to have other mental health issues like anxiety or depression triggered by the circumstances and the pressure they are under. Zero surprises here.

The statistics are startling but not surprising:

– 43 per cent increase in adult community mental health presentations.
– 37 per cent increase in emergency presentations.
– 69 per cent increase in child and youth mental health service presentations, which would be higher without CDHB’s schools programme.
– 65 per cent increase in rural mental health presentations.

Canterbury District Health Board has a lot on its plate to deal with. In addition to the increase in mental health presentations following the quakes, 30,000 people moved into the area post-quake to help with the rebuild, and those people have a range of mental health issues, just like any other population. The problem here is that mental health services in Canterbury have received less than a puny 1% increase in funding, with even the growth in population ignored, never mind the increase in the incidence of mental illnesses in the area.

The lack of funding makes me angry and sad. At bare minimum, there should have been a funding increase in line with population growth. To present themselves as having even a scrap of humanity, the architects of the health budget needed to have acknowledged the effects of the quakes on people’s mental states and provided at least a token gesture toward relieving the pressure on an overstretched service. But none of that has happened, and it is disgraceful.

Where now for CDHB’s mental health service? Well, it’s the same as everywhere else in the country, scrambling to try and make things work on a shoestring budget. It’s worse for them than many others, but two things they have going for them is a well-performing service before the quakes, and the amazing resilience that people, communities, and institutions have shown in the last four years. They shouldn’t be struggling with this, though. We can do better, damn it, and why don’t we?

We’ve prioritised a bloody convention centre over so may more important projects. Health services of all kinds go without. Social housing has been 98% destroyed, and the shortfall has not been addressed in any useful measure. There are still people living in garages and tents, struggling through the winter, because their houses are written off and their insurance hasn’t come through. There is overcrowding due to a lack of suitable and affordable housing in the area. Why on earth would we need a conference centre, which will be empty for significant stretches of time, when there are so many other, more urgent needs? The misguided waste of it all is painful.

The Canterbury region has suffered mightily these past four years, and yet still the carry on. We should be supporting them in any way we can, not letting them down as attention drifts away from their needs due to the passing of time and the waning of urgency.

The costs of suicide

The costs of suicide to society are high. There are not only the ‘intangible costs’; the grief and bereavement of family, whänau and friends, and the lost potential of lives cut short, but also the direct economic costs of suicide. The annual economic cost of suicidal behaviour to New Zealand society is estimated to total $1,381,492,000 – nearly $1.4 billion. – NZ Suicide Prevention Strategy, p.4

Suicide, then, is expensive business. I hate that we measure it in dollars when the more important measures are those of human cost, but human costs just aren’t important enough to people with budgets and calculators on their desks. The devastation that suicide causes to people should be reason enough to throw anything we could at prevention, but we live in a world of pennies and pounds.

$1.4 billion is a lot of money. What if we threw a bunch of that at decent suicide prevention? If the bean-counters really think that we could pull back $1.4 billion if we prevented suicide in NZ, then why aren’t we throwing money at this? Good suicide prevention tends to involve good mental health care, and that would reduce the burden of disease that depression, anxiety, and other mental illnesses place on society.

There are plenty of good economic reasons to treat mental illness before it becomes suicide. Why on earth aren’t we doing it? I believe it’s partly because those in power don’t actually believe the costs of mental illness and suicide. If they really understood how much mental illness cost society, they would absolutely pour some cash into prevention and cure. The numbers are meaningless to them though, just figures on paper. There’s no visceral awareness of how much mental illness and suicide cost, in dollars and in pain.

Suicide prevention is neglected, because it’s seen as expensive and ineffective, while the real expense is leaving suicidal people untreated. It’s neglected because suicide is still seen as shameful. It’s neglected because of a lack of understanding, and a lack of compassion. We can do better, and the government’s own figures tell us that it would be a logical investment.

Poverty keeps kids home from school

The Rotorua Daily Post ran an article yesterday about the impact of poverty on poor kids. Some of what it says is just heartbreaking. One principal says

Parents who don’t have suitable food for their child’s lunch have been known to keep them at home so poverty does create a real barrier between children and their education.

These kids are undernourished in body and in mind, and it’s the shitty way we address both beneficiaries and the working poor that puts them there. It’s just awful that in a country with as much wealth as ours, we actually have kids in this situation. The government promises over and over again to address child poverty, while leaving the minimum wage too low for a family to live on, and setting benefit rates even lower. Our approach to poor people is punitive, particularly those with children. Being poor is a character flaw in the model we use, because good people get an education and a good job. It’s only people who don’t bother to get a qualification, who don’t try hard enough, or who don’t really need the work (teenagers, for example) who get minimum wage jobs. As for beneficiaries? Well! people like that are just lazy! and they shouldn’t have kids, even more than minimum wage workers. It’s just irresponsible to procreate if you’re not financially secure enough to raise them.

These attitudes are the kind of prejudice that leaves kids hungry, cold, and without much hope of things getting better. Kids that are not getting to school because they’re too poor, who are getting to school but going hungry and unable to concentrate, who are chronically unwell from the diseases of poverty, are not going to learn the way rich kids are. They’re going to struggle, and in all likelihood they are going to perpetuate the cycle of poverty. It’s called a cycle for a reason – it just keeps going around and around and it’s so hard to break out of.

Many of these children – 52% of decile one students, according to the Ministry of Education statistics – are living in overcrowded homes, where their is little privacy, little space, and more chance for the spread of illness. Many of these homes are poorly insulated, and in the winter are damp and cold. Sickness is more common in the homes of the poor, and the government needs to take some responsibility for that. Phasing out the insulation subsidy for rental properties and refusing to pass the rental warrant of fitness has condemned many to sub-stander housing. Sure, it makes things cheaper for landlords, who are part of the current government’s core constituency, but it’s at the expense of the poor and vulnerable.

One of the more shocking parts of the article is the proposal by one of the principals interviewed to build a respite house for children on school grounds for when their home life became “a little chaotic”. Is this idea restricted to one low-decile principal because he’s more enterprising than most? Is it a low-decile problem, or is it more widespread but only talked about because this is a low-decile school and reality hits harder there?

I can think of a few things that can go on for a kid that might make respite a good option. Parental breakups, illness, a special needs sibling, all these things are fairly normal and common enough that there is a legitimate need for respite care for kids. What are people going to think when ‘a little chaotic’ comes up? Abuse, neglect, all the terrible things that happen to poor kids. It’s a little tale of prejudice all on its own – poor kids are prone to bad parenting, and that just doesn’t happen in well-off families. I tell you, it does. It’s just not seen or acted upon.

Poverty does awful things to kids, and as a society we are responsible for a lot of that. We can, of course, do better. Will we? Well, maybe not.

Cutting dental advances

I’ve written before about the tooth-shaped gap in our health care system. It’s a terrible oversight, and one that, it turns out, has just got a whole lot worse.

The way poorer people tend to cobble together dental care is a mixture of whatever they can spare and the $300 emergency dental grant available once a year. Unfortunately, often this is just not enough for even basic emergency dental care when things have become serious. One of the gap-fillers available to beneficiaries is to get an advance on the benefit from WINZ.

This is problematic in that it is an advance, so they will have to pay it back out of their already inadequate benefit. That’s an unreasonable thing to ask beneficiaries to do. The payment for dental assistance has not changed in at least seven years, and I suspect that it may well have been set at the same level for decades. Dental costs, like all other costs in this world, have been climbing steadily over those decades, and $300 won’t cover all that much any more. A 2013 Consumer survey revealed that it costs, on average, $140 for a single simple filling. By the time you qualify for a dental grant, you’re likely to need a lot more than just a filling. Just pull the thing out and save the trouble? Assuming that there is only one tooth involved, extraction can cost up to $300. Add on consultation and x-ray fees, and whoops, there we are over the $300 mark by quite a bit.

Now, things are getting worse for beneficiaries. They aren’t touching the dental grant (yet. Who knows with governments?), but the advance on benefits is now being cracked down on. In the 2010/11 financial year, WINZ loaned $9,398,451 to beneficiaries for emergency dental care. In the last year, they loaned $45,100. Look at those numbers for a moment.

There are still ten million-odd dollars of dental work that needs doing (probably a lot more, but at least that ten million). If WINZ are only loaning out $45k in a year, what is happening to all the other people that have been eligible for dental loans in the past? It has been suggested that people are making time-payment arrangements with their dentists, and I don’t doubt that some do. I suspect, however, that there are more people than ever going without the dental treatment they need.

I also learned that emergency hospital dental care commonly has a limit – they are likely to only extract one tooth. I guess it’s a case of choosing the one that hurts the most. That sounds so cynical, and I am sure that there are hospital dentists that bend the rules for people who are suffering whenever they can get away with it, but the reality will be just that brutal.

So our government has, yet again, pulled the rug out from under the poor. Why do they keep doing this? Saving money, blah blah surplus blah. I would hate to be a policy maker at the Ministries of Health and Social Development. To have to balance the wellbeing of their fellow man against budgets that just don’t match the need out there must be hard.