Mental health is more complicated than two lines on a chart can convey, but that reality rarely gels well with partisan politics, Marc Daalder reports
Analysis: The saga of Shane Reti's misleading self harm charts is over, but shines a light on the difficulties in interpreting mental health data, advocates say.
The National Party Health spokesperson and Whangarei-based List MP writes a regular column for The Northern Advocate. His latest, published on the New Zealand Herald website on March 6, alleged that mental health had been worsened by the Government's Covid-19 response based on a supposed increase in hospital admissions for intentional self harm.
Herald data journalists said the data was misused and the charts were misleading, and the article was pulled the next day. But the issue highlights the challenge facing anyone who wants to get a good look at mental health trends.
Depending on which data set you use, hospitalisations for intentional self harm either fell slightly over the first 15 months of the pandemic compared to the year beforehand or rose slightly. The data Reti used, turned up by this public Official Information Act request, appeared to show the latter.
How reliable is that data? It certainly ought to have a margin of error attached. This hospital data is based on a complex coding system that could see people admitted for unrelated issues classified as an intentional self harm case if they give certain answers to questions about their mental health.
Imagine someone goes to hospital with a broken arm. The nurse asks them how they're feeling and they reported they had recently had suicidal ideation. That could potentially trigger the nurse to classify the incident as intentional self harm.
Reti was on leave and unable to comment for this article.
Moreover, how are we to process a potential rise in self harm alongside a decline over the same period in suspected suicides? Could it just be random variability? The percentages in both of these cases could look significant but the change in the actual number of people involved is generally quite small, University of Otago psychologist Roger Mulder told Newsroom.
"The big issue in New Zealand is the small population, particularly if you go into sub-groups. If you go and look at young females who harm themselves, you could get a very distorted picture if you just looked at a couple of points in a year, because they'll be going up and down quite a lot," he said.
"The smaller your numbers, the more the figures move around. One year we could look good, one year we could look terrible."
Mental Health Foundation chief executive Shaun Robinson said there's another, bigger issue: We're not looking at the bigger picture.
"The fundamental issue is peoples' conception and understanding of mental health," he said. "Many people are still operating out of a very traditional view of mental health which is a biomedical, sickness-oriented model which defines mental health as two-dimensional. You've got mental illness and then you've got lack of mental illness."
In reality, mental health is a lot more complex. Robinson thinks of it as a broader spectrum, with one axis about mental illness and another about wellbeing.
"Flourishing or wellbeing is feeling good and being able to function well. Having positive emotions, a sense of engagement with life goals, it flows into your relationships, your engagement with your work, your engagement with your community, a sense of resilience when bad things happen," he said. The opposite of that is "languishing", which is "kind of the inverse of that. People who may not necessarily have a diagnosable mental illness but have a general low mood, low engagement, are easily knocked off their perch by life events."
If we understand mental health as something more holistic than the presence or absence of a diagnosis - which politicians are increasingly agreeing to do - then we have to measure it with statistics that go beyond self harm hospital admissions. Robinson says there will always be a place for understanding clinical need and that biomedical side of the coin, but that we can't really understand how mental health as a whole was affected by something like Covid-19 without taking the wellbeing data into account either.
"We've been critical of every political party, there is no political party that has not received some kind of letter from me admonishing them for trying to score points off the state of mental health," he said.
Exactly how to measure mental health holistically is still an area of active research. One of Robinson's preferred metrics is called the WHO-5 - five statements about one's emotions that people rate on a scale of zero (in which they didn't feel that way at all over the past two weeks) to five (in which they felt it all of the time).
The total score for the test is then ranked out of 25, with higher indicating greater emotional wellbeing. Anything below 13, the halfway point, is considered "dangerous", Robinson said.
There's no official body that conducts this test in New Zealand, but the Mental Health Foundation has worked with Ipsos to launch regular polling of the WHO-5 since December 2020. The fourth round of data was collected in February and shows a trend of worsening mental health, according to figures supplied by the Mental Health Foundation.
New Zealand's average score in the latest survey was just 14, down from 15.9 just over a year ago, while those with high incomes were underrepresented.
This doesn't tell us much about the impact of Covid-19, because the data doesn't exist prior to December 2020 but Robinson says it's still cause for concern. There is, however, a silver lining.
The Ipsos survey also measured 12 different habits which Robinson says evidence shows can improve mental health and wellbeing. Of the quarter of the country who fell below the 13-point threshold, most of them didn't engage in any of those behaviours.
"Adopting even one of those 12 behaviours on a regular basis gave you a 48 percent chance of having positive mental wellbeing," he said.
"The wellbeing promotion stuff works. It's been validated by years of research, but even in this context of Covid, it's absolutely validated."
Robinson is hopeful that this shows the way forward for work in the mental health space: Holistic data, holistic approaches and no political point-scoring.
Where to get help:
Safe to Talk national helpline 0800 044 334 or www.safetotalk.nz
Women's Refuge (For women and children) - 0800 733 843.
Shine (For men and women) - free call 0508-744-633 between 9am and 11pm.
1737, Need to talk? Free call or text 1737 any time for mental health support from a trained counsellor
What's Up – 0800 942 8787 (for 5–18 year olds). Phone counselling is available Monday to Friday, midday–11pm and weekends, 3pm–11pm. Online chat is available 7pm–10pm daily.
Kidsline – 0800 54 37 54 for people up to 18 years old. Open 24/7.
Youthline – 0800 376 633, free text 234, email talk@youthline.co.nz, or find online chat and other support options here.
National Rape Crisis helpline: 0800 88 33 00
If you or someone else is in immediate danger call 111.
