Prof Grant Schofield talks to Prof Julia Rucklidge about the mental health treatment gap, what the main problems are and how we could find a solution.
The treatment gap is the number of people who are currently not receiving any treatment, but who struggle with a mental health issue. We know this is a big problem in New Zealand. Only 3% of the population have access to mental health services. You have to be in the severe range in order to be able to get into the clinics in the public health system. If you’re experiencing mild, even moderate mental health issues you’re getting turned away.
“I read stories about kids who are not suicidal enough in order to get into the services,” says Julia Rucklidge.
“We know this is a huge problem, and it’s got to do with having a lack of professionals to adequately address the mental health issues that are present in New Zealand. There’s just not enough of them.”
This is true not only in New Zealand but worldwide as well.
“The number that gets thrown around is about 20%, one in five of us, is struggling with a mental health issue. But that depends on how you want to define it. Everybody struggles to some extent, at some point in their life, with a mental health issue. Do you need to see professional services? Not necessarily. Struggling with anxiety and depression can be a normal part of life,” says Rucklidge.
Lack of professionals and infrastructure
It’s interesting how with physical health, we’re okay with the idea that everybody needs to look after their physical health, she says. We all need to look after our heart health, and we need to make sure that we’re eating adequately to ensure that we don’t go down a path of say, type 2 diabetes. But we just don’t think about that in terms of mental health. We seem to think that that’s reserved for a certain part of the population.
“If I look at our best practice guidelines in this country, it’s got quite specific, clear guidelines about the treatment for mild or moderate depression, and even for major depressive disorder,” says Grant Schofield. “It’s very clear that medicines for mild to moderate depression should never be the first line of treatment.”
“It quite clearly and specifically lists out a range of evidence-based therapies, which start with exercise and physical activity. It mentions nutrition and diet. It mentions sleep. It mentions talk therapies and connecting with other people,” he says.
“But we don’t have enough professionals,” says Julia Rucklidge. “That’s the challenge.”
We don’t even have the infrastructure, even within the professionals that we have, Grant Schofield says.
Julie Rucklidge agrees. She teaches in a clinical psychology programme. Over the time she’s been there, the number of students have doubled – it’s gone from 8 students to 16.
“And we are seriously struggling with training 16 clinical psychologists per year, because we don’t have the internships. We don’t have the placements for them. We don’t have enough staff to be able to one-on-one monitor them and supervise them, which is essential for them to get that expertise in conducting cognitive behaviour therapy.”
Current model is not working
“So, we have a model that requires an enormous amount of investment to train them and an enormous amount of time for them to get through,” she says. “You have a bottleneck in the terms of the number of psychologists you can ever graduate in one year.”
“When they say we just need more of them, and that’s the solution – you would need to double, or triple, the workforce, and still, you’re not going to adequately be able to service that 20% of the population.”
This model demands an intense level of training, it’s not achievable and is it not something our country can afford, she says.
She adds that only 50% of people get better with psychotherapy.
Nutrition and health coaching for better mental health
Julia Rucklidge’s new book, co-authored with Bonnie J. Kaplan, PhD, The Better Brain, presents a different way of thinking about mental health. Kaplan and Rucklidge suggest treating mental disorders like anxiety, depression and ADHD with food and nutrients. Both scientists have dedicated their careers to studying the role of nutrition in mental health, and their research reveals the surprising role that nutrients – especially minerals and vitamins – play in brain health.
“One of the risk factors that has been really emerging over the last decade is our nutritional foundation. It’s been eroded because of this social experiment of eating ultra-processed foods,” says Rucklidge.
If we could address and tackle that, that could be part of the solution.
Grant Schofield suggests a solution involving health coaching, mental health coaching, community health workers and health improvement practitioners. This is already a workforce, they have some training in this area and there is some evidence that they’re achieving results – without the level of training of a clinical psychologist, but interacting and being overseen by a psychologist, he says.
“Yes, we need that,” says Julia Rucklidge.
Julia Rucklidge (PhD) is a Professor of Clinical Psychology in the Department of Psychology at the University of Canterbury, Christchurch, New Zealand
Stay tuned for PreKure’s podcast series on mental health – to be launched soon!