Chaired by Speaker of Parliament Niki Rattle, the six panellists included Minister of Health Nandi Glassie, Mereana Taikoko of non-government organisation Te Kainga O Pa Taunga, mental health practitioner doctor Rangiau Fariu, leader of the opposition William Heather, young person representative Teuru Tiraa-Passfield and community advocate Memory Mills.
Approaching the question, “how is mental health addressed in the Cook Islands, and is it effective?’, from a policy angle, Glassie said that over the past few years the Ministry of Health has been putting in strategic plans to strengthen mental health services.
One aspect of that was to look at integrated responsive care, especially during disaster situations, which would mean that there is a plan in place to care for the mentally ill during an event such as a cyclone.
Glassie added that they would look at 20-year health strategy, one that would cater from a five-year-old child to a 65-year old adult, and would strengthen the mental health wellbeing programme, as well as include suicide provision awareness.
The minister made sure to impress that there will soon be a facility that will exclusively cater for mental health patients.
“The building will be based on special plans from New Zealand, and we are just waiting for those to come through to the Cook Islands Investment Corporation (CIIC) so that we can design it.”
In the meantime, the prison will continue to be used as the primary housing facility for the mentally ill, as that is seen as the only secure building on the island to accommodate patients.
Following Glassie was Tiraa-Passfield, who relayed an emotional story about the dangers that the stigma of mental illness can hold.
While she was at school, a classmate of hers was called an ‘attention-seeker’, after making an attempt to take their life.
“They said if she wanted to do it, she would have. I wonder how they later felt at her funeral,” she said.
“I wonder if we could have done more, what might have happened had we been the community that made her feel OK to ask for help.”
She also shared a social media story that she saw about a crime committed by a local with a mental illness.
“There were terrible comments, with people saying that they should be arrested, as well as blaming the family.
“No wonder people resist using mental health services, because of shame for things that shouldn’t be.”
Dr Fariu spoke next, and said that in his estimation, having travelled to other countries, the Cook Islands provided one of the best mental health services in the Pacific.
Although by his own admission the mental health sector was understaffed and underfunded, he maintained that the service is fantastic.
“Any time patients are referred to us, they are seen immediately, or within 24 hours. We provide a 24/7 emergency service, all performed by two people,” Dr Fariu explained.
“We also have outreach and awareness programmes, medical and psychiatric services for prisoners, screenings in the outer islands, and social work for the young and elderly.”
In regards to suicide, he said that no matter what safeguards put in place, people will still do it, that it is human nature.
“We try our best, but human circumstances, they will do it. We can only support them and their family. We can’t conduct blood tests to find out if someone has mental illness, so we have to use our experience.”
Taikoko, of the NGO Te Kainga, said that her experience in the field has shown that the state of mental health in the country is poor.
“That is indicated by the high rate of youth suicides, domestic violence and substance abuse, and Non-Communicable Diseases. The decrease in population has put further pressure on the remaining family members too,” Taikoko explained.
In her work with Te Kainga, which opened in 2004, they helped and supported 2032 people with mental health problems, and she believes that the Cook Islands are on the right track
“But there is still much more to do be done, as the government must allocate budget for mental health for core funding.”
Opposition leader Heather agreed with Taikoko that there is more work to be done, as he believed the current system is ineffective.
He spoke of his 84-year-old mother, who has been battling a mental illness over the past eight years, as well as watching his uncle be put into prison due to his mental state.
“I had to hold my uncle down, which I could do because of my size, and then we then took him to prison. My uncle does not deserve to be in prison. I thought to myself, ‘what have I done’?” Heather said.
“We realised that this is not a small issue here, it’s far bigger than what we think. I put the question to the (health) ministers, ‘how would you address this’?”
His answer was funding, which he found disappointing.
“Lives of our people are being put aside. I’d like to ask please, get some money and help to these people who are trying their best.”
Last of the panellists to speak was Mills, who lost her son Trumayne to suicide two years ago.
“Since his death, I have reflected on his life and can pick out all the little signs that my son needed help,” Mills said.
“Our beautiful boy fought as hard as he could, but in the end it took him. But if I’m going to be quiet about it, how will others know? We need to bring it out in the open.”
Following her son’s death, the family was visited by a number of qualified mental health professionals.
She noted that she didn’t know them until it was too late, and that was an indication for her that the government needs to put more effort into mental health.
Having only moved to Rarotonga in 2013, Mills soon become aware of the overbearing stigma that is associated with mental illness.
“Is this one of the many reasons that locals are reluctant to speak up about mental health issues? I personally would not want anyone to know I have it.
“So no it is not being addressed effectively, and sometimes people need open communication.”
She suggested a 24/7 local helpline, or suicide prevention, programmes, or something as simple as stopping to have a conversation with someone.
“Let’s get together and construct a straight forward suicide programme that can be launched here, something that caters to those who are considering suicide, those who have attempted suicide and those who are left dealing with the scars of losing a loved one,” Mills said.
“Create one group that leads in suicide prevention, and place the issue at the forefront of the community.”
Following the panellists speaking, the floor was opened up to questions from the audience, and the speakers seemed reluctant to comment on over half the queries, although it must be said that not all were experts on the topic.
One of the questions aimed at Dr Fariu was regarding patient confidentiality.
The speaker said that she had gone to New Zealand for treatment, as she had no confidence that if she sought local help that it would stay private.
Dr Fariu said that although there are policies, it is very difficult to enforce.
“I battle this issue every day when I call family meetings. Mothers and fathers want to know what is happening to their children,” he explained
“If I refuse their request, they will go to the person above me, and it’s not unusual to have people go to the minister to release info.
“My take is if they agree to family meeting, they agree to give the information, then I’ll go with that. In some ways it does help to break the confidentiality.”
Tiraa-Passfield passed on the number for Youthline (0800 Help or 4357), which provides free, confidential service.
In her turn to speak, Cook Islands National Council of Women coordinator Taputu Mariri said that the building that Glassie mentioned was a necessity, as Taikoko had nearly been attacked in the current facilities.
Glassie said that security was something they were mindful of until they could move patients and carers into the new facility, although Dr Fariu supported the use of the prison.
“In some ways I like using the prison. Our patients tend to recover much quicker in that environment, somehow, then when in the ward.”
Taikoko responded to a question about the lack of Alcoholics Anonymous, which was run by Charles Little until he passed away last June.
She said that there was a volunteer from America that was happy to run meetings (phone number 20162), while at the same time they were trying to train locals that would be able to run meetings.
An audience member also enquired about the possibility of a scholarship for mental health studies in New Zealand, but Glassie believed that at this stage there seemed to be a lack of interest in that field.
Rattle finished by saying that she hoped what was discussed would push the government into action
“What I think should happen after this debate tonight, is that we need to give them to the policy makers, so that it will mean something in coming here, that we haven’t just come to talk backwards and forwards,” Rattle said.