In a crisis or emergency, if someone has attempted suicide or you’re worried about their immediate safety, do the following:
- Call your local mental health crisis assessment team or go with them to the emergency department (ED) of your nearest hospital.
- If they are in immediate physical danger to themselves or others, call 111.
- Stay with them until support arrives.
- Remove any obvious means of suicide they might use (e.g. ropes, pills, guns, car keys, knives.)
- Try to stay calm, take some deep breaths. Let them know you care.
- Keep them talking: listen and ask questions without judging.
- Make sure you are safe.
More information and support
Talk to your local doctor, medical centre, hauora, community mental health team, school counsellor, or counseling service for more information and support. If you don't get the assistance you require the first time, keep trying.
How to find a therapist
Your mental health is just as important as your physical health. When you need extra help, one of the most effective treatments is counselling, but it can be difficult to obtain. If you're looking for a therapist, we've put together a resource to help you navigate the system.
Will I have to pay for therapy? Government-funded mental health services are available, but you may need to fill out paperwork or get a doctor's referral. You may also be able to obtain free or low-cost care through your workplace or a local charity.
Shaun Robinson, CEO of the Mental Health Foundation, suggested that people in need of assistance ask a friend or family member to help them make calls and navigate the options. Here are some alternatives:
The public health system provides fully-funded mental health care. You may be offered an extended GP or nurse appointment, a brief intervention (a few sessions provided by a nurse, social worker, or therapist), or longer-term individual and group therapy, depending on how your needs are assessed. The availability of care varies by DHB. Often, you won't have much say over who you see or how long you see them.
You'll need a referral from your primary care doctor to take this route. Even if you can afford private therapy, the medical director of the Royal New Zealand College of GPs, Bryan Betty, says your family doctor should be your first port of call when you need help.
If you don't have a regular doctor, look up your nearest medical practice and give them a call. Even if it is not currently accepting patients, you will be directed in the right direction.
Employee assistance programmes
Many larger companies have enrolled in employee assistance programmes provided by third-party providers such as EAP Services, Raise, or Workplace Support. One significant advantage is the availability of free and confidential counselling sessions. You don't have to have a work-related problem to qualify.
Check to see if your company has signed up for a service – there may be a link on your intranet or information in your induction documents. The number of sessions that will be funded is likely to be limited. To schedule an appointment, contact the service directly.
If you require counselling as a result of sexual violence, ACC will cover 14 hours of one-on-one therapy. However, you must make an appointment with a therapist registered with the agency – a list can be found at findsupport.co.nz – demand in some areas can result in claimants waiting months.
Once you've met, the therapist will submit a form to ACC, and the agency will cover the cost (even for previous appointments). If you are determined to require long-term care, ACC will continue to fund counselling sessions and other services.
If you’ve made an ACC claim for a physical injury that’s affecting your mental wellbeing, the agency may refer you to a therapist and pay for 10 counselling sessions (or more if needed).
Work and Income support
Those suffering from a long-term condition, such as depression or stress, are eligible to apply for the Disability Allowance. The weekly payment of $66.11 can be used to pay for ten counselling sessions (more if deemed necessary). However, your household income must fall below certain limits. Couples, for example, must earn less than $53,622 per year to qualify.
You must first fill out a form – with sections completed by your GP and counsellor – and schedule an appointment with Work and Income (unless you already receive payments from the agency). Work and Income will not cover counselling sessions retroactively. Visit workandincome.govt.nz to apply.
Health insurance claims
Some health insurers will cover certain mental health services as part of their standard insurance policies. Southern Cross, for example, will pay up to $3500 for specialist hospital care and $750 for psychiatric consultations. UniMed provides up to $5000 in payment for specialised hospital care.
Day-to-day counselling is usually only available if you have a premium plan, such as Southern Cross' UltraCare, or if you purchase an add-on package, such as Nib's EveryDay Cover.
Some plans will pay for counselling if the problem is related to a surgical or cancer claim.
Charity, Iwi and youth services
Non-profit organisations in your area may provide free or low-cost counselling services. These range from major national charities like Presbyterian Support and Asian Family Services to small-town organisations like women's shelters.
Some counselling services provide free or low-cost services to youth. Often, these are small non-profits based in a single city (for example YOSS in Palmerston North), though Youthline has counselling centres in several cities.
Your doctor or the local Citizen's Advice Bureau can direct you to this type of service in your area. Both the Citizen's Advice Bureau Community Directory and the Family Services Directory have searchable databases that can assist you in locating free or low-cost counsellors.
Kaupapa Mori services frequently include mental health and addiction treatment. Your local Iwi can point you in the right direction.
On campus, university students (with the exception of international students at some institutes) have access to free support services.
Some national hotlines provide face-to-face or e-counselling services that are either free or heavily subsidised. Lifeline, which also operates the Suicide Crisis hotline, offers online and in-person counselling from its Auckland headquarters.
The 1737 hotline is available to anyone who is stressed, anxious, depressed, or in need of advice – you do not need to be in a crisis to call.
The website of the New Zealand Association of Counsellors (NZAC) includes a list of accredited counsellors. Talking Works is another professional directory, and most of them have detailed profiles where you can learn about their qualifications, experience, fees, and approach.
According to NZAC president Christine Macfarlane, many counsellors offer new clients a free phone consultation to get to know each other and the style of talk therapy. Surveys show the cost per session is on average $125 in Auckland, $132 in Wellington and $135 in Christchurch. Psychologists (those who have completed postgraduate training) typically charged higher fees, ranging between $150 and $200 per session.
Your therapy records
At your initial appointment, you should be informed about what happens to your therapy records or notes, from the type of information collected to who will have access to them (including government agencies). Under privacy law, all counsellors, psychotherapists, psychologists, nurses, and doctors are required to make this clear.
Check how long your notes will be retained and how they’ll eventually be destroyed. You can request notification when your records are erased. If you change providers, you will be asked to sign an informed consent form so that your records can be sent to your new therapist. This may not be your top priority at first, but your therapist should always be willing to talk about the safeguards surrounding your information.
Counsellor, therapist or doctor?
Qualifications and training for mental health professionals vary.
Counsellors offer what is known as talk therapy to improve mental health. They may specialise in certain types, such as cognitive behavioural therapy, and may recommend lifestyle changes, but they cannot prescribe medication. They may have a qualification, but it is not required by law. A counsellor accredited by NZAC or the New Zealand Christian Counsellors Association (NZCCA) must, however, have a bachelor's degree, diploma, or certificate, a certain amount of experience, and complete ongoing professional development. Before scheduling an appointment, enquire about a counsellor's industry memberships and experience.
Psychotherapists provide a type of talk therapy known as psychotherapy, which investigates how early life experiences may influence current thoughts and behaviours, particularly those that are detrimental to your life. They are unable to prescribe medication. Psychotherapists are required by law to be registered with the Psychotherapists Board of Aotearoa New Zealand, which requires practitioners to have a tertiary qualification or industry training and to meet ongoing professional development requirements. Inquire about the therapist's annual practise certificate when you sign up.
To improve mental health, psychologists (like counsellors) employ a variety of talk therapy techniques. Although they may help a client with a short-term problem, such as a stressful period in their life, they can also help with chronic problems, such as addiction and depression. They are unable to issue prescriptions. Only those who are registered with the New Zealand Psychologists Board – which requires at least a Master's degree in psychology – can call themselves psychologists. They must participate in ongoing professional development. Check to see if your psychologist has a current annual practise certificate.
Psychiatrists are licenced medical practitioners. As a result, they are able to diagnose and treat mental illnesses. They may prescribe medication, talk therapy, and lifestyle recommendations; the treatment may include individual sessions with a psychologist, psychotherapist, or counsellor. They must complete medical school, six years of psychiatric training, register as a specialist with the New Zealand Medical Council, and participate in ongoing professional development. Seeing a psychiatrist usually necessitates a referral from your primary care physician.
Will talking really help me?
Clinical trials have extensively tested talk therapies. Some, such as cognitive behavioural therapy for youth anxiety or postnatal depression counselling, have received the ultimate seal of approval: the Cochrane Collaboration or the US Preventive Services Task Force have endorsed their efficacy (independent organisations that systematically review healthcare).
However, counselling is only one tool for improving mental health. Medication can be just as effective – and in some cases, it can be faster acting. There is evidence that the two treatments work better together than separately for conditions like depression. Maintaining healthy lifestyle habits is a third important tool that doctors and counsellors frequently encourage or can introduce. Eating a balanced diet, staying active, learning new skills, volunteering, connecting with loved ones, and taking notice (or practising mindfulness) all improve wellbeing and protect against mental distress, according to the Mental Health Foundation.
Will I have to wait for help?
When people's mental health problems reach a crisis point, they frequently seek help but the wait times for counselling or specialist care vary. Surveys have found that some private counsellors who had appointments available in a matter of days. Most, however, had to wait one to two weeks. Others would have to wait at least two to three months to see a new client.
You have options if you are forced to wait for an extended period of time. Inquire with your doctor if the practise provides in-house counselling or a rapid intervention service. Some therapists maintain a wait list, allowing you to pick up an appointment at the last minute if another client cancels. The helplines can provide immediate assistance. Although these phone services cannot replace in-person counseling, they can provide a listening ear and advice if you are facing a long wait.
Wait times for employee assistance programmes are typically shorter. However, only the first few sessions will be funded, with the possibility of extensions (depending on your employer). Following that, the counsellor may be able to accept you as a patient, but it will most likely be on your dime.
What if I don’t click with my counsellor?
It's perfectly normal to change therapists or counsellors. It all comes down to the connection between the individual and the counsellor. You must ask yourself, "Is this someone I can be open with?" Counselling can be a challenging process at times. It can be unsettling because we're sometimes discussing difficult topics that we don't usually discuss. Professional therapists are aware of this and will be understanding if you prefer to see someone else.
We encouraged anyone who didn't connect with their first counsellor to try another instead of giving up. Don't think to yourself, "I tried it and it didn't work." It's possible that the first person you meet isn't the right one for you.
You can file a complaint if your problem involves unprofessional behaviour. Concerns about any NZAC-accredited counsellor should be directed to the Ethics Secretary email@example.com . Complaints from NZCCA members can be emailed to firstname.lastname@example.org. Complaints about psychotherapists, psychologists, doctors, and psychiatrists should be directed to the Health and Disability Commissioner (HDC). There is an online complaint form, and you can also contact the commision by email email@example.com or postal mail. You can also contact the regulatory bodies directly, though any investigations must be conducted in conjunction with the HDCs. Contact the Psychotherapist Board via email at firstname.lastname@example.org, the Psychologist Board via an online form, or the Medical Council via email at email@example.com.
The truth about PTSD
90% of people with PTSD (or PTSI) haven’t been to war, they’re survivors of abuse and assault, car accidents, natural disasters and other forms of trauma.
PTSD is a serious mental health issue that affects the everyday lives of people who suffer from it. However, it isn’t talked about much, and when it is it’s often assumed that only military personnel or veterans suffer from PTSD, but they’re not the only ones.
We aren’t certain exactly why PTSD happens but some theories say it could be the brain's way of trying to keep us better prepared next time something happens. After going through something traumatic stress reactions are normal, and the brain can heal fully after a few weeks or months.
PTSD is when these feelings don’t go away and it can last for months or even years, this is when it becomes a problem as we don’t need to keep thinking about the event constantly as it can have a serious impact on our lives.
What is it like to have PTSD?
Flashbacks are what most people think of when PTSD is brought up, these can come out of nowhere or be triggered by a sound or something else that reminds the person of the event/s. People who live with PTSD can also experience a number of other symptoms:
- Insomnia or nightmares (often but not always relating to the traumatic event/s).
- Trouble concentrating.
- Avoiding thoughts, feelings, locations, and people associated with the traumatic event/s (isolation).
- Flashbacks, or the sensation that the event is happening again.
- Inability to enjoy old hobbies.
- Low mood.
People with PTSD aren’t dangerous. Aggression and psychosis are not symptoms of this disorder, and although movies may display people suffering from PTSD as “crazy” - this is not a diagnosis but rather a stigmatising and damaging label.
Are flashbacks hallucinations?
The short answer is no. Flashbacks are “intrusive memories”, meaning they really happened - they’re not made up, whereas hallucinations are perceiving something as real that never happened, like a sound or visual. However, flashbacks aren’t always like the ones seen in movies, people may not always experience a visual but may feel everything they felt when it happened - the fear, panic and stress. They might also experience it with their other senses, hearing or feeling things that happened in the past.
How to help someone
Remember, everyone's experience with PTSD is different. Some people with PTSD say they feel that nobody understands them - but the more time they spend alone the less they feel like others will get what they’re going through.
Getting into this cycle of isolation can be particularly damaging - with any mental disorder it's important to know that nobody has to go through it alone, so if you feel that someone you know may be suffering from PTSD, it can be really helpful to gently reach out to them - let them know you’re there to talk if they need to.
How to seek help
Anyone can call any of New Zealand's free helplines - visit www.pmgt.org.nz/directory/#mental-health-directory for a list of mental health-specific ones. The people there can give advice on what to do and what your next step can be, these organisations are here to support people, it's okay to ask for help.
And remember there are others who understand the feelings PTSD can bring. Talking to people with similar experiences can really help you feel seen and understood. It shouldn’t be substituted for professional help but can be a great resource alongside it as it can help you work through any feelings such as shame, guilt, and fear.
- Post-traumatic stress disorder Mental Health Foundation, NZ
- PTSD Royal Australian and New Zealand College of Psychiatrists
- I can't get over it Books On Prescription, NZ
- Self-help guide – post-traumatic stress Moodjuice
- PTSD symptoms, self-help, and treatment HelpGuide.org
Addiction is defined as doing/taking/using something despite the fact that it causes harm to you or those around you, and you no longer have control over it. Anything you use a lot of and all the time (compulsively and obsessively) to relieve tension or improve your mood has the potential to become addictive.
Addictions that are common include:
- cigarettes (tobacco)
- P (meth), cannabis and other illegal drugs
- prescription medicines
- gaming and social media
- work and study
- sex and porn
Addiction is a serious problem in New Zealand affecting a broad range of people. Its impact and costs are not only experienced by the individual, but also by family, friends and wider society.
- Around 12 percent of our population will experience a
- substance use disorder in their lifetime.
- The estimated social cost from illicit drug use is $1.8 billion.
- In 2014/15 the Government spent just $152m or so on addiction treatment services. Funding has not significantly increased despite the sector struggling to meet rapidly increasing demands.
What causes addiction
Addictions develop for a variety of reasons. Certain behaviours may appear harmless at first, but harmful patterns of use may develop over time.
The reward centres in your brain are thought to be involved in the biological processes that cause addiction. When the brain finds something pleasurable, it forms a positive memory and changes the neurotransmitters in the brain (chemicals). This causes mental and physical changes that increase motivation to relive the pleasure. For an addict, these changes in the brain create an urge so strong that you feel compelled to recreate the pleasurable high and/or to avoid an unpleasant comedown, regardless of the consequences. Often, you will require more and more to achieve the high ('tolerance,' causing the addiction to spiral out of control.
Addiction can occur without the presence of tolerance or withdrawal, and the presence of tolerance or withdrawal does not always imply addiction.
What are the signs of addiction
Addiction is characterised by the selection of an action, behaviour, or substance to the exclusion or detriment of other aspects of one's life.
Additions are frequently linked to the following feelings and behaviours:
- craving and fixation
- not being able to stop
- secrecy or denial
- loss of control over the use or behaviour
- increased or excessive use
- withdrawal symptoms
- sacrificing other commitments so you can continue your addiction
- continuing addiction in spite of negative consequences.
Addiction and misuse
Not everyone who uses/takes/does something excessively or inappropriately suffers from an addiction. Addiction is defined as a long-term inability to moderate or discontinue intake. Misuse differs from addiction in that a person retains control over what they use/take/do, but it can still have a negative impact on their health, relationships, and overall well-being.
For example, someone who consumes a large amount of alcohol on a night out may experience both the euphoric and the harmful effects of the substance. However, this alone does not constitute an addiction. It will not be considered an addiction until the person feels the need to consume this amount of alcohol on a regular basis, possibly alone, or at times during the day when the alcohol is likely to impair regular activities, such as getting out of bed and going to work.
Harmful side effects may temporarily deter a person who has not yet developed an addiction from further use. For example, vomiting or waking up with a hangover after consuming too much alcohol may deter some people from consuming that amount in the future. An addict will continue to engage in the behaviour despite the negative consequences.
Both addiction and misuse cause harm.
How is addiction treated
Addiction can be overcome with the right treatment and support. Your treatment strategy will be determined by the nature of your addiction.
Addiction treatment options in general include:
- talk therapy
- inpatient rehabilitation
- outpatient treatment programmes
- support groups
- self-help programs
- lifestyle changes
- therapeutic community living.
Treatment works to transform lives and to prevent people from descending into addiction. It also reduces the impacts on family, friends and wider society. An estimated $7 in social costs is saved for every $1 spent on treatment.
Anxiety is a perfectly normal human emotion. However, some people experience worry or anxiety so frequently that it interferes with their daily lives.
Anxiety disorders are extremely prevalent. They affect approximately one in every four New Zealanders at some point in their lives. At any given time, 15% of the population will be affected. Anxiety disorders are classified as follows:
- separation anxiety disorder
- selective mutism (not speaking)
- specific phobia (spiders, heights, flying, receiving an injection, etc)
- social anxiety disorder (social phobia)
- panic disorder
- agoraphobia (fear of situations where escape might be difficult or embarrassing in the event of anxiety or other incapacitating symptoms).
- generalised anxiety disorder
- substance/medication-induced anxiety disorder
- anxiety disorder due to another medical condition.
Depression and anxiety are quite wide-spread: one in five young New Zealanders will be affected by depression by the age of 18; almost one in five meet the criteria for an anxiety disorder by age 19.
What are the symptoms of an anxiety disorder
The most common type of anxiety disorder is generalised anxiety disorder. This is when you are extremely concerned about something or are overcome with anxiety and fear – even when there is little or no reason to be concerned about it.
Generalized anxiety disorder manifests itself in a variety of psychological and physical symptoms, including:
- a sense of dread
- feeling constantly "on edge" or irritable
- difficulty concentrating
- being easily distracted
- irregular heartbeat
- dry mouth or excessive sweating
- shortness of breath
- nausea and or stomach ache
- a headache
- poor sleep
- painful or missed periods
Symptoms can appear gradually or suddenly. As your anxiety level rises, your behaviour may change. To avoid feelings of worry and dread, you may withdraw from social contact and refuse to see family and friends.
What is the treatment for an anxiety disorder
Generalised anxiety disorder is treatable. Treatment options include talking therapy, self-care, learning anxiety management techniques, and medication. The first step is to consult with your doctor, who will go over these options with you and help you decide which is best for you. For talking therapy, your doctor may refer you to a mental health specialist.
Depending on the severity of your anxiety, your doctor may prescribe anxiety medication. Medication is most effective when combined with other therapies, such as cognitive behavioural therapy (CBT). Medication can help with symptom relief, but addressing the underlying issue (either through self-help or therapy) is usually required to produce long-term change.
Antidepressants, specifically selective serotonin reuptake inhibitors (SSRIs), have been shown to be effective in the treatment of panic disorder, social anxiety disorder, and generalised anxiety disorder. Citalopram, escitalopram, fluoxetine, paroxetine, and sertraline are examples of SSRIs. Venlafaxine may be used to treat panic disorder in some people.
When you first start taking these medications, your doctor will start you on a low dose and gradually increase it if necessary. This allows your body to adjust to the medication and minimises side effects. You must continue to take your medication on a daily basis, not just when you are anxious.
It may take 4 to 6 weeks to notice all of the medication's benefits. These medications may temporarily worsen your symptoms before you notice an improvement. Other side effects include nausea (sickness), headaches, sleep problems, and sexual problems.
Other antidepressants such as tricyclic antidepressants, may be used if SSRIs or venlafaxine are unsuitable or have not been successful. Read more about antidepressants.
The choices you make every day of how much you move, what you eat, how much sleep you get, whether you take time to relax and whether you smoke or drink are all important to reducing anxiety.
Regular exercise, particularly aerobic exercise like walking, swimming, or running, is an excellent stress and tension reliever. Our bodies are designed to move, not sit for the majority of the day. Being active for 30 minutes or more per day is one of the most effective ways to improve your mental and physical health. Exercise stimulates the release of the chemical serotonin in your brain, which can improve your mood and make you feel calmer.
Caffeine, sugar, and fast food can all disrupt the balance in your body and mind that keeps you feeling good. Caffeine and energy drinks can disrupt sleep, increase heart rate, and cause anxiety. Consume regular meals, a nutritious breakfast, more fruits and vegetables, and fewer processed foods.
While anxiety can interfere with sleep, not getting enough sleep can also contribute to anxiety. Make sleeping a top priority.
Taking time to relax each day can help reduce anxiety. Try relaxation and breathing exercises, as well as yoga, pilates, and tai chi. Spend some time in nature. Do things that you enjoy, that make you feel at ease, or that make you happy.
Smoking and alcohol
Smoking and drinking have been shown to exacerbate anxiety symptoms. Aim to limit your drinking to no more than one or two drinks per day, or avoid it entirely. If you smoke, put it down! Consult your doctor or nurse, or call QuitLine for help, support, and nicotine replacement therapy.
Obessive compulsive disorder (OCD)
OCD is diagnosed when you have regular and ongoing thoughts and urges that are unwanted and cause you distress. You feel the need to deal with them through certain repeated actions.
About 1 in 100 people develop OCD in New Zealand.
What is not OCD
OCD is not just about being careful, fussy or very organised. It is not uncommon for someone who likes order to describe themselves as “a bit OCD”. This doesn’t recognise the challenges for people who live with OCD, who get no pleasure from their repeated actions and rituals.
People with OCD experience a lot of distress and there is a significant impact on their day-to-day functioning. OCD disrupts people's lives in a most distressing way.
What is OCD
It can affect anyone of any age and usually starts in childhood. It is diagnosed when you have recurrent and persistent thoughts, urges or impulses that are intrusive, unwanted and cause you distress. These thoughts and images are called obsessions. They can include themes of disaster, health and hygiene, dirt, sex, violence, religious and other taboos and self-worth.
To try and feel better, you may feel compelled to deal with the thought, images or actions by doing something that you hope will prevent the situation you are dreading. This may be a physical or mental activity, and it is aimed at reducing anxiety or distress. These actions are known as compulsions.
Obsessive thoughts can be quite overwhelming, while compulsions can take up hours of your day and to others usually seem excessive or a little strange.
Most people who live with OCD are aware that the obsessions are products of their own mind, just like other thoughts, images and impulses. However, obsessions are much harder to control.
The link between the obsessional thought and the compulsion can be quite strange. It can revolve around your self-worth and this can lead to significant distress.
The overwhelming nature of obsessions mean that trying to stop them can lead to self-doubt and cause more distress.
Compulsions are usually, but not always, linked directly to the obsessional thoughts. They can include repetitive behaviours such as cleaning, checking, counting or praying, but can also include mental acts, such as repeating words or saying things to yourself about your self-worth.
Performing the compulsion temporarily relieves the anxiety and distress caused by the thoughts. For example, obsessional thoughts about your hands being dirty lead you to feel anxious about catching a disease. This leads to repeatedly and excessively washing your hands.
When you perform the compulsive action you feel a little better initially. But then the anxiety returns, and as time passes, doing the compulsion has less effect on it. This can lead to more and more compulsive behaviour in an attempt to control the rising level of anxiety.
What are the symptoms of OCD
Some people experience OCD as a constant in their lives, but it is usually worse during times of stress and increased anxiety and uncertainty. This means that the symptoms can get better or worse over time.
You might notice yourself doing the following:
- having constant intrusive, unwanted thoughts or mental images
- washing your hands more often than is necessary or washing them for longer than necessary or using more soap than is necessary
- cleaning your clothes, house or belongings more than is necessary or usual
- putting things in a particular order
- counting, repeating words, tapping, praying, having negative thoughts about the type of person you are
- checking things – door locks, appliances, taps
- feeling you have to do things over and over again to make sure they are as you expect them to be
- constantly asking people for reassurance
- having routines and rituals that you have to follow every day or under certain circumstances
- being aware that your thoughts are irrational but being unable to stop the thinking.
What are the causes of OCD
The exact cause of OCD is unknown. There is some evidence that OCD runs in families, but more research needs to be done in this area.
Many people who live with OCD also struggle with other conditions such as anxiety and depression. OCD is driven by the anxiety that comes with obsessions and compulsions. This anxiety can become extremely severe and is typically more difficult to manage when you are stressed and your levels of anxiety increase.
The energy used in trying to manage OCD can affect your sleep and have an impact on your mood. Feeling anxious and even having panic attacks are not uncommon experiences for people living with OCD. Feeling depressed is not uncommon and this might be as a result of getting worn down by the OCD or it might be contributing to some of the obsessions.
Some people report suicidal thinking, particularly when their OCD is severe, untreated and lasts for a long time. Some people may try to reduce their symptoms with alcohol or substance use and this can lead to problems of addiction.
How is OCD treated
Some people take a long time to seek treatment for OCD. This can be because they think that the discomfort or distress they feel is somewhat normal. They often feel embarrassment or shame for having particular thoughts and feeling compelled to perform specific acts.
Treatment is 70% effective for those with OCD. The first step is to see your doctor, who can discuss with you the options available. These options may include a referral to a mental health specialist for talking therapy or medication to help you manage the obsessive thoughts and heightened anxiety you may feel.
A variety of medicines have been helpful in the management of OCD. Selective serotonin reuptake inhibitors (SSRIs) are the most common medicines used for the treatment of OCD. SSRIs are also used to treat generalised anxiety and depression but may be prescribed at a higher dose for OCD.
After a number of weeks, you should begin to notice that you are having fewer intrusive thoughts, improved mood, reduced anxiety and an ability to begin tackling your compulsions through talk therapy.
Cognitive behavioural therapy (CBT) examines how you think, act and behave. The CBT approach to OCD proposes that obsessional thoughts continue because you can't stop or ignore them easily. It is difficult to stop or ignore the thoughts, but you do have some choice around how you respond to your thoughts.
Compulsions aim to relieve the anxiety produced by obsessive thoughts. Compulsive rituals, such as hand-washing after obsessive fear of contamination, produce only temporary relief before the anxiety builds up again. Each time the compulsion is repeated in response to the mounting anxiety, it strengthens the cycle.
CBT treatment often includes exposure and response prevention, which helps you to break the cycle and reduce the anxiety and need to perform the compulsive acts.
The treatment starts with a list of activities that make you anxious. You order them on a scale, from easiest to most difficult. Then, starting at the easiest activity, you do it, with the help of your therapist. While you're doing it, your psychologist will encourage you to experience the anxiety without performing a compulsion and to wait for your anxiety level to slowly drop. You repeat the activity until you become used to it.
Self care for OCD
Learning to recognise which thoughts and feelings are fuelled by anxiety and OCD helps you make better choices about how you wish to respond to certain situations.
Once you begin to recover, there are things you can do to help yourself.
- Continue to challenge yourself by facing situations that make you anxious.
- Find fun activities to fill in your extra time.
- Join a support group in-person or online.
- Be aware of the signs of depression.
- OCD symptoms can come back, so have a plan ready so you can act as soon as you notice yourself becoming unwell.
- Perinatal OCD: New baby, distressing repetitive thoughts Perinatal Anxiety & Depression Aotearoa, NZ, 2020
- Obsessive compulsive disorder Mental Health Foundation, NZ
- Obsessive compulsive disorder Your Health in Mind, The Royal Australian and New Zealand College of Psychiatrists
- OCD challenge A free online course to help you challenge your OCD and take back your life.
Phobias are strong irrational fears of something that poses little or no danger. They cause you to avoid certain objects, animals, situations or activities. We all have some fears, but a fear becomes a phobia when it is unrealistic and interferes with your everyday life. However, there are things you can do to reduce your phobias and people who can help you.
What are the different types of phobias
Phobias fall into three main types:
- fear of social activities or situations, known as social phobia or anxiety
- fear of being away from home or safety and fear of places where you might have a panic attack, known as agoraphobia.
- Specific phobias
- Specific phobias are very common. You may have a mild aversion to something that doesn't affect you very much, through to a full phobia, which will affect your day to day life.
Specific fears fall into 5 categories:
- fear of animals, such as dogs, snakes or spiders
- fear of the natural environment
- fear of blood and needles
- fear of activities, such as flying
For example, if you are phobic of dogs, you will feel extremely anxious anywhere near a dog and want to get away from it quickly. You will avoid dogs if at all possible. This happens even though you may realise your fear is unreasonable. Once you leave the situation you feel fine.
Or if you have a fear of blood and needles, you will avoid reading or talking about these subjects and may find it hard to visit a friend in hospital. You may avoid going to the dentist and find it really hard to agree to have an injection or blood test. The sight of blood might make you panic or faint. Away from these subjects and situations, you feel okay.
If you have a phobia of blood/needles/injections, it's a good idea to see a health professional about this. Rather than learning to relax, which can be helpful for people with other phobias, it will be more helpful for you to learn how to tense up to stop fainting at the sight of blood or injections.
The prevalence of individual disorders ranged from 7.3% for specific phobia to less than 0.1% for anorexia and varied several-fold within each disorder group. The most common anxiety disorders were specific phobia (7.3%) and social phobia (5.1%).
A social phobia, known as social anxiety disorder, is a fear of being judged negatively in social situations. It’s common for most of us to have occasional moments where such situations can feel a bit daunting, but someone with social phobia experiences strong anxiety or panic in most social situations.
If you have this type of phobia, you feel anxious that you will act in a way or show anxiety symptoms that will be humiliating or embarrassing. This can lead to avoiding social situations, which affects your ability to create or maintain relationships. It can seriously affect your quality of life, employment and career goals. Find out more about social anxiety disorder.
Agoraphobia is a fear of situations or places that would be difficult to get away from or get help in. As a result, people with agoraphobia often experience severe panic attacks. It is a more severe and complex form of phobia. Find out more about agoraphobia.
What causes phobias
There doesn’t seem to be one cause of phobias, but there are several factors that might play a part in them developing.
- A specific incident – for example, if you experienced a lot of turbulence on a plane at a young age without adequate reassurance, you might later develop a phobia about flying.
- Trauma – if you experienced abuse in a particular setting, you may develop a phobia about similar places or an object that you associate with the abuse. You can also develop a phobia from observing others going through a traumatic event.
- Family environment – parents who are very worried or anxious can have an effect on the way you cope with anxiety in later life, and you may even develop the same phobia as a parent or older sibling.
- Hearing about a traumatic event – if there is a lot of talk or media coverage about a threatening or traumatic event, such as a plane crash.
- Genetics – some people appear to be born with a tendency to be more anxious than others, which can develop into a phobia.
- Responses to panic or fear – if you have a strong reaction (a panic attack) in response to a particular situation or object, and you find this embarrassing or people around you react strongly, this can cause you to develop a more intense anxiety about being in that situation again.
- Long-term stress – this can cause feelings of anxiety and depression, and reduce your ability to cope in particular situations. This can make you feel more fearful or anxious about being in those situations again, and over a long period, may lead to you developing a phobia.
What is the treatment for phobias
Most people who experience phobias find relief from their symptoms when treated with therapy, medication and education, or a combination of these. There are many things that people develop a phobia of, so don’t worry if you have an unusual phobia – the treatment and self-help methods will work for you as well.
Education can be a helpful first step towards recovering from or managing your phobia better. You can start by looking at the self-help books and websites suggested below.
- Anxiety disorders - your guide.
- Anxiety - manawaru.
- Panic attacks - hopohopo.
- A guide to what works for anxiety.
- Mind over mood - change how you feel by changing the way you think.
- Living with it - a survivors guide to panic attacks.
- Feel the fear and do it anyways.
- They can help you:
- Understand how phobias develop.
- Find ways of describing what happens to you, including problems that you may have kept completely to yourself up to now.
- Teach you about some of the ways of dealing with your phobia.
- Learn about how addressing your anxiety is key to reducing your phobias.
- Realise that you are not alone – lots of people experience phobias and most of them recover from them or at least learn to manage them much better.
Counselling or therapy
There are trained professionals who know about phobias and how to help someone who is affected by them. They can provide you with support and help for working through any distressing thoughts and feelings you have and support you to make positive changes in your life. For some people, it might be helpful to understand why your phobia developed and may involve processing earlier trauma. For others, this is not important or useful, and instead, the key is to focus on changing your thinking and behaviour.
Cognitive-behavioural therapy (CBT), a psychological therapy that largely focuses on overcoming unhelpful beliefs, can be helpful for people with specific phobias. Therapy will involve desensitisation, that is, you gradually having more exposure to the object or situation you feel anxious about. This is a very effective step in overcoming your phobia. Don’t worry – this only happens when you are ready and at a pace that is right for you.
Medication isn't usually recommended for treating phobias, because talking therapies are usually effective and don't have any side effects. However, medication is sometimes prescribed on a short-term basis to treat the effects of phobias, such as anxiety.
Examples of medications recommended for treating anxiety include:
Antidepressants: selective serotonin reuptake inhibitors (SSRIs) are most often prescribed to treat anxiety, social phobia or panic disorder. They are most effective when used alongside counselling or therapy.
Benzodiazepines: these may be used on a short-term basis to treat severe anxiety when other treatments have not been effective. Benzodiazepines are habit-forming therefore they are used at the lowest possible dose for the shortest time.
The term complementary therapy is generally used to indicate therapies and treatments that differ from conventional Western medicine and that may be used to complement and support it. In general, mindfulness, hypnotherapy, yoga, exercise, relaxation, massage, mirimiri (traditional Māori massage) and aromatherapy have all been shown to have some effect in alleviating mental distress.
What can I do to help myself manage my phobia
The key things you can do to help yourself are to:
- learn about phobias and how to manage and improve your condition
- learn a relaxation technique or mindfulness
- get help if you need it
- join a support group
- stretch yourself a small step at a time in confronting your phobia
- stay connected to others
- stay engaged with the rest of your life that’s not affected by your phobia
- avoid alcohol and other drugs
- be physically active
- spend time in nature
Find out more about living well with phobias.
Support for people with phobias
- Anxiety New Zealand Trust 24/7 anxiety helpline phone 0800 14 269 4389 Auckland
- Wellington Anxiety Specialists Wellington phone 04 386 3861
- Anxiety Support Canterbury Canterbury phone 03 377 9665
- Social Anxiety Support Canterbury 03 377 9665
- Find a GP or Counsellor Mental Health Foundation of NZ
- Grow A support group for mental wellness using the 12-step programme run by people who have experienced mental illness.
We all get the blues from time to time, but when you have depression, the feeling is stronger, affects your thinking and behaviour, and can last for weeks or months. However, there is always hope, no matter how low you feel. There are people who can assist you and things you can do to get back on track.
The prevalence of teenage depression in New Zealand has more than doubled since the 1980s, a new University of Otago-led study reveals. Nearly half the population will meet the criteria for a mental illness diagnosis at some stage during their lives, and one in five of us will experience depression in any given year.
A 2014/15 New Zealand Health Survey reported:
An estimated 636,000 adults (17%) have been diagnosed with a mood disorder and/or anxiety disorder at some time in their lives (including depression, bipolar disorder and/or anxiety disorder). 225,000 (6.2%) of adults reported experiencing mental distress in the previous four weeks (including anxiety, confused emotions, depression or rage).
What are the symptoms of depression
Depression is characterised by a shift in mood, behaviour, and feelings that can be mild, moderate, or severe. Among the symptoms are:
- low mood
- frequently feeling sad and tearful
- not wanting to socialise anymore
- being unable to enjoy activities that once were fun
- feeling stressed and anxious
- poor appetite or overeating
- physical symptoms such as pain (eg, headache, back pain)
- tiredness and too much or too little sleep
- difficulty concentrating and making decisions
- not thinking straight
- difficulty getting much done.
If your depression is severe, you may also consider self-harm or suicide. If you are having these thoughts, you should seek immediate assistance from your doctor or one of the helplines listed on this page. There are people who can assist you in getting through this.
What causes depression
Sometimes depression appears out of nowhere, while other times it appears to be triggered by something. Although the exact cause of depression is unknown, many factors may contribute to depression. For instance, you are more likely to suffer from depression if you:
- have someone in your family who has been depressed, such as a parent or sibling
- experienced trauma or abuse at an early age
- have certain chronic physical health conditions, such as diabetes, cancer, heart disease, Parkinson’s disease or coeliac disease, or have had a stroke or have low thyroid hormone
- are going through major life changes or have recently suffered a loss, such as a relationship break-up, redundancy, or a significant injury or accident
- are or have just been pregnant
- are an older adult
- use alcohol or recreational drugs
- are taking certain medicines, such as for blood pressure or hormonal medication.
What are the different types of depression
Depression can be classified into several types. Even if you don't meet all of the criteria for one of these types, you can still be depressed. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) categorises depression as follows:
- Major depressive disorder – depression symptoms that interfere with your ability to work, sleep, study, eat and enjoy life. These may be mild, moderate or severe.
- Persistent depressive disorder – a depressed mood that lasts for at least 2 years.
- Premenstrual dysphoric disorder – a severe form of premenstrual syndrome experienced by some women before their periods.
- Other depressive disorders – not meeting major depressive disorder criteria due to substance abuse, medication side effects, medical conditions, or other specified or unspecified reasons.
- Other conditions also include symptoms of depression, such as the following:
- Postpartum depression – a type of depression that some women experience after giving birth.
- Seasonal affective disorder (SAD) – depression during the winter months, when there is less natural sunlight.
- Bipolar disorder – different from depression, but includes episodes of extreme low moods as well as extreme high moods (mania).
What can I do if i’m depressed
- Small steps are the key to change – choose what feels manageable and build from there.
- Making your own self-care a priority builds your resilience so you can cope better with the challenges of life.
- Looking after your physical health helps your mental wellbeing.
- Having ways to reduce and manage stress increases your resilience.
- Getting help when you need it is a sign of strength, not weakness.
- Staying connected to family, whānau and friends can help you feel better.
- Spending time in nature is key to your wellbeing.
- Finding a purpose increases your sense of meaning and belonging.
If you would like to talk to someone, visit our directory of 24/7 available and free helplines as a first step, or contact your doctor.
Having a child is a life-changing event that may be both joyful and challenging. Postnatal depression can strike at any point during pregnancy or after your baby is born, lasting up to a year. It's typical for new mothers to feel a variety of emotions in the weeks following the birth of their child. However, other mothers experience depression for much longer, and those feelings may progress to postpartum depression. 10-20% of new mothers suffer from postpartum depression.
It entails significant negative emotional changes that last longer than two weeks and prevents you from accomplishing the things you need or want to do on a daily basis.
Symptoms of postnatal depression include:
- losing your joy or feeling an absence of pleasure
- feeling sad, hopeless, worthless, and/or useless
- having little or no energy
- feeling like you just can’t cope with anything, even the small stuff
- feeling angry or irritated and don’t know why
- crying a lot
- not sleeping well, even when your baby is asleep
- having an unusually small or excessive appetite
- not caring about how you, or things around you look
- getting angry with the people around you, like your partner, other children or your whānau
- having aches and pains
- feeling that you are a bad mother, and blaming yourself unnecessarily when things go wrong
- not feeling interested in or close to your baby or any other members of your whānau
- feeling that the baby is your only source of pleasure or interest
- feeling overly anxious or panicky about your baby
- thinking bad thoughts, or have thoughts of harming yourself or your baby.
While each mother will experience some of these sentiments at times, postnatal depression occurs when these feelings persist. Depression and anxiety are frequently experienced jointly.
Talk to your doctor, midwife, Plunket nurse, or Well Child provider straight away if you or your whanau experience any of these feelings, especially if they last more than a few days.
Depression is a medical condition; it does not imply that you have failed as a parent or as a person. Hormonal changes, tremendous exhaustion, and the psychological adjustment to everything that comes with being a new mother are all common causes in moms. You're not alone in dealing with so much at once.
If you're pregnant and have previously had depression or another mental illness, you should consider what kind of care or support you might require once your baby is born. You could ask others to be on the lookout for you or tell people what to watch for so you can seek help sooner.
There are numerous resources available to you for advice and support.
Call PlunketLine any time, day or night, on 0800 933 922 or text 1737 any time to speak with a trained counsellor.
Visit our directory of free 24/7 available helplines here.
Seasonal affective disorder (SAD)
Seasonal affective disorder (SAD) is a type of depression that is linked to seasonal changes — SAD begins and ends at roughly the same times each year. If you're like most SAD sufferers, your symptoms begin in the fall and last through the winter, sapping your energy and making you moody. These symptoms usually go away in the spring and summer. SAD causes depression less frequently in the spring or early summer and resolves in the fall or winter months.
Seasonal affective disorder affects 10% of New Zealanders. This condition affects children and is four times more common in women than in men. Light therapy (phototherapy), psychotherapy, and medications may all be used to treat SAD. Don't dismiss that yearly feeling as a case of the "winter blues" or a seasonal funk that you must endure on your own. Take steps to maintain your mood and motivation throughout the year.
Seasonal affective disorder symptoms typically appear in late fall or early winter and disappear during the warmer months of spring and summer. People with the opposite pattern are more likely to experience symptoms in the spring or summer. In either case, symptoms may begin mild and worsen as the season progresses.
SAD symptoms and signs may include the following.:
- Feeling listless, sad or down most of the day, nearly every day
- Losing interest in activities you once enjoyed
- Having low energy and feeling sluggish
- Having problems with sleeping too much
- Experiencing carbohydrate cravings, overeating and weight gain
- Having difficulty concentrating
- Feeling hopeless, worthless or guilty
- Having thoughts of not wanting to live
Symptoms unique to the winter season SAD, also known as winter depression, may include:
- Appetite changes, especially a craving for foods high in carbohydrates
- Weight gain
- Tiredness or low energy
Summer-onset seasonal affective disorder, also known as summer depression, can cause a variety of symptoms.:
- Trouble sleeping (insomnia)
- Poor appetite
- Weight loss
- Agitation or anxiety
- Increased irritability
Seasonal changes and bipolar disorder
Seasonal affective disorder is more common in people who have bipolar disorder. Mania episodes in some people with bipolar disorder may be linked to a specific season. Spring and summer, for example, can bring on symptoms of mania or a milder form of mania (hypomania), as well as anxiety, agitation, and irritability. During the fall and winter months, they may also experience depression.
When to see a doctor
It's normal to have down days from time to time. However, if you are feeling down for several days at a time and are unable to motivate yourself to engage in activities that you normally enjoy, consult your health care provider. This is especially important if your sleeping and eating habits have changed, you use alcohol for comfort or relaxation, you feel hopeless, or you consider suicide.
Seasonal affective disorder's exact cause is unknown. Some of the factors that may come into play are as follows:
- Your biological clock (circadian rhythm). The reduced level of sunlight in fall and winter may cause winter-onset SAD. This decrease in sunlight may disrupt your body's internal clock and lead to feelings of depression.
- Serotonin levels. A drop in serotonin, a brain chemical (neurotransmitter) that affects mood, might play a role in SAD. Reduced sunlight can cause a drop in serotonin that may trigger depression.
- Melatonin levels. The change in season can disrupt the balance of the body's level of melatonin, which plays a role in sleep patterns and mood.
Women are more likely than men to be diagnosed with seasonal affective disorder. SAD is more common in younger adults than in older adults.
The following factors may increase your risk of seasonal affective disorder:
- Family history. People with SAD may be more likely to have blood relatives with SAD or another form of depression.
- Having major depression or bipolar disorder. Symptoms of depression may worsen seasonally if you have one of these conditions.
- Living far from the equator. SAD appears to be more common among people who live far north or south of the equator. This may be due to decreased sunlight during the winter and longer days during the summer months.
- Low level of vitamin D. Some vitamin D is produced in the skin when it's exposed to sunlight. Vitamin D can help to boost serotonin activity. Less sunlight and not getting enough vitamin D from foods and other sources may result in low levels of vitamin D in the body.
SAD, like other types of depression, can worsen and cause problems if not treated. These are some examples:
- Social withdrawal
- School or work problems
- Substance abuse
- Other mental health disorders such as anxiety or eating disorders
- Suicidal thoughts or behavior
There is no known way to prevent seasonal affective disorder from developing. However, if you take steps to manage symptoms early on, you may be able to prevent them from worsening over time. You may be able to avoid serious changes in mood, appetite, and energy levels if you can predict when these symptoms will appear. Treatment can help prevent complications, especially if SAD is detected and treated early.
Some people find it beneficial to begin treatment before symptoms appear in the fall or winter, and then to continue treatment after symptoms have subsided. Others require ongoing treatment to keep their symptoms from reappearing.
Digital tools and resources
Mentemia is an app that allows you to set daily goals and track your progress in order to monitor, manage, and improve your mental health.
Small Steps are digital tools that can assist you in maintaining wellness, finding relief, or obtaining assistance for yourself, friends, or whanau.
HABITs Messenger (including Aroha Chatbot) is a uniquely New Zealand chatbot app designed for young people that feels like you're talking to a trusted friend. Download it from your mobile device's app store.
Triple P Online – provides online parenting support through Triple P, Teen Triple P, and FearLess Triple P. Designed to assist parents in assisting their children and teenagers in dealing with life's ups and downs, promoting wellbeing, and making family life more enjoyable.
Toxic positivity is the belief that people should maintain a positive attitude no matter how dire or difficult their circumstances are. It's a "only positive vibes" way of life. While being an optimist and engaging in positive thinking has advantages, toxic positivity rejects difficult emotions in favour of a cheerful, often falsely positive, facade.
We are all aware that having a positive outlook on life is beneficial to one's mental health. The issue is that life isn't always sunny. We are all affected by painful emotions and experiences. While these emotions are often unpleasant, they are important and must be felt and dealt with openly and honestly.
Toxic positivity takes positive thinking to an overgeneralized extreme. This mindset not only emphasises the importance of optimism, but it also minimises and denies any trace of human emotions that aren't solely happy or positive.
Forms of toxic positivity
Toxic positivity can take many forms. Some examples you may have encountered in your own life:
People tell you to "just stay positive" or "look on the bright side" when something bad happens, such as losing your job. While such comments are frequently meant to be sympathetic, they can also be used to silence anything you might want to say about what you are going through.
People will tell you that "everything happens for a reason" after you have suffered a loss. While such statements are frequently made in the belief that they are comforting, they are also used to avoid someone else's pain.
When you express disappointment or sadness, someone tells you that “happiness is a choice.” This implies that if you are experiencing negative emotions, it is your fault for not "choosing" to be happy.
Such statements are frequently well-intentioned—people simply don't know what else to say or how to be sympathetic. Nonetheless, it is critical to recognise that these reactions can be harmful.
Such statements, at their best, come across as trite platitudes that let you off the hook so you don't have to deal with other people's feelings. At worst, these comments shame and blame people who are often dealing with extremely difficult situations.
Toxic positivity denies people the authentic support that they need to cope with what they are facing.
Why it’s harmful
Toxic positivity can be harmful to those who are going through a difficult time. People's genuine human emotions are dismissed, ignored, or outright invalidated, rather than being able to share them and receive unconditional support.
It's humiliating: When someone is in pain, they need to know that their feelings are valid, but that they can find comfort and love in their friends and family. Toxic positivity tells people that their emotions are unacceptable.
It instils guilt: It sends the message that if you don't find a way to be positive in the face of tragedy, you're doing something wrong.
Toxic positivity serves as an avoidance mechanism for genuine human emotion. When other people engage in this type of behaviour, it allows them to avoid potentially uncomfortable emotional situations. But sometimes we internalise these toxic ideas and turn them against ourselves. When we experience difficult emotions, we discount, dismiss, or deny them.
Toxic positivity is frequently subtle, but learning to recognise the signs can assist you in better identifying this type of behaviour. Among the warning signs are:
- Avoiding problems rather than confronting them.
- Feeling guilty because you are sad, angry, or disappointed.
- Hide your true emotions behind feel-good quotes that appear more socially acceptable.
- Hiding or masking your true feelings.
- Other people's feelings are minimised because they make you uncomfortable.
- Shaming others when they lack a positive attitude.
- Attempting to be stoic or "get over" difficult emotions.
How to avoid toxic positivity
If you've been affected by toxic positivity, or if you recognise this type of behaviour in yourself, there are steps you can take to develop a more supportive, healthy approach. Among the suggestions are:
Negative emotions should be managed, not denied. Negative emotions, if left unchecked, can cause stress1, but they can also provide important information that can lead to beneficial changes in your life.
Be honest with yourself about how you should feel. It is natural to feel stressed, worried, or even fearful when confronted with a stressful situation. Don't put too much pressure on yourself. Concentrate on self-care and taking steps to improve your situation.
Pay attention to others and show your support. Don't shut down someone who expresses a difficult emotion with toxic platitudes. Instead, assure them that their emotions are normal and that you are available to listen.
In summary, allow yourself to experience your emotions. Allow yourself to feel difficult emotions rather than trying to avoid them. These emotions are genuine, valid, and significant. They can provide information and assist you in seeing aspects of a situation that you need to work on changing. So, when you're going through a difficult time, consider ways to express your emotions in a productive way. Create a journal. Speak with a friend. According to research, simply putting what you are feeling into words can help reduce the intensity of those negative feelings.
Examples of toxic statements include:
- Just stay positive!
- Good vibes only!
- It could be worse.
- Things happen for a reason.
- Happiness is a choice.
Non-toxic alternatives include:
- I’m listening.
- I’m here no matter what.
- That must be really hard.
- Sometimes bad things happen. How can i help?
- Your feelings are valid.
- Failure is sometimes part of life.
Suicide is when a person deliberately and consciously acts to end their life, most often as a result of depression or other mental illness. If you are having suicidal thoughts you are not alone. Lots of people have thought about suicide and have found a way through.
In a crisis?
In an emergency call 111
- 1737 Free call or text 1737 any time, 24 hours a day to talk or text with a trained counsellor.
- Lifeline Phone 0800 543 354 or 09 522 2999 or text HELP (4357) any time
- Suicide Prevention Helpline 0508 828 865 (0508 TAUTOK0)
- Youthline 0800 376 633 or free text 234
- Samaritans 0800 726 666
If you think someone is at risk
If you are worried someone might be suicidal, ask them. It could save their life.
- Ask them if they are thinking about suicide and if so what plans they are making. If they have a clear plan, support them to get help right away.
- Ask them if they want to talk to you or someone else about what’s going on for them. Listen openly, without judgment.
- Let them know you care and make sure someone stays with them until they get help.
- Help them find support, like a doctor or counsellor, as soon as possible. Offer to help them make an appointment, and go with them if you can.
It can be really hard for a person to tell you they are feeling suicidal. Thank them for telling you and let them know there is help available.
- Be gentle and compassionate. Even if you can't understand why they are feeling this way, try to accept that they are.
- Listen openly. You don't need to have all the answers. The best thing you can do is to be with them and really listen to them.
- Try to stay calm and hopeful that things can get better.
- Let them talk about their thoughts of suicide – avoiding the topic does not help. Ask them if they've felt this way before and what they did to cope or get through it. They might already know what could help them.
- Do not agree to keep secrets about their suicidal thoughts or plans. It's okay to tell someone else so that you can keep them safe.
- Don't pressure them to talk to you. They might not want to talk, or they might feel more comfortable talking to someone who is not as close to them.
- Don't try to handle the situation by yourself. Seek support from professionals, and from other people they trust including family, whānau or friends.
Signs someone may be feeling suicidal
Suicide is when a person deliberately and consciously acts to end their life, most often as a result of depression or other mental illness. A person who is suicidal might show some of the following signs:
- rage, anger, seeking revenge
- acting recklessly or engaging in risky activities, seemingly without thinking
- feeling trapped – like there is no way out
- increasing alcohol or drug use
- withdrawing from friends, family/whānau or society
- anxiety, agitation, unable to sleep, or sleeping all the time
- dramatic changes in mood
- feeling as though there is no reason for living, having no sense of purpose in life
- making gestures of departure, closure or saying goodbye, such as updating a will, closing down a Facebook account or repaying outstanding debts.
A person may show some of these signs but not be suicidal. If you think somebody is at risk, it’s okay to ask them directly if they are thinking about suicide. However, not all suicides can be prevented and most can't be predicted.
Signs someone may be in need of immediate help include:
- Threatening to hurt or kill themselves, eg, direct or indirect statements, such as “I wish I was dead”, “Does it hurt to die?”
- Looking for ways to kill themselves, such as seeking access to pills, weapons, or other means.
- Talking or writing about death, dying or suicide.
Why do people feel suicidal
People from all walks of life can feel suicidal. Different factors combine to either increase or decrease a person’s risk of suicide. Protective factors can enhance a person’s wellbeing and resilience, and reduce their risk of suicide.
Being aware of suicide risk factors and why people choose to take their own life can help us understand the warning signs and tipping points for suicide.
Promoting positive mental wellbeing and learning about what help is available are some of the ways we can prevent suicide and suicidal behaviour.
For more information about supporting yourself or someone else who is suicidal, the Mental Health Foundation has developed the following series of online factsheets:
- Suicide – worried about someone?
- Suicide – coping with suicidal thoughts
- Suicide – after a suicide attempt
- Suicide – supporting someone online
Youth (15-24 years) have higher suicide rates than any other age group.
Bay of Plenty, Lakes, MidCentral and South Canterbury DHB regions have significantly higher suicide rates than the national average.
Compared with other countries in the OECD, New Zealand’s suicide rates (males and females) are toweards the middle of the range however, New Zealand’s male youth suicide rate was the third highest and New Zealand’s female youth suicide rate was the highest.
Around 30% of people who died by suicide were hospitalised for self harm in the year before they died.
Around 20% of people who died by suicide did not use a GP service in the year before they died.
Self-harm is the intentional, direct act of hurting or injuring one's body without intending to die. Some people use it to cope with intense or very difficult emotions, as well as overwhelming situations and life events.
Self-harming methods that are commonly used include:
- cutting skin on wrists, arms or legs
- biting and scratching at skin
- head banging and punching self
- burning of skin
- hair or eyelash pulling
- taking overdoses of drugs or medication
- taking poisonous substances
- inhalation of a harmful substance.
Self-harm is not unusual. You are not weak, insane, or attention-seeking if you self-harm. It simply means you are overwhelmed by how you are currently feeling, and this is a method you hope will help you feel better.
You may feel better after self-harm for a short time, but this will not last. Continuing to self-harm can exacerbate the situation. It could be harmful to your physical or mental health, as well as your relationships with others. Self-harming behaviours can become addictive and difficult to break.
If you self-harm, you may feel embarrassed about it or fear that others will judge you or try to stop you if you tell them. For this reason, many people who self-harm keep it a secret.
It is critical to talk to someone you trust if you are self-harming. If you don't want to talk to your doctor or someone you know, you can call a helpline and remain completely anonymous while speaking with someone who understands what you're going through.
Call free 24/7 available helplines on our directory here.
If you are in a crisis
If you have seriously injured yourself, ingested poisonous substances, or overdosed on medicine or medicines, you should see a doctor right away. Call 111 and request an ambulance, or go to your nearest hospital's emergency department (ED).
It's critical to remember that you can get help if you want to stop self-harming. Even if you've been self-harming for a long time, you can learn new ways to cope with your feelings without hurting yourself with support.
If you are concerned about your immediate safety after injuring yourself or trying not to injure yourself, do the following:
- Call your local mental health crisis assessment team or ask someone to take you to an emergency department (ED) at your nearest hospital.
- If you are in immediate physical danger, call 111.
When you're ready, the best thing you can do to stop self-harming is to consult with a doctor or a mental health professional. They will speak with you privately and ask you questions about yourself and your situation. This is so they can assist you and you can work together to develop a plan of action for changing the self-harming behaviour and addressing any underlying mental health issues.
Your health professional will discuss the following treatment options with you:
- Therapy. Many people who self-harm benefit from supportive counselling because it helps them understand the underlying issues that are causing their behaviours. Talking therapies can aid in the transformation of thoughts that lead to self-harm. Your doctor will advise you on the best type of talking therapy for you.
- Medication. If you have an underlying mood disorder, your doctor may prescribe antidepressants or other medications. Finding the right medication can be a trial and error process because there is no way to predict which will be effective for and tolerated (have fewer bothersome side effects) by any one person. No medication is completely safe if you are breastfeeding. Before making any medication decisions at this time, consult with your doctor about the potential benefits and drawbacks. If you are given medication, you have the right to know the names of the medicines, what symptoms they are supposed to treat, how long it will be before they take effect and how long you will have to take them for and what their side effects (short and long-term) are.
- Complementary therpaies. The term complementary therapy refers to therapies and treatments that differ from conventional western medicine and can be used to supplement and support it. Certain complementary therapies may improve your life and help you stay healthy. Mindfulness, hypnotherapy, yoga, exercise, relaxation, massage, mirimiri, and aromatherapy have all been shown to help with mental distress.
What can I do to help myself
You must decide when to stop self-harming. It is also up to you to decide whether or not to speak with anyone. But keep in mind that it will be much easier on yourself if you can find someone you can talk things through with.
Other ideas to help you stop hurting yourself include:
- Keep taking any medication your doctor prescribed for you.
- Cut down on or stop taking alcohol and recreational drugs.
- Keep your house safe - get rid of pills, weapons etc that you could use to hurt yourself.
- Learn your patterns of self-harm – keep a diary and note down what happened to make you feel that way. Over time you will see a pattern.
- Learn what your triggers are – the things that make you want to hurt yourself – it could be places, certain behaviours in other people, times of day etc. Use your diary to note these down as well.
- If you are part of a group with people who self-harm, find other people to be with and do things that you enjoy with.
- Learn how you feel before you want to hurt yourself – physical sensations such as a racing heart, shallow breathing, feeling ill; feeling as though you aren’t in your body; or strong emotions like anger, or sadness or desperation.
- Think about what sort of things you can do to distract yourself if you feel the urge to hurt yourself – try exercise, music, talking on a helpline, having a very cold drink, draw or paint. No matter how strange it may be, if it works for you it’s important.
- Look after yourself – get enough sleep, good food and exercise.
- Find a support group.
- Don’t ignore any bad feelings you have – have a plan for those times.
- Keep attending all your appointments with your mental health professional.
Worried about someone else
If you notice scars, marks, or unusual behaviour but are unsure whether the person is self-harming, speak with them. Ask them if they want to talk about what's going on in their lives, and be patient. Remember that they may not want to open up right away, but letting them know you are there for them will go a long way. Demonstrate that you care and are concerned.
Supporting someone who is self harming
Take someone seriously if they say they are self-harming or want to hurt themselves. Get help right away if they are seriously injured or have consumed any poisonous substances. Call 111 and request an ambulance to transport them to your nearest hospital's emergency department (ED). Inquire with them if you are concerned that they are suicidal. It has the potential to save their life. Inquiring about suicide will not cause them to consider it. Ask them about their suicidal thoughts and plans. If they have a specific plan, they require immediate assistance. If the person is feeling unsafe or you believe they are in danger, do not leave them alone. You could ask someone else to accompany them when you need to leave or take a break. Ask them if they want to talk about what's going on in their lives, and be patient. Remember that they may not want to open up right away, but letting them know you are there for them will go a long way. Encourage them to seek professional help, such as from a doctor or a counsellor.
Supporting someones recovery
To help someone stop self-harming, you must first identify the support they require, as well as the support you require to be a source of strength for them. Recognize that you can't do everything and that you don't have to deal with this alone – remember that it's okay to ask for help. Prepare to have difficult conversations about what's going on in their lives and how they're feeling. Prepare to be present, to offer assistance, and to remain involved. Continue talking to them and don't be afraid to discuss the difficult aspects of their lives. If they refuse to speak with you, ask others you both trust to stand by them – friends, family or whnau members, youth workers, or others. Assist them in obtaining professional assistance, such as from a doctor or a counsellor. You could offer to accompany them or assist them in making an appointment. If they want you to, assist them in developing a plan of alternative coping strategies for when they feel like hurting themselves. Allow them to make their own decisions about reducing or discontinuing self-harm. Try not to judge their actions, but rather to comprehend why they are self-harming. Encourage and support them to pursue their interests and connect with others. Accept them as they are and show them you care. Assist them in making future plans, resolving problems, and setting goals.
An eating disorder is an overall term for a number of conditions that involve eating in a disordered way. The most common eating disorders are anorexia, bulimia and binge eating disorder.
It is estimated 103,000 kiwi's struggle with an eating disorder. Less than 6% of people with eating disorders are medically diagnosed as “underweight” Eating disorders are second only to opioid overdose as the deadliest mental illnesses.
A new category of eating difficulties is avoidant restrictive food intake disorder (ARFID). This is different from other eating disorders as it involves a disinterest in food for reasons other than a preoccupation with weight and shape.
What is ‘’disordered eating’’
Disordered eating refers to when you no longer have the usual habits of eating that most people have. This can affect how often you eat, how much you eat, the type of food you eat, how flexible you are around your eating habits and whether you experience pleasure in eating. Depending on the eating disorder, it may involve severe avoidance of eating or purging (getting rid of) food you have eaten.
If you no longer have a sense of what is normal eating, you can read about healthy eating basics.
What causes an eating disorder
Eating disorders happen because of a combination of factors. These factors can be biological (the way your brain works), genetic (things your inherit), psychological (how you think), social (your relationships with other people) or cultural (the customs and values of the people around you).
Who is at risk of getting an eating disorder
Eating disorders can affect any age or gender; however, women are more often affected, particularly younger women.
Anorexia and bulimia can develop at any stage in life, but most often occur during adolescence and early adulthood. Binge eating disorder can occur at any time, but can often start in mid-adulthood. Avoidant restrictive food intake disorder is likely to start in childhood. Any of these disorders can have a serious impact on your health.
People at risk of an eating disorder often have experienced the following:
- having feelings of low self-esteem or worthlessness
- living in a western culture in which being thin is considered the ideal body shape
- living in an urban area
- taking part in activities in which body image is a concern (eg, professional or competitive dancing, gymnastics or fashion modelling)
- having a history of strict dieting and body dissatisfaction
- having lived in an environment in which leanness or obesity has been a concern
- experiencing depression or loneliness
- being a perfectionist or impulsive, or having difficulty managing emotions
- migrating from a developing country to a western culture
- experiencing stressful life changes (eg, leaving home to go to university, a relationship breakup or the physical bodily changes of puberty)
- having experienced physical, emotional or sexual abuse.
What should i do if i have an eating disorder
Self-care and getting support from others is vital in recovering from an eating disorder and feeling happy again. If eating disorders are not treated, they can result in serious medical problems, so seek help sooner than later.
Start by talking to your GP as they can refer you to an eating disorder specialist who understands what you are going through and knows how to help you. Find out more about eating disorder services in New Zealand.
It also helps to learn about your condition. Read more about anorexia, bulimia, binge eating disorder and avoidant restrictive food intake disorder.
What is the treatment for an eating disorder
If your doctor thinks you most likely have an eating disorder, they will refer you to an eating disorder specialist or service. Most services that treat people with eating disorders bring together a team of different healthcare professionals, including psychiatrists and other doctors, psychologists and dietitians. Some treatment is publicly funded.
Treatment for eating disorders involves healthy eating, together with medical care and psychological treatment. You may need to learn how to manage your feelings in a different way. Some people might also be prescribed medications.
Most people with eating disorders have mainly outpatient treatment, but you may need to go to hospital for treatment if you are at risk of serious medical problems. With treatment, most people with an eating disorder make a good recovery, although it may take several years.
Learning how to take good care of yourself and manage your emotions is key to recovering from an eating disorder. The following steps can help you on your road to recovery.
- Learn about eating disorders to help you make sense of how you feel.
- Seek help early. The longer you leave it, the harder it is to get well.
- Make a decision to recover: see your doctor and get the treatment you need.
- Don’t be so hard on yourself – seek support and learn strategies to help you deal with difficult emotions and thoughts.
- Learn about nutrition and develop a healthy relationship with food.
- Learn ways to improve your body image – self-acceptance and kindness to yourself are important to help you recover.
- Feeling good about yourself is key – make time for pleasurable activities and spend time with people who can boost your mood.
Stress (mate māharahara) is your body’s natural reaction to a threat or an excess demand. Some stress is good for you and helps motivate you to get something done. But when you are under too much stress for too long, it affects your health and wellbeing. Learning how to manage stress is a key life skill.
Mental distress affects many New Zealanders. 1 in 5 adults aged 15 years and over are diagnosed with a mood and/or anxiety disorder.
Recent research found that: Almost one-third of people in New Zealand have a personal experience of mental distress.
Stress can come from many sources such as health issues, relationship problems, work, financial issues, deadlines, exams or unrealistic expectations you put on yourself. What causes stress for you may not be stressful for someone else.
Some stress is helpful as it can motivate you to meet a deadline or get things done. But long-term stress can increase the risk of health conditions, such as:
- high blood pressure
- obesity and diabetes
- depression or anxiety
- heart disease
- muscle tension, headaches
- irritable bowel syndrome (IBS)
- suicide in extreme situations.
A stress-related condition called post-traumatic stress disorder (PTSD) can develop after experiencing trauma, such as from war, physical or sexual assault, or a natural disaster.
It helps to learn how to recognise stress and find ways to cope with it before your body's stress response fully kicks in.
Here are some ideas to help you get started:
- Include things you find relaxing in your everyday life, such as listening to music, mindfulness meditation, connecting with friends and regular exercise.
- Learn useful anti-stress life skills such as effective problem solving, healthy communication and healthy thinking.
- Maintain a healthy work-life balance, take frequent breaks and find other ways to manage stress at work.
- Take care of yourself by being physically active every day, eating a healthy diet, having good sleep habits
- Make time to do fun things and spend time with the people who are important to you.
What can I do if im feeling stressed
- Talk with someone who will listen and provide good support and advice if you want it.
- Review all the sources of stress in your life – what can be reduced, stopped or changed to take some pressure off?
- Learn about time management and setting priorities – you can only do so much each day.
- Plan breaks in your day – change your habits to make this part of your routine.
- Problem-solve and make action plans to help break things down into doable steps.
- Look at your lifestyle and make sure you are eating healthy foods and getting enough sleep and exercise.
- Connect with what is really important in your life to give you perspective about the things that don't matter as much.
If you are finding it difficult to manage your stress, tell your doctor or find a counsellor or therapist to talk to.
Bipolar disorder is a mood disorder characterised by extreme high moods (mania) and extreme low moods (depression) (depression).
We all experience mood swings and times when we are happy or sad. These mood swings are more severe in bipolar disorder and impair your ability to carry out normal daily tasks. These mood swings can last for several days, weeks, or months.
Bipolar disorder can be a frightening, isolating, and overwhelming experience.
When you are in a crisis, you may feel as if you can't control your extremely negative emotions or grandiose feelings, and you may come to regret actions you took while in a good mood. It may appear that your world has come crashing down around you, that everything is black, that nothing makes sense, or that you are in danger. If you are experiencing these symptoms, please seek immediate crisis assistance.
What causes bipolar disorder
The cause of bipolar disorder is unknown. However, genetics, brain chemicals, social and environmental factors, substance abuse, and medical illnesses are thought to play a role. Its onset is sometimes linked to a stressful or traumatic life event.
In New Zealand, bipolar disorder may be more prevalent among Māori (4.6%), compared to Pacific peoples (3.7%) and people of European and other ethnicities (1.8%).
Genetic factors are thought to account for 60–80 percent of the condition's cause. If one parent has bipolar disorder, his or her child has a 10–25 percent chance of developing the illness. If both parents have bipolar disorder, their child has a 10–50% chance of developing the illness.
What are the symptoms of bipolar disorder
Bipolar mood swings are referred to as mood episodes. You may experience manic or hypomanic (milder mania) episodes, depressive episodes, or a combination of the two (which include both manic and depressive symptoms). Elated mood can range from mild to extremely elated mood, also known as mania.
In a manic episode you may:
- feel very up or high
- feel jump or wired
- feel extremely energised despite a lack of need for sleep over several days
- have exaggerated self-confidence
- talk really fast about a lot of different things
- be agitated, easily irritable or touchy
- have trouble relaxing or sleeping
- think you can do a lot of things at once and be more active than usual
- do risky things, like spend a lot of money or engage in sexual activities outside of your normal sexual behaviour.
Depression can be identified by extreme tiredness despite adequate sleep, uncontrollable crying, loss of interest and motivation, feeling hopeless, helpless, or worthless for an extended period of time, and having suicidal thoughts.
In a depressive episode you may:
- feel very down or sad
- feel worried and empty
- have trouble concentrating
- forget things a lot
- lose interest in fun activities and become less active
- feel tired or slowed down
- have trouble sleeping
- think about death or suicide.
These behaviours may emerge gradually, making it difficult to determine whether some are part of your normal personality. It can be beneficial to ask significant others in your life who are familiar with you if they have noticed any unusual behaviour. In severe cases, the symptoms are so intense that you may endanger yourself or others, or you may feel ashamed after you have recovered.
How is bipolar disorder diagnosed
Consult your family doctor if you believe you or someone you care about is experiencing these symptoms (GP). The earlier a diagnosis is made, the better the prognosis.
To rule out any other conditions that could be causing your symptoms, your doctor may perform a physical examination and request a blood test. If they suspect you have bipolar disorder, they will examine your symptoms.Bipolar disorder is divided into two types: bipolar I and bipolar II. Bipolar I disorder is a manic-depressive disorder with or without psychotic episodes.
Bipolar II disorder is characterised by depressive episodes (ranging from mild to severe) and at least one hypomanic episode that does not interfere with normal daily functioning. A diagnosis of Bipolar I Disorder is warranted if a full manic episode has occurred.
The depressive side of bipolar disorder is distinguished by a major depressive episode that results in a depressed mood or a loss of interest or pleasure in life. To be diagnosed with a major depressive episode, you must have 5 or more of the following symptoms for at least 2 weeks:
- depressed mood most of the day, nearly every day
- insomnia or hypersomnia
- loss of interest or pleasure in all, or almost all, activities
- significant weight loss or weight gain, or decrease or increase in appetite
- engaging in purposeless movements, such as pacing the room, or the opposite, minimal physical movement/activity
- fatigue or loss of energy
- feelings of worthlessness or guilt
- diminished ability to think or concentrate, or indecisiveness
- recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt.
Furthermore, these symptoms must cause significant impairment in daily functioning and are not the result of substance abuse, medication, or other mental health issues.
What is the treatment for bipolar disorder
If your physician suspects you have bipolar disorder, he or she may refer you to a psychologist or psychiatrist.
Most people learn to manage their bipolar disorder and move on with the help and support of family and friends. You will most likely have times when you are well and times when you are not. Your doctor's or psychiatrist's medication treatment is tailored to your specific needs in order to help you recover from periods of illness and return to your normal moods and behaviours. They will then modify your treatment to ensure that you remain healthy.
Medical treatment is typically accompanied by psychological support to help you learn about the triggers and early warning signs of your symptoms, as well as to teach you effective and healthy coping strategies.
After a period of illness, most people return to their normal level of functioning, though about one in every five will experience some ongoing difficulties.
There are several medicines that have been shown to be helpful in relieving depression and others that are useful in stabilising moods. It is quite common for people with bipolar disorder to be taking some medication long term. Your doctor can help you find the ones that suit you best without causing unnecessary side effects.
Treatment for bipolar disorder can be tricky, when compared to treating (unipolar) depression, because taking an antidepressant drug at the wrong time runs the risk of 'flipping' your depression into a manic mood. This means that mood stabiliser drugs and antidepressants are used carefully, and introduced gradually.
You may be referred to a psychiatrist so that your mood problems and the best treatment for you can be worked out early on. Even so, there may be some trial and error until the best combination for you is worked out.
Talking to your doctor will help you understand your moods and regain control of your life.
Commonly used mood stabilising medications are Lithium, Valproate and Carbamazepine. Sometimes antipsychotic medicines (eg, Olanzapine and Quetiapine) or antidepressants (eg, Fluoxetine, Paroxetine and Citalopram) are also useful.
If you are taking lithium, you will need regular blood tests to check the right amount is being given. The mood benefits may take a few months to really be noticed. If the lithium level in your blood gets too high you may notice shakes and twitches, weakness, slurred speech, sleepiness, stomach cramps, loss of appetite and vomiting. Contact your doctor, psychiatrist or practice nurse right away. Stop the lithium if you can't contact your doctor.
Also talk to your doctor, nurse or psychiatrist if your other medications appear to cause you problems. They can check you have the most appropriate medication at the right dose. Your doctor will be happy to talk about any medication side effects that might be a problem. Depending on the medicine, these can include weight gain, stomach problems, slowed thinking, tremors (shakes, twitches) or nausea.
The use of medications during pregnancy needs consultation with an expert. Taking your medication every day as directed is important for keeping well long term.
Psychotherapy can help you develop skills and strategies to manage the condition. It also gives you a non-judgmental place to deal with any emotions, such as sadness, guilt, anger or shame.
Electroconvulsive therapy (ECT)
In some circumstances, electroconvulsive therapy (ECT) might be recommended. Read more about ECT.
Self care for bipolar disorder
There is much you and your family/whānau can do to help you develop skills and strategies for reducing mood swings and staying well.
- Exercise helps your mental as well as physical wellbeing (the benefits can be substantial).
- Avoid all alcohol and illegal drugs (they cause mood changes).
- Eat a healthy, balanced diet.
- Develop a good sleep routine and get a good sleep every night – a few nights of poor sleep can trigger a manic episode, so if sleep is a problem ask your doctor about ways to help you sleep (which may include medication).
- Learn about your condition and ways different people manage it.
- Try to keep your life balanced and learn how to manage stress.
- Learn your warning signs so you can get help early before your mood becomes too high or low.
- Talk to trusted friends and relatives about bipolar disorder so they can be there for you when you need it.
- Keep a Daily Mood Swing diary to rate your moods from 1–10 and record factors affecting your mood and sleep. This helps to detect changes early.
- Find out if there is a self-management programme near you.
Psychosis is when your perception of reality is changed and you find it hard to know what is real. This means that psychosis may cause you to misinterpret or confuse what is going on around you.
Psychosis is when the way you perceive reality changes and you find it hard to know what is real. Experiencing the symptoms of psychosis is often referred to as having a psychotic episode.
During a psychotic episode, you may have trouble thinking straight, experience delusions (false beliefs or ideas) and/or hallucinations (seeing, hearing, smelling, sensing things that others can’t). You may feel disconnected from who you normally are, and from others around you. Your behaviour and mood can change. You might feel very sad or very happy.
A psychotic episode is most likely to first happen in your teenage years or early twenties. Because psychosis can be distressing and can distort your reality, it’s important to get help early. There is a range of treatments available, including medication, psychological therapies and social support. After recovering from the first episode many people never have an episode again, but others may experience a number of relapses.
If you are worried that you or someone else is at immediate risk of self-harm, call 111. If there is no immediate risk, contact your family doctor.
What causes psychosis
There is no one cause of psychosis. But there are certain risk factors that can make you more vulnerable to psychosis.
- Mental illness. Psychosis can be a symptom of different conditions, eg, schizophrenia or severe mood disorders like depression or bipolar disorder.
- Substance use. Some substances can cause psychosis eg, cocaine, amphetamines (speed), marijuana, methamphetamine (meth), PCP, hallucinogens and sedatives. Alcohol, sedatives and hypnotics (sleep medication) can cause psychosis when you suddenly stop using them.
- Other health problems or a medical condition – physical injuries, diseases or health conditions such as brain injury or lupus can cause psychosis.
- Stress. Inntense stress can cause or contribute to psychosis.
What are the symptoms of psychosis
Symptoms of psychosis vary from person to person and may interfere with day-to-day life. Signs of psychosis may be mild at first and become more serious over time. Symptoms include:
- delusions and confused thinking – beliefs that people from your background don’t usually believe
- hallucinations – hearing, seeing, smelling, tasting or touching something that isn’t actually there
- suspicion or paranoia
- lack of initiative and interests
- preoccupation with unusual ideas or beliefs
- change in function at school, work or home
- change in relationships
- changes in mood, irritability or anger
- avoidance of normal activities and social contact, isolation
- changes in self-care (ie, personal hygiene).
People who experience psychosis are rarely violent. They are more often frightened, confused and despondent (low, down on themselves).
Talk to your doctor if you are experiencing any signs of psychosis. These could be signs of mental or physical health problems, and your doctor can help you figure out what is causing them.
With treatment, many people never experience psychosis again after they recover from their first episode. Because psychosis can change your behaviour and make you do or say things you wouldn’t normally do, it can affect your relationships, your performance at work or study and your general sense of wellbeing. Starting treatment as early as possible can help limit these effects.
Treatment for psychosis usually includes medication and counselling. The treatment plan may be overseen by a GP or a specialist mental health service. Some people need to stay in hospital for assessment or treatment.
Your doctor will ask about:
- any recent major or stressful events
- physical and mental health history
- drug and alcohol use
- any family history of mental illness.
They may also ask for blood and urine tests, an X-ray and for you to see a mental health specialist.
To make a diagnosis they will follow criteria in the Diagnostic and Statistical Manual (DSM-5) or the International Statistical Classification of Diseases and Related Health Problems (ICD-10).
What are the different types of psychosis
There are several types of psychosis, depending on what has caused it.
- Drug-induced psychosis – using or withdrawing from drugs, especially cannabis and amphetamines, can cause psychotic symptoms that last for short or long periods.
- Brief reactive psychosis – psychotic symptoms that appear suddenly after a major stress in your life. Recovery is often quick.
- Schizophrenia – an illness in which the symptoms of psychosis have continued for at least six months. Many people with schizophrenia lead happy and fulfilling lives, and many make a full recovery. Read more about schizophrenia.
- Bipolar disorder – this condition involves major changes including extreme highs and lows. You can experience psychotic symptoms as part of this disorder. Read more about bipolar disorder.
- Depression – psychotic symptoms can occur in people with very severe depression. Read more about severe depression.
What is the treatment for psychosis
The aim of treatment is to help you regain your normal perception of reality. Treatment usually includes antipsychotic medicines, counselling and social support. With appropriate treatment, most people recover from psychosis. However, getting treatment and support early makes a good recovery more likely.
Your treatment plan may be overseen by your GP or specialist mental health service. Some people need to stay in hospital for assessment or treatment.
Your care team
Your treatment is likely to involve a team of mental health professionals working together. This may include a psychologist, a social worker, a psychiatric nurse and your GP or psychiatrist. You may be assigned a case manager to help coordinate everything from accessing self-help groups and managing crisis situations to getting help with job hunting and housing.
For Māori, Western models of mental health and mental healthcare will not always be appropriate. An approach based on a Māori model of health has a more holistic understanding of wellbeing. For example, the four cornerstones (or sides) of Māori health in the Te Whare Tapa Whā model of health are:
- whānau (family health)
- tinana (physical health)
- hinengaro (mental health)
- wairua (spiritual health).
You can find a health practitioner who has a kaupapa Māori approach to wellbeing in this directory.
Your treatment may include:
Antipsychotic medicines can help reduce feelings of anxiety associated with psychosis within a few hours. Other psychotic symptoms such as hallucinations and delusions may take several days or weeks to improve. Other medicines like antidepressants or mood stabilisers may also be used.
Counselling and psychological therapy
Psychological treatment can help reduce the intensity and anxiety caused by psychosis. Some possible psychological treatments are discussed below.
- Cognitive-behavioural therapy (CBT) teaches how behaviours, thoughts and mood influence each other.
- Family therapy is a way of helping both you and your family cope with your condition.
- Social skills training – this focuses on improving your communication and social interactions and your ability to fully participate in daily activities.
- Social and life skills support –Occupational therapists or social workers can help with day-to-day issues or connect you with community services that can. They can also help you prepare for, find and keep jobs.
- Support groups – If you're experiencing episodes of psychosis, you may benefit from being around other people who've had similar experiences.
What can I do to help myself?
You can help yourself by:
- having a plan for who to contact if you start to feel unwell and so others know what you need from them
- asking your friends and family to support you
- learning about what psychosis is, treatment options, coping skills, how to avoid relapse and how to access services – check out the links on this page
- taking medicines as agreed with your doctor
- looking after your self by eating well, getting enough sleep and keeping in touch with family and friends
- avoiding illegal drugs or alcohol
- avoiding stressful events and situations and learning how to cope with stress
- getting plenty of sleep and eating well
- keeping up with your normal activities as much as you are able to.
What support is available?
For ongoing support, see your family doctor, your contact person at community mental health services or your psychiatrist or psychotherapist. Find your nearest early intervention in psychosis team.
There are also support groups around the country. See also Supporting Families, who provide support for families and whānau to provide the best possible quality of life and recovery to their loved one who has a mental illness and to their own self-care.
If you need urgent help, phone:
- Lifeline 0800 543 354 (available 24/7), or
- Healthline 0800 611 116, who can give you the phone number for your local mental health crisis line.