There is a way through: A guide for people experiencing stress, depression and anxiety - HE2570

Hurihia tō mata ki te rā kia taka te ātārangi ki muri i a koe.
Turn your face to the sun and the shadows will fall behind you.

There is hope

Throughout New Zealand, right at this moment, there are other people like you who have lots of stress, low mood, depression or anxiety; every year one in five people experience depression, anxiety or both.

Most people come through those experiences to a happier place. There is help. There is hope.

"I was lucky enough to be around other people who had survived being really down or living with big fears. I would look at them and think, ‘Well, you’re OK. You’re living your life’, and that gave me hope.”
Tania

About this booklet

This booklet lets you know how to recognise depression and anxiety, how to help yourself and how to get help from others. There is also a section for whānau and friends.

Depression and anxiety can impact just about every part of our lives.

This booklet uses a Māori framework for wellbeing called Te Whare Tapa Whā (the four walls of the house) to address all these impacts: Te Taha Hinengaro (mental); Te Taha Tinana (physical); Te Taha Whānau (social); and Te Taha Wairua (spiritual).

How can I tell if I have depression or anxiety?

Everyone goes through times of stress, fear, worry and feeling down. But when those feelings get really bad or go on for a long time you may have depression or anxiety.

It’s common to experience both depression and anxiety at the same time.

If your main problem is feeling really down or losing interest in things that you usually enjoy, we call it depression.

If your main problem is panic, being on edge and worrying, we call it anxiety.

Key signs to look out for

Depression and anxiety can show up in all parts of your life.

These experiences can be overwhelming and frightening. However, there are ways through them.

TINANA (PHYSICAL)

• Feeling tired and lacking energy.
• Sleeping too much or too little.
• Eating too much or too little.
• Moving or speaking more slowly or more quickly than usual.
• Trouble relaxing.
• Racing heart, chest pains, sweating and breathlessness.

HINENGARO (MENTAL)

• Difficulty thinking and concentrating.
• Losing interest in things you used to enjoy.
• Worrying that awful things will happen.
• Feeling sad and hopeless.
• Feeling whakamā, shame or a failure.
• Feeling nervous or anxious a lot.
• Feeling like ending your life or harming yourself.

WHĀNAU (SOCIAL)

• Losing interest in whānau and friends and avoiding contact with them.
• Feeling like other people don’t understand.
• Feeling empty and lonely.
• Wanting to be left alone.
• Getting irritated or hōhā with others.

WAIRUA (SPIRITUAL)

• Feeling there is no purpose to life.
• Feeling numb and disconnected.
• Feeling cut off from your tīpuna or spiritual sources of meaning.
• Having bad dreams.

Why this is happening to me?

Hongihongi te wheiwheia.
Know and understand those unseen things that can cause worry, anxiety and fear.

If you have depression, anxiety or both you’re not alone. But it’s natural to wonder, why me?

Many things contribute to depression and anxiety – sometimes there is no clear reason at all.

Your past

Bad things happening, especially early in life, can increase your chances of depression and anxiety later on:

• Difficult childhood experiences, like abuse, neglect or family violence.
• Traumatic events at any time of life.
• Family history of depression or anxiety.
• Family history of trauma.

Major life changes

We all go through major changes throughout life where we need to adjust to new roles and situations. These changes, even when they are positive, can bring about depression and anxiety:

• Becoming an independent adult.
• Becoming a parent.
• Coming out about your sexual or gender identity.
• Redundancy or retirement.
• A relationship break-up.
• The death of someone close to you.
• Disability, illness and ageing.

Life stresses

Life throws up all sorts of stresses that can lead to depression and anxiety, such as:

• Conflicts with your whānau or friends.
• Money problems.
• Relationship and/or sex problems.
• Accidents and natural disasters.
• Problems with work or school.
• Bullying and harassment.

"I had low self-esteem at a young age. Anxiety. Panic attacks. And then not finding out until almost five years old that I actually had a hearing disability, and it wasn’t that I was a problem child.”
Vesna

What I can do to help myself

Even when it seems you can’t control your feelings, you can control what you do. Just taking a small first step is enough to get you on the path to enjoying life again.

First, talk to someone you trust

Reach out to someone you trust – kōrero with a friend, a whānau member, a workmate, someone at church, an elder or a health professional. They can just listen and be there for you. They may also give you advice and information, as well as practical support.

People who have been through depression and anxiety themselves can be especially helpful. There may be support networks, often run by and for people with experience of depression and anxiety in your area.

Go to mentalhealth.org.nz/get-help/in-crisis/support-groups/ to find out more.

"My father said only weak people seek help. But I knew I needed help. Now, how I stay well is by ringing friends and family.”
Gillian

Te taha hinengaro – look after your mental wellbeing

Many people find these approaches helpful:

• Get back into your daily routine, by doing little things like showering, cooking or housework.
• Relax through yoga, meditation or mindfulness.
• Do a gratitude journal for five minutes every day where you list down all the things you are thankful for in your life.
• Postpone major life decisions until you’re feeling better.
• Help someone else.

"Writing down my thoughts greatly reduces my anxiety. One thought would lead to another thought and that’s why I got anxious. As long as I can do a reality check and know that everything is OK then I can get through my anxiety.”
Kate

Te taha tinana – look after your physical wellbeing

There are lots of ways you can look after your physical wellbeing:

• Go to a park, the beach or the bush to absorb the peacefulness and fresh air.
• Do something physical, like going for a walk, a run or a swim.
• Get your hands dirty in the garden.
• Get regular sleep.
• Cut back on alcohol and recreational drugs.
• Eat healthy meals.

"I can’t wait to go have some exercise to know how good I’ll feel afterwards.”
Vesna

Te taha whānau – spend time with other people

Connecting with people can help you feel better faster. Sometimes it helps to plan your social contacts ahead of time, and to go even if you don’t feel like it on the day:

• Meet up with a friend for a coffee.
• Help out at the local community centre or marae.
• Join a local group or a club.
• Go to family or whānau birthdays, anniversaries and get-togethers.
• Spend more time with the children and mokopuna.
• Join an online forum or chat group.

"What helps the most are people who accept it, listen to me and support me. My partner and family who are always there for me, no matter what. They give me hope and push me to keep fighting.”
Angela

Te taha wairua – reconnect with your purpose

Everyone needs meaning and purpose in life, to connect with their wairua or their spiritual source:

• Do things that make you feel connected such as meditation, enjoying the sunset or listening to music.
• Open yourself to inspirational readings, stories or videos.
• Spend time in your tūrangawaewae or the place you belong and feel safe in.
• Talk to a spiritual adviser, such as a priest or a tohunga.

"The whānau better understood what was happening for me than I knew myself, and they guided me through a process of kaupapa Māori healing. Mostly, reconnecting me with my whenua, my moana, my maunga and my marae, and guiding me through tikanga and matters of wairuatanga.”
Tania

Ways of coping that don’t work in the long term

Some of our attempts to cope with trauma, changes and stresses help us in the short them but can make things worse in the long term. Most of us know for ourselves what these things are. They include:

• ‘Self-medicating’ with alcohol and drugs.
• Working all hours.
• Eating a lot more junk food than usual.
• Self-harm.
• Avoiding whānau, friends and stressful situations.
• Stopping physical exercise.

"At first, alcohol eased my anxiety in social situations but as time went on this changed. Alcohol was a slow corrosive, gradually stripping me of my ability to cope with life. I’d spend days in bed, feeling depressed and wanting to die.”
Paul

Professionals who can support me

It can be tough dealing with the way you feel, so it’s a good idea to call in someone to help. There are different kinds of mental health professionals. Each kind takes a different approach. You’ll want to think about which one feels right for you.

Don’t be afraid to ask for help. If you are suffering a lot, unable to do the things you need to in life or have thoughts of wanting to die – you need extra support from people trained to help with depression and anxiety.

Where to start

Many people visit their family doctor or primary care nurse. Or they may decide to go straight to see a counsellor, psychologist or other type of talking therapist if they can afford it.

Your doctor or nurse will ask you about your depression and anxiety and then talk with you about what might be the best treatment – usually talking therapy, medication or a combination of both.

They may also help you work out some self-help strategies and keep an eye on your progress.

Suggestions for your visit

There are things you can do to get the best out of your visit to a health professional:

• If you are making an appointment with a doctor or nurse, ask if you can have extra time to talk because the usual 15 minutes may not be enough.
• Ask a friend or whānau member to come with you as a support person and to give their perspective if you want them to.
• Write down the anxiety and/or depression signs you have been experiencing. See these lists to help you.
• Write down the things you’ve tried that have helped and not helped.
• If your current treatment is not working, ask for alternatives.

Remember, if you’re not satisfied with your health professional, you can change to another one. It’s really important to like and trust the professionals you talk to.

"My cousin, he gave me that kick, gave me that shove that I needed to talk to a professional person. I went and talked to a counsellor, and that was my turning point.”
Paul

Talking therapies

Talking therapies involve talking to a specially trained mental health professional, usually for several or more sessions, about the challenges in your life. They should help to understand your experiences as well as work with you on developing more coping skills.

"I did a combination of group therapy and individual therapy. The group therapy was awesome for the fact that it made me realise I’m not alone.”
Gillian

Medications

Your doctor may suggest medication for your depression or anxiety. It usually works best in combination with talking therapy.

Your doctor should explain to you:

• What experiences the medication should help with.
• How long it will take to work.
• How long you may need to take it.
• Possible side effects and how to manage them.
• How to stop taking the medication safely.

Anti-depressant medication for depression and anxiety often takes a few weeks to work. People sometimes have to try a few medications before they find one that works for them.

All medications can have side-effects so let your doctor know if they are bothering you.

Some medications have distressing withdrawal effects if you go off them too quickly, so it is important to involve your doctor if you want to stop.

"Medication formed one piece of my recovery journey. In the past, I’d expect medication to make me happy. Whereas this time around I expected it to be part of my support kit. It helped me to be able to think clearer, to understand what was going on and to do the work with my counsellor.”
Hannah

Complementary and alternative treatments

Complementary and alternative treatments have developed outside the mainstream of modern western medicine or psychology. If you plan to try a complementary or alternative treatment, talk to your pharmacist, doctor or nurse first, particularly if you are already taking other medication.

Traditional Māori healing

Tohunga and other Māori healers provide rongoā Māori healing that offers:

• Mirimiri (massage).
• Karakia (prayers and chants).
• Rākau rongoā (native flora herbal preparations).
• Whitiwhiti kōrero (cultural support).

"I had to first connect with the wairua, through karakia, waiata, and also regular visits to the awa. The main thing I had to do was kōrero, talk and unload.”
Jamie

How much will it cost?

Family doctor

The cost of a visit to a family doctor varies. You may be asked to pay less if you have a Community Services Card.

Medications

Most medications for anxiety and depression cost five dollars per prescription.

Talking therapies

Talking therapy often costs but there are ways to get it for free:

• Family doctors often have access to funding that will give you several talking therapy sessions for no charge.
• Workplaces often have employee assistance programmes where you can get free, confidential counselling for problems or stresses.
• The Accident Compensation Corporation can also fund counselling for people who have experienced sexual abuse or an accident.

Online tools I can use

It might take time for the positive feelings to return, but keep at it. Things will get better.

If you are online, there are tools that can help you recover from depression and anxiety.

Depression.org.nz

Depression.org.nz is a website where you can:

• Answer questions to find out your level of depression and anxiety.
• Find out the signs of depression and anxiety.
• Read and view personal stories and self-management tips.
• Ring or text a helpline.
• Participate in Small Steps

The website also has specific resources sharing Māori, Pasifika, Deaf, Rainbow and Rural perspectives on mental health.

Smallsteps.org.nz

Small Steps are brief digital wellbeing activities designed to support you to develop a range of skills that can contribute to positive wellbeing.

These tools can be used as little or as often as you desire - on a one-off or an ongoing basis.

Online tools for young people

• thelowdown.co.nz – a space created with rangatahi, for rangatahi. Find support here for your hauora, identity, culture and mental health.
• sparx.org.nz – an online game that will teach you skills to deal with what you are going through.
• auntydee.co.nz – an online tool for anyone who needs some help working through problems, particularly for Pasifika youth.

Helplines I can call or text

There are a lot of free phone, text and online chat services staffed by people who are trained to give confidential support to people struggling with anxiety, depression and thoughts about wanting to die.

General helpline support

1737, need to talk?

Open 24/7
Phone or text: 1737

1737 Peer Support

When you phone 1737 you now have the option to talk to someone with lived experience of wairangi/mental distress.

Depression Helpline

Open 24/7
Phone: 0800 111 757
Text: 4202
Webchat or email: depression.org.nz

Lifeline

Open 24/7
Phone: 0800 543 354
Text: 4357

Samaritans

Open 24/7
Phone: 0800 726 666

"I rang the helpline when I was feeling suicidal. Somehow it felt safe to talk about it to a stranger who wasn’t in the same room but who you knew was a trained counsellor. The helpline person was amazing. She listened with compassion and guided me though what I needed to do to keep myself safe.”
Maria

Helpline support for children and young people

thelowdown.co.nz

Open 24/7 for young people experiencing depression or anxiety.
Phone: 0800 111 757
Text: 5626
Webchat or email: thelowdown.co.nz

What’s Up

For 5 to 18 year olds.
Phone: 0800 942 8787 (11am to 11pm)
Webchat: whatsup.co.nz (11am to 10:30pm)

Youthline

Open 24/7 for young people, and their parents, whānau and friends.
Phone: 0800 376 633
Text: 234
Webchat: youthline.co.nz
Email: talk@youthline.co.nz

Support and counselling for specific issues

Alcohol Drug Helpline

Open 24/7 for people dealing with alcohol or other drug problems.
Phone: 0800 787 797
Text: 8681
Webchat: alcoholdrughelp.org.nz

Gambling Helpline

Open 24/7 for people dealing with problem gambling.
Phone: 0800 654 655
Text: 8006

OUTLine

For sexuality or gender identity issues.
Phone: 0800 688 5463 (10am to 9pm weekdays, 6pm to 9pm weekends)

PlunketLine

Open 24/7 for new parents, including mothers experiencing post-natal depression.
Phone: 0800 933 922

Rape Crisis

For victims of rape or sexual abuse and their whānau.
Phone: 0800 883 300 (hours vary depending on area – see rapecrisisnz.org.nz for more details)

RASNZ Refugee Health and Wellbeing

For refugees and asylum seekers.
Phone: 0800 472 769 or 021 838370 (9am to 4pm Monday to Friday)

Rural Support Trust

For people in rural communities dealing with financial or personal challenges.
Phone: 0800 787 254 (hours vary depending on area – this is not a crisis line.)

Shakti Crisis Line

Open 24/7 for migrant or refugee women living with family violence.
Phone: 0800 742 584

Women’s Refuge Crisis Line

Open 24/7 for women living with domestic violence or fear of it.
Phone: 0800 733 843 (to be put through to your local refuge).

What if it’s an emergency?

If you need urgent help, please call 111 or go to your local hospital emergency department.

Helping whānau and friends

Mauria ko ōku painga. Waiho ko ōku wheru.
Highlight my strengths. Ignore my weaknesses.

Sometimes it’s easy to tell when someone isn’t their usual self, but it’s a lot harder to know how to help, or even how to raise the issue with them. Don’t be afraid to start the conversation. Say you have noticed some changes lately and ask them if they’re OK.

There are many ways you can make a difference. The most important thing is to ask what they need and don’t make assumptions. Listen with open ears. Be patient and hold hope for them:

• Learn about depression and anxiety especially if you haven’t experienced it yourself.
• Do things together and keep the person involved.
• Give practical support, like cooking a meal or looking after the children.
• Go through the self-help options in this booklet with them.
• Offer to go with them to see their health professional.

If the person talks about wanting to die

If the person talks to you about wanting to die, always take them seriously but don’t panic. These feelings are common in people with anxiety or depression and it is good for people to open up about them to someone who cares and doesn’t get alarmed.

If the feelings of wanting to die persist the person may need extra support from a health professional.

People are at more risk if they have tried to take their own life before; if someone close to them has taken their own life; if they are overwhelmed with hopelessness or panic; if they believe others would be better off if they were dead; or if they have access to the means, such as firearms.

If the person starts to talk about how, when or where they want to take their own lives, or if they look as though they are making preparations for death, you need to act urgently. Discuss the additional support they need, such as support from a close family member, a doctor, or the mental health crisis team.

If you think they are at immediate risk, either call 111 or take them to the hospital emergency department, with their consent if possible.

"Don’t make assumptions about where we feel safe and how it is best for us to heal. For some of us it’s with our whānau and for others it’s on their own. We’ve got a right to make those choices. I was better off sleeping on the floor at my kuia’s house, going to the hot pools, being with my whānau, and just allowing the process to run its course.”
Tania

Getting support for you

Make sure you get support for yourself when you are supporting someone else, as it can take a lot out of you.

Visit the ‘Help someone’ page on depression.org.nz for more information.

"One of the most helpful things has been our determination to get through my daughter’s depression as a family. We spend a lot of time talking to each other and supporting each other. This has meant that we have never given up hope. The family has stayed together as a family unit and we are strong because of it.”
John

Code: HE2570