Q&A: Dr John Crawshaw

Dr John Crawshaw was appointed Director and Chief Advisor of Mental Health in November 2011. As the principal advisor to the government on matters of mental health, he fulfils several key statutory functions. He has also served as the Chair of the Royal Australian and New Zealand College of Psychiatrists’ Board of Education.

A graduate of Otago University’s Medical School, Dr Crawshaw has senior management experience in public health. Prior to his current role, he worked in Tasmania where he was responsible for the state’s Mental Health and Alcohol and Drug Services. Dr Crawshaw sat down with Matters of Substance to talk about addiction and mental health.

Q What are the three biggest challenges facing the mental health and addictions sector?

A We still have large parts of the community who really continue to have some stigma towards people with mental health and addiction issues. That has the adverse impact of people not being prepared to seek help, or they deny some of their problems. This leads to ongoing challenges in getting them into treatment early, which will make a big difference.

We know that work done in the early years, particularly in security of selfesteem and resilience, makes a real difference in terms of life outcomes. By addressing issues for children and youth early, we can prevent them from going on to develop significant problems. The strategies that we have been doing, in terms of the Prime Minister’s youth mental health project, have a real focus on making our services more youth friendly and more youth accessible.

And then there are some of our societal attitudes in terms of where we see the place of substances, particularly alcohol. It’s not always the case that people see the harms that are associated with alcohol and substances, or if they do, they do not seem as applicable to them. Some of this means individual attitudinal change. Others require wider societal attitudinal changes.

Q Any trends around alcohol and drugs?

A We are, like any other country, beholden to some of the overseas trends. While we are fortunate that we are a long way away from a number of the drug sources, we will undoubtedly follow some of those trends. We’ve seen that with the new psychoactive substances. While there is a structure in New Zealand to deal with that, which is fortunate, we do have more work to do. I think that it’s likely that we are going to have to continue to do the work in the alcohol space. What we’re doing at the moment is developing the new national drug policy.

Q Is the addiction treatment sector well placed to meet the challenges?

A New Zealand has some real strengths in the mental health and addiction sector. We have a diversity of players, which, from my experience in Australia, we didn’t have. I think that we have some very talented individuals who certainly are leading their fields. With a diverse treatment sector, with both NGOs and DHBs delivering services, there is that breadth of treatment providers to be able to meet the needs of people coming through.

My sense is that the sector is strong, but like any sector, it needs more development. I think that we probably need more strategic focus as to how each of those elements fit together – something the Ministry is beginning a piece of work on. Another area of focus is asking how do we ensure that every door is the right door, regardless if someone presents in the mental health space or the addiction space.

Q You seem to put a lot of emphasis on collaboration?

A The work that we have to do collectively – and it’s not something that just the Ministry can do – is to articulate how the sector works with each other. That may mean that new services, such as some of the youth exemplar services funded by the Ministry, need to be developed to find different ways of working, because we know what works for youth is not necessarily the same thing that works for adults. So I think that it really is crucial that, as a sector, we keep pushing the boundaries, keep looking for the evidence and keep thinking about how we put the people we’re helping at the centre of the services that we deliver.

Q Are organisations adequately resourced to do their work?

A That’s a questions that needs to be worked through by the Ministry, the DHBs and the NGO sector, so I don’t think I’ve got the final answer to that question. I think that it’s something that has to be looked at in a collaborative fashion. Sitting behind this is also whether we are using the resources that we do have in the most effective way. This is one of the major focuses in Rising to the Challenge.

Q Can you share your advice on maintaining mental wellbeing?

A I usually suggest to people that the whole approach of positive psychology is the thing to do. Mental health and wellbeing is a state of mind. Take time to look after yourself and your family. Try to ensure you have something in your life that gives you a sense of value, purpose and belonging. We also know that physical activity is important. And actually taking time to appreciate the world around you. I recommend the Mental Health Foundation’s website, particularly the ‘Five Ways to Wellbeing’.

Q How do you put this into practice?

A I walk a lot for my physical exercise. Exercise is a great way of improving your sense of mental wellbeing. I’m passionate about music of all sorts, so if I need to switch off or recharge, you’ll usually find me listening to some music. And family. Family is really important.