The Bureaucracy of Mental Health: How Our System Is Failing Us

Isis Wright (she/her)

With a 2.9 star rating on Google, anyone who has been at Vic long enough probably has a story about Mauri Ora. Mauri Ora is an incredibly valuable aspect of student life, and plenty of students take advantage of the free healthcare available to them on campus. Yet, anyone who has approached Mauri Ora for mental healthcare might not have a hugely positive story. Under-resourced, under-staffed, and lacking in funding, the cracks in the mental healthcare system are starting to show more than ever in 2021. I set out to find out where the issues are coming from and investigate the major flaws in the Government’s mental healthcare funding and sat down with Kevin Rowlatt, Associate Director of Mauri Ora.

It has been over a year now since 25 March 2020, the day New Zealand went into a nationwide lockdown. It’s no secret what a difficult time it continues to be for many students across the country, especially for those entering their first year of tertiary study. No one can really prepare you for just how hard it is to adjust to university life, let alone during a pandemic. During times like these strong mental healthcare systems are as important as ever to ensure the ongoing health and safety of students. The flaws within Victoria’s Student Health system have long been discussed; in fact, it was something I had heard about upon enrolling, but it wasn’t until last year that I experienced the University’s counselling system for myself.

I would first like to explain the key differences between psychiatrists and psychologists, and how they work within Mauri Ora. A psychologist is someone who studied psychology at university and then went on to specialise in a certain field. You would normally meet with a psychologist at a typical Mauri Ora counselling session. A psychiatrist is a doctor who studied medicine and specialised in psychiatry. In New Zealand, it takes 12 years to become a psychiatrist. As a result of their medical training psychiatrists are able to diagnose mental health conditions and prescribe medication, while psychologists are not. Many people feel the need to meet with a psychiatrist before seeking counselling, though it is absolutely not necessary to have a mental health diagnosis to get help when you need it. 

To get a diagnosis you need a psychiatric evaluation. In my experience, a psychiatric evaluation looks like this: you sit in a (hopefully) comfortable psychiatrists office and they ask you a bunch of questions. At the end of it, if you’re successful, you should have a diagnosis and a treatment plan. I was lucky, and I walked out of the office with all of the above, feeling like my life had changed. I was the last patient referred to the psychiatrist before they left to work for another practice. Since October, the University has not had a psychiatrist on staff, leaving an enormous gap in the Mauri Ora counselling system.

General practitioners and psychologists do not have the training or qualifications to diagnose, instead they simply treat what they already know is there. As a result of this, myself and other students are unable to easily trial new medication as a GP is not in the position to comfortably change a course of treatment set by a psychiatrist. This has left students in a compromised position where they are unable to be accurately diagnosed, and leaves the remaining Mauri Ora team to pick up the workload left behind by the absence of a psychiatric doctor.

The average cost of a psychiatric evaluation in Wellington is $500 an hour; follow-up treatment sessions are typically $250 an hour. Sometimes it can take multiple sessions for a doctor to come to their conclusion on a diagnosis. The cost of a psychiatric evaluation usually includes a diagnosis and prescription, a letter to the patient's GP, and a detailed report written by the psychiatrist. Of course, psychiatrists have professional expenses to cover, but where does that leave those of us who can’t afford it? 

Counselling and psychotherapy are valuable resources that are significantly cheaper, however they are only options for those who have been diagnosed and want long-term therapy, not those wanting a formal evaluation. Vic has a team of psychologists on hand who students can book regular counselling with, but psychologists are unable to diagnose mental health conditions or write prescriptions, and many find the wait time and the length between appointments to be frustrating and ultimately unhelpful.

A $25 million tertiary mental health fund was announced by the Government in July of last year. This fund is included as part of the Government’s wider initiative to keep lower-risk patients out of hospitals and into community mental healthcare, to allow for patients requiring more immediate attention to receive the care they need. On paper, the tertiary student mental health fund is a fantastic initiative, until you realise that not a cent of that money has been spent.  There is a lot of bureaucracy behind healthcare funding; funds are distributed to the Ministry of Health who then dictate where the money should be allocated. Apparently, the Ministry has been struggling to make their decisions.

So with a lack of Government funding, where does that leave the University? The budget for the 2020 Student Services Levy shows that the cost of providing mental healthcare to students set the University back over $3 million last year, with an extra $2,654,335 coming from levies, and $504,504 coming from “other sources”—presumably the Ministry of Health. It cost the University an extra $5,100,419 to fund Mauri Ora’s health service, with another $2,476,805 coming from “other sources”, a considerably larger amount than what is currently being allocated to counselling. 

In the 2021 budget, the Government has stated their healthcare funding initiative this year is to allocate $2.7 billion to DHBs, $200 million to PHARMAC, and $301 million for “funding rate increases to enable early learning, schools and tertiary providers to continue providing quality education”, with no mention of funding regarding tertiary mental healthcare. 

I then spoke with Kevin Rowlatt, the Associate Director of Mauri Ora. Kevin acknowledges the lack of a psychiatrist on staff, and tells me of the stress that this has put on the Mauri Ora staff. He assures me that hiring a new psychiatrist is well within the University budget, however there is a shortage of trained psychiatrists worldwide. A healthcare clinic going long periods of time without a psychiatrist is not an issue exclusive to Mauri Ora. 

Kevin says he wishes the Government would invest more in tertiary mental health, as that would improve conditions for staff and students across the board. He has not seen any of the $25 million tertiary health fund released last year. 

“We are still waiting for the Ministry of Health to do their RFP process (Request For Proposal). That was supposed to happen before Christmas; the money was supposed to be available to those who were successful in March or April of this year, and that’s gone quiet.” 

It is worth noting that the $25 million is destined to be spread across all New Zealand tertiary institutes over four years, which is not a lot of money. Kevin states that having PIKI counselling services available throughout the Wellington region cost the Ministry of Health $10 million alone for a three-year contract. 

When I asked Kevin what he would like students to know about Mauri Ora, he stressed the dedication of both the admin and health staff. 

“I’ve worked in healthcare management for 20 years now, so I’ve seen many models of care in various general practices, and after three years [at Mauri Ora] I’m still blown away by the dedication of the counsellors, GP’s, nurses, and admin staff. It’s much busier than you would get in any other typical general practice in the community; the needs are very different from what you would normally get from general practice [...] But staff are totally student-centric in everything that they do, and I don’t think I’ve ever worked with a workforce like that.”

There is also a Mauri Ora student portal set to be rolled out soon, which will enable students to book and cancel appointments online without having to speak to reception. 

I feel it is worth noting the ongoing positive experience I have had throughout the last year with Mauri Ora Health and Counselling. I love my GP who I have developed a great doctor-patient rapport with, and I am grateful that I was able to meet with the University psychiatrist before he moved on to another position. The opportunity to access these services for free has undoubtedly changed my life for the better. Mauri Ora Health and Counselling is an incredibly valuable resource for students, and it’s only free for those few years of study—so take advantage of it while you can. 

While the flaws in Mauri Ora may be detrimental to us as students, there’s no real way for the University to be able to fix them anytime soon. As hard as the staff at Mauri Ora try to provide the best possible care they can, our Government simply doesn’t advocate enough for us, and we fall short.