Work to improve the mental health of New Zealanders could be at risk of a “significant loss of traction” if the Government fails to produce an action plan by the end of the year, Oliver Lewis and Laura Walters report

In the nearly two years since the release of He Ara Oranga, those behind the once-in-a-generation review of the mental health and addiction sector have stayed largely silent on its implementation.

Not any more.

In an exclusive interview with Newsroom, former panel chair Professor Ron Paterson spoke out to back a call by Mental Health Commissioner Kevin Allan on the urgent need for an action plan to deliver the He Ara Oranga reforms.

His comment was made in consultation with the five other former panel members.

“We as a group agree with the Mental Health Commissioner’s call for an action plan and we share his concern about the risk of a significant loss of traction without one,” Paterson said.

Allan made the recommendation in his 2020 monitoring report and in a July letter to Health Minister Chris Hipkins, in which he stressed an action plan for implementing the transformative reforms needed to be prepared by December 31.

In an interview with Newsroom, he said the plan needed to spell out what implementing He Ara Oranga would look like, provide clear timeframes and say who was responsible.

“I think there is a risk that if it’s not clear what’s going to change, when, by whom and how then there is the risk of a loss of direction and traction.”

Mental health was “too important to let that slip”, Allan said.

He Ara Oranga made 40 recommendations to transform the sector, covering everything from the need to significantly increase access to services for people with mild to moderate mental health needs to taking a stricter approach to the sale and supply of alcohol.

The Government, in its May 2019 response, either accepted, accepted in principle or said further consideration was needed for 38 of the recommendations; it rejected just two outright, including a target of a 20 percent reduction in suicide rates by 2030.

The Initial Mental Health and Wellbeing Commission is working on a report due in November assessing progress against the recommendations, but more than a year after the Government response — and following its $1.9 billion investment in mental health as part of Budget 2019 — there is still little public information on how it plans to deliver on many of the specific points.

Allan said he was not after a paint-by-numbers action plan, but did say it was reasonable to expect clarity from the Government. There had been good progress to-date, he said, adding it needed to be acknowledged that the Government was treating mental health seriously.

“There’s been really good progress, but there’s also a considerable way to go to make sure we’re lifting our investment in mental wellbeing and looking after people in the way we need to in specialist services.”

David Clark and Jacinda Ardern announced the Government’s response to He Ara Oranga in May, last year. Work has been progressing on some priority areas, but delivery of frontline services has been slower-than-expected. Photo: Lynn Grieveson

Health Minister Chris Hipkins said work was continuing to develop the Government’s response to the recommendations it agreed to in principle or said required further consideration. But it had been prioritised behind the urgent recommendations and the public and mental health response to Covid-19.

“This continuing work includes consideration of a wide ranging whole of community, whole of Government action plan which goes beyond a health agenda,” he said.

Allan had given the Government until November 30 to respond to the recommendations in his monitoring report. Hipkins said he would be responding soon.

A Ministry of Health spokesman said there was an action plan in place covering the next 12-18 months, the Covid-19 Psychosocial and Mental Wellbeing Recovery Plan. While the plan was devised in response to the Covid-19 pandemic and anticipated increase in mental distress, the authors say He Ara Oranga informed its development and focus areas. There were also specific plans for initial focus areas, including the Suicide Prevention Action Plan for 2019-2024.

In contrast to Allan and Paterson, the ministry said it was confident traction would not be lost if further planning was delayed.

The Government was committed to developing a “longer-term pathway” in response to He Ara Oranga to sequence actions, guide investment and support cohesion across government and the wider mental health and wellbeing system, the ministry spokesperson said.

But the Covid-19 action plan represented the initial focus of the longer-term pathway and work was underway to adjust the pathway for the post-Covid environment, he said.

According to the ministry, a static action plan would not provide the necessary flexibility — both the Covid-19 plan and the pathway would be ‘living documents’, which would be adjusted as needed.

Asked if the pathway amounted to the action plan he was calling for, Allan said the Covid-19 psychosocial plan was a helpful starting point, but it did not amount to a full action plan responding to He Ara Oranga.

Allan said labels mattered less to him than what was delivered.

“If I didn’t have a sense it was being progressed then I would be very concerned, but the latest information I had from the ministry is that it is being progressed and I’m expecting to see the results at the end of the year.”

Initial Mental Health and Wellbeing Commission chair Hayden Wano had a more optimistic view of the Covid-19 plan, describing it as a “key pillar” in bringing He Ara Oranga to life.

However, he, too, stressed the need for a long-term implementation plan developed with people and whānau.

“They’re not bad people at the ministry, I just think they’re overwhelmed with the volume of work they’ve got to do.”

While the Government had not delivered a specific action plan to implement the inquiry recommendations, it had been working on four priority areas: establishing the Mental Health and Wellbeing Commission, strengthening suicide prevention efforts, beginning the process to repeal and replace the Mental Health Act, and expanding service access and choice.

So far, the Government has re-established a standalone Mental Health and Wellbeing Commission, and set up a Suicide Prevention Office within the Ministry of Health, along with the delivery of the suicide prevention strategy and action plan, backed up by $40m of funding.

Parliament has also established a cross-party working group on mental health and wellbeing, something He Ara Oranga recommended as a tangible demonstration of collective and enduring political commitment to improved mental health and wellbeing.

But the Government’s flagship investment, $455m over four years to establish a new network of primary mental health and addiction services, has rolled out slower than expected, with the Government failing to meet its own first-year spend target, in part due to Covid-19. 

At the end of July, just $30m of the $455m had been spent, with a further $100m committed in contract.

However, Allan said the new services, which will include specific Māori, Pacific and youth services, were making an impact.

Former mental health commissioner Mary O’Hagan says mental health action plans have a history of failure, particularly when they’re long and complicated. But government does need a clear roadmap of how it’s going to transform the mental health sector. Photo: Lynn Grieveson

Former mental health commissioner and advocate Mary O’Hagan said the ministry originally had plans to create working groups focused on He Ara Oranga’s nine chapters, in order to create a comprehensive plan, based on consultation with communities.

But those plans were abandoned, as the Government faced pressure to deliver on its promise of new services.

The ministry got “snowed under”, and started working in isolation, trying to push the new services out the door, O’Hagan said.

“They’re not bad people at the ministry, I just think they’re overwhelmed with the volume of work they’ve got to do.”

Any plan needed to be simple, and progress needed to be tracked, she said.

“But you do need a roadmap for where you’re going. And you certainly need a vision for where you want to end up in five or 10 years time. 

“And I don’t see evidence of that.”

While mental health policy has historically been a bipartisan area, it became a political football in the lead-up to the last election.

Labour used the opportunity to differentiate itself from National by promising to launch a national inquiry if they made it into government.

The coalition delivered on that promise within its first 100 days in power, and a year later He Ara Oranga was hailed as an opportunity to transform a system that was under pressure and failing the country’s most vulnerable.

At a cost of $6m, it was the first national mental health inquiry since the watershed report by retired judge Ken Mason in 1996.

The inquiry attracted about 5000 submissions from experts, those with lived experience, and their family members, and highlighted the need for an all-of-society approach to mental health and addiction; as well as the need to gain a better understanding of the role social determinants like poverty, colonisation and trauma played in mental health and wellbeing outcomes.

Despite this vision of system overhaul, and the big Budget spend last year, there has been little talk of mental health on the campaign trail in the lead-up to October 17.

Neither Labour or the Greens have launched specific mental health policies so this campaign.

“My view is that there’s probably enough things for us to argue about in Parliament, mental health doesn’t have to be one of them.”

The Labour Party’s website points to the work done in the last term of government, with focus on its rollout of frontline mental health services; investing in mental health facilities in neglected areas of the country; and re-establishing the independent Mental Health and Wellbeing Commission.

Labour is due to launch its full health policy on Tuesday.

The Green Party’s policy on its website also talks about extending the work started last term, expanding funding for free counselling, improving postnatal mental health services, and working through the Cross-Parliamentary Mental Health and Addiction Wellbeing Group to reduce stigma and educate MPs.

Meanwhile, National released its mental health policy on Monday, which included a promise to fund 100,000 free counselling sessions in response to Covid-19, commit to a Zero Suicides multi-sector suicide prevention stratgey, and place a primary care navigator in every general practice.

If elected, the party said it would also establish New Zealand’s first minister for mental health, who would be responsible for the He Ara Oranga recommendations.

National’s mental health spokesperson Matt Doocey said the minister would drive the all-of-government approach, bringing together health, justice, education and housing. Clear accountability and measurability were important, he said.

While Doocey was critical about the speed at which the last Government has rolled out the promised frontline services, and the related underspend, he told Newsroom New Zealand needed a more bipartisan approach to mental health policy.

“Most politicians have heard the call of members of the public, who want politicians to work together on mental health.

“My view is that there’s probably enough things for us to argue about in Parliament, mental health doesn’t have to be one of them.”

ACT has also released a standalone mental health policy, which is based on doing away with the “messy and disorderly” mix of DHBs, NGOs and primary care providers. If in a position of power, the party would replace the current system with a standalone Mental Health and Addiction Agency.

– Later this week, Newsroom will look at the state of the country’s mental health services, what government delivered in the past three years, and what political parties are promising this election.

Oliver Lewis is a freelance journalist with a background in health and employment issues reporting.

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