The Government promised big on mental health at the last election. Oliver Lewis and Laura Walters take a look at how far we’ve come in the past three years.
Mental health and suicide prevention were hot-button issues in the 2017 election, driven by mounting public dissatisfaction over the state of struggling services.
Since then, New Zealand has had a ‘once-in-a-generation’ inquiry into the mental health and addiction sector, culminating in the He Ara Oranga report.
As part of its response, the Government announced an unprecedented $1.9 billion spend to support mental wellbeing as part of its 2019 ‘Wellbeing Budget’.
But almost two years after He Ara Oranga, problems remain.
Now Covid-19, with its associated economic downturn, is expected to lead to more people experiencing mental distress, making the need to improve the system even more pressing.
In August, Chief Ombudsman Peter Boshier said inspections of acute mental health units had revealed two to be in breach of a United Nations convention on torture and other degrading treatment; one Wellington unit had been using seclusion rooms as bedrooms when it was over capacity, while another, in Auckland, had been housing a patient in its intensive care unit.
The senior doctors’ union says units across the country are at breaking point. And there is a sense the Government has focused on primary mental health services at the expense of hospital-level, specialist care.
Staff have reported feeling scared, distressed and unsafe at work.
Meanwhile, the suicide rate remains high. In the year to June, 654 people around the country died by suicide, 31 fewer than the previous year.
While He Ara Oranga was supposed to initiate a process of transformation, many of the issues plaguing the system are the same as they were three years ago.
So, how far have we come in the past three years? And what are the parties promising if they are in power after October 17.
‘Good progress, but a considerable way to go’
For its initial response to He Ara Oranga, the Government set four priorities: 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 it has passed legislation to set up the permanent commission, which is expected to be in place by February, and created the Initial Mental Health and Wellbeing Commission to monitor progress.
It has set up a Suicide Prevention Office and launched a suicide prevention action plan, with the backing of $40 million.
Within the $1.9b Budget allocation, there was also money for housing support, employment support and the justice system.
The Ministry of Health has started developing new legislation to replace the outdated Mental Health Act.
And the Government has allocated $455 million over five years for new primary mental health and addiction services — its flagship policy.
The new services, which will include dedicated Māori, Pacific and youth services. The rollout to general practices has begun. However, the process — which was always meant to be staggered — has been slow, and the Government has not met its first-year spend target, in part due to Covid-19.
Written parliamentary questions between National’s Matt Doocey and Health Minister Chris Hipkins show at the end of July, just $30m of the $455m had been spent, with a further $100m committed in contract.
Of the $1.9b promised through Budget 2019, $125m had been spent, with about $435m committed in contract.
Doocey said he agreed with increasing the provision of frontline services, but criticised the slow rollout and underspend when the need was urgent, and growing.
“Being told to have patience doesn’t hold weight when you or your loved ones are struggling.”
Mental Health Commissioner Kevin Allan told Newsroom these services were already having an impact, and he praised the Government for bringing more attention to mental health.
“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 specialised services.”
Taimi Allan, chief executive of lived experience advocacy organisation Changing Minds, took a similarly balanced perspective. While she believed this Government had done more for mental health than any other, sometimes the wheels of change moved frustratingly slowly, she said.
“The work has certainly started, and we cannot hope for total transformation without doing the groundwork first.”
“The problem is, however, that while this work is going on, the public haven’t seen much change that they would be affected by yet. Being told to have patience doesn’t hold weight when you or your loved ones are struggling.”
By the end of June 2021, there should be more than 350 workers these services across more than 100 GP sites. Nearly 28,000 sessions had been delivered in the past year, a ministry spokesperson said.
The new network of primary services is supposed to cater to the ‘missing middle’ — people with mild to moderate mental distress.
Former mental health commissioner Mary O’Hagan said she was skeptical of the underpinning theory that treating people earlier would reduce pressure on specialist services.
“It might actually increase demand, because you’ve got more people who may be identified as needing that extra level of service.”
And, given the current state of secondary services, that may not be such a good thing.
“If you go further along the spectrum, the secondary services are pretty depressed and feeling neglected.”
Adding extra primary services was a bit like building motorways, she said.
“They just get clogged up as soon as you build them.”
Instead, the focus should be on improving mental wellbeing, and equipping communities to respond. O’Hagan championed a braver type of reform, saying He Ara Oranga, and the Government’s response, could have been more far-reaching.
O’Hagan said there needs to be a clear vision of what success looks like, but currently the Government is lacking a plan for wider reform.
Recently, the focus has shifted to the Covid-19 response. And while the ministry works to plug gaps in parts of the system, without a clearly articulated long-term vision, others appear to be growing wider.
Inpatient units ‘more like overcrowded hotels’
Acute mental health inpatient units and other specialist mental health and addiction services have been under sustained pressure for years.
Of the 24 units assessed as part of the ministry’s hospital stocktake, 70 percent had designs that did not support proper privacy, safety and therapeutic space.
Strategies to cope with excess demand were evident in 70 percent of the units, including using day, seclusion, interview and meeting rooms as bedrooms.
In short, the units are poor, and they don’t have enough beds.
“The money going into the community and lower-level end is kind of robbing Peter to pay Paul — that’s our perception.”
The Association of Salaried Medical Specialists (ASMS) says almost all DHBs are struggling with a shortage of inpatient beds and understaffing.
“We’ve heard cases in which patients have had to be sedated in emergency departments and forced to wait several hours before moving onto a ward,” ASMS executive director Sarah Dalton said in a September press release.
This was likely to get worse due to Covid-19 and continued methamphetamine use, according to the ASMS (the ministry said there was no evidence that Covid-19 was driving demand for acute services, although it was closely monitoring occupancy).
Speaking to Newsroom this week, Dalton said one of her members had likened the units to overcrowded hotels, not treatment facilities.
“It’s not safe,” she said.
“The money going into the community and lower-level end is kind of robbing Peter to pay Paul — that’s our perception.
“We think it needs to be a ‘yes-and’, we think there needs to be serious front-loading to acute hospital services as well as the preventative, lower-level end.”
In his 2020 monitoring report, Allan said specialist services remained under pressure, despite recent funding increases.
Forensic mental health services were particularly stretched; while the prison population had increased by 25 percent between 2013 and 2019, the number of forensic beds had increased just 3 percent, or eight beds.
Allan also pointed to a need to address high rates of compulsory care under the Mental Health Act and rising national seclusion numbers, especially for Māori.
The last government committed $42m over four years to enhance specialist mental health services, focusing on forensic and crisis services; $14m had been allocated to primary responses to addictions, and $44m for specialist alcohol and drug services.
Hipkins said specialist services had been under pressure for some time, and pointed the blame at the previous government for neglecting mental health facilities.
With the increase in funding for DHBs, the mental health funding ring fence had increased by more than $170m since the coalition government took office, he said.
But what are the parties promising now?
On Wednesday, Hipkins was in Rotorua announcing a new mental health inpatient unit for the local hospital. Notes accompanying the press release put the total funding to upgrade mental health facilities during this term of government at $435 million.
In a progress list provided to Newsroom, the ministry pointed to gains made over the past term, with a focus on improvements for young people, including Mana Ake – a service providing primary and intermediate-aged children in Canterbury and Kaikōura with access to mental health and wellbeing support in schools – and setting up Piki, a free youth mental health support service for people aged 18 to 25 in the Greater Wellington area.
Labour released its health policy on Monday, which included some dedicated mental health promises:
- Expanding the Mana Ake programme to every school at a cost of $151m over five years; and continued expansion of the nurses in school programme in secondary schools.
- Investing $1.6m for an extra 12 maternal mental health respite beds.
- Continuing to roll-out the $1.9b response package to He Ara Oranga.
- Expanding and improving suicide prevention efforts.
- Enhancing the quality and capacity of specialist drug and alcohol services.
Hipkins said a Labour-led government would continue investing in mental health facilities, and continue to prioritise “the ongoing transformation of mental health services we began in our first term”.
“Improving our approach to mental health care remains a key challenge for all of New Zealand therefore it remains a key focus for this and the next Labour-led government.”
National’s policy promises focus on many of the same areas as Labour, such as primary care and counselling for young people. But National placed a stronger emphasis on wellbeing promotion and community-based solutions.
National released its mental health policy on Monday, including:
- Establishing a minister for mental health.
- Implementing a ‘national stepped care approach’ for commissioning and delivering services to provide a joined up and integrated network of services, to address the “postcode lottery” and inconsistent service provision.
- Urgently funding 100,000 free counselling sessions in response to Covid-19.
- Establishing a $10m mental health support package for SMEs.
- Committing to a nationwide ‘Zero Suicides’ suicide prevention stratgey.
- Requiring schools to deliver skills-based mental health and resilience training.
- Creating a $10m contestable fund to increase access to psychological first aid training.
National’s mental health spokesman Matt Doocey, who is part of the new cross-party mental health and addictions wellbeing group, said mental health should be a bipartisan issue.
“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.”
Doocey said while services and communities weren’t currently prepared to cope with the growing demand, he was optimistic about the future.
“If politics is about timing. I think the timing for mental health has come.”
ACT has the most radical mental health and addiction proposal.
It would take the newly created Mental Health and Wellbeing Commission, rename it Mental Health and Addiction New Zealand (MHANZ), and give the agency the nearly $2 billion annual spend on mental health and addiction currently provided through the ministry and DHBs.
MHANZ would not provide services itself, instead it would act as a commissioning agency, contracting providers and helping assess individual’s needs.
ACT’s deputy leader and mental health spokesperson Brooke van Velden said there had not been enough progress in the past three years.
“We’ve been sold headlines.”
She believed ACT’s approach would resolve the postcode lottery issue, provide greater choice, and level the playing field between DHBs and other providers. (She did accept DHBs would likely continue to provide some services.)
“It doesn’t matter where I go in New Zealand, no one I’ve met has been happy with the mental health care that they’re receiving.”
It would be more like ACC than the existing model, van Velden said, as funding would be attached to individuals, who could choose their own providers.
And she dismissed the idea that changing the system would be too disruptive, saying “to push it back and just say that it’s too hard means that we’re failing New Zealanders”.
“It doesn’t matter where I go in New Zealand, no one I’ve met has been happy with the mental health care that they’re receiving. And there seems to be huge discrepancies from where you live in the country.”
The Green Party
The Green Party won’t be announcing any new money for mental health, this election.
The Green Party’s policy talks focuses on addressing the determinants of mental ill health:
- Expanding free counselling to everyone under 25, and working towards extending this to all adults.
- Champion recognition of mental health as a community and country-wide responsibility, instead of placing the burden on people experiencing issues.
- Fund inpatient and community mental health services at all levels.
- Improving postnatal mental health services.
- Funding innovative initiatives that indicate high recovery rates with minimal medication.
- Working through the cross-parliamentary group, to further destigmatise mental ill health, and build consensus on policy solutions.
The party is expected to promote its full policy on October 10, to mark World Mental Health Day.
Where to get help:
1737, Need to talk? Free call or text 1737 any time for support from a trained counsellor
Lifeline – 0800 543 354 or (09) 5222 999 within Auckland
Samaritans – 0800 726 666
Suicide Crisis Helpline – 0508 828 865 (0508 TAUTOKO)
thelowdown.co.nz – or email email@example.com or free text 5626
Anxiety New Zealand – 0800 ANXIETY (0800 269 4389)
Supporting Families in Mental Illness – 0800 732 825