The He Ara Oranga Report: What’s wrong with ‘Big Psychiatry’ in New Zealand?

The portrayal of psychiatry in the recent He Ara Oranga (HAO) Report into New Zealand’s mental health and addiction services raises significant concerns for the profession as a whole. This once-in-a-generation report recommends a decisive shift away from what is termed ‘Big Psychiatry’ towards a new sector called ‘Big Community’ (New Zealand Government, 2018: 97). Big Psychiatry is characterised as a medically led system where ‘most resources are used for psychiatric treatments, clinics and hospitals’ (p. 36). Big Psychiatry is criticised as having a colonising worldview, together with a legacy of paternalism and human rights breaches. In response to this depiction of psychiatry, the HAO Report recommends creating Big Community where ‘resources are used for a broad menu of comprehensive community-based responses’ (p. 36) that embrace multiple worldviews, and respond to people at risk with compassion and support. Big Community is praised as having a strong commitment to partnership, recovery, spirituality and human rights