Mental health inquiry a blueprint for the future

An inquiry into the quality of New Zealand’s mental health and addiction services must set up a long-term blueprint for the troubled sector, experts say.

Prime Minister Jacinda Ardern revealed the terms of reference for the inquiry — a pledge from her government’s 100-day plan — on Tuesday, after Labour and other coalition parties campaigned on addressing the poor state of mental health services during the 2017 election.

Ardern said the quality of mental health services were something she and her Government felt strongly about.

“This is a very personal issue for many many New Zealanders, for those who have experienced mental health issues and the family of those who have experienced mental health issues.”

The suicide rate was “shameful”, while existing mental health services were stretched from high levels of demand, with more than 170,000 Kiwis using mental health and addiction services in 2016/17 — 71 percent higher than a decade earlier.

The inquiry’s terms of reference task it with hearing the voices of the community, reporting on New Zealand’s efforts to prevent mental health and addiction problems, and recommending specific changes to the system, with a focus on equity of access, community confidence in the mental health system, and better outcomes.

Health Minister David Clark said the inquiry would be chaired by Ron Paterson, a law professor at Auckland University who was the Health and Disability Commissioner from 2000 to 2010.

Clark said he would be joined by former Mental Health Foundation director Dr Barbara Disley, Māori health expert Sir Mason Durie, Māori consumer advocate Dean Rangihuna, Pasifika mental health expert Dr Jemaima Tiatia-Seath, and youth development expert Josiah Tualamali’i.

Ardern said the Government had agreed to include addiction services within the inquiry after receiving feedback from those in the sector about the “interlinked issues” between mental illness and addiction.

The inquiry must report back to the Government by the end of October, which Clark said would give ministers time to feed its findings into the Budget process for 2019.

'Vacuum' of leadership

News of the inquiry has been welcomed by many in the sector, although their varying views on the areas of concern offer some indication of the challenge ahead.

Psychotherapist Kyle MacDonald, who worked with Action Station on the crowdsourced People’s Mental Health Review which recommended an “urgent independent inquiry” into New Zealand’s mental health services, said it would help to make sense of existing research and develop a long-term plan for the sector.

“It is true that we have a lot of documents already floating around ... the important thing is that a review allows all of that information to be collated and influence their recommendations.

“It’s the beginning of a process of restructuring and reorienting and setting up hopefully a five- to 10-year plan for how we deliver mental health services in this country.”

“There are people in the system currently that are struggling. It’s not just a matter of accessing help, it’s also the quality of help ... they’re not able to speak up and share their stories.”

MacDonald said there had been a “vacuum” of leadership, while DHBs had also been underfunded and people struggled to get the support they needed.

Mental Health Foundation chief executive Shaun Robinson said the inquiry was “an investment in getting mental health right for New Zealand”, with a focus on prevention and system reform needed on top of providing more specialist services.

“We are encouraged that the inquiry acknowledges the drivers of poor mental health (such as poverty, domestic violence, unemployment, discrimination, racism and homophobia) and the inequalities which currently exist, and want to make sure that addressing these issues forms part of our national response to mental health.”

Corinda Taylor, who founded the Life Matters Suicide Trust after her son Ross committed suicide in 2013, said many in the mental health system felt their concerns weren’t being listened to by professionals.

“There are people in the system currently that are struggling. It’s not just a matter of accessing help, it’s also the quality of help ... they’re not able to speak up and share their stories.”

Royal Commission ruled out

One of Taylor’s concerns was whether a ministerial inquiry would be able to “dig deep enough” into the issues facing the sector; her preference, shared by some others, was for a full Royal Commission of Inquiry.

Clark said the Government had considered a Royal Commission, but wanted to be able to receive the inquiry’s findings more swiftly than that would allow.

The inquiry would have subpoena powers, allowing evidence given anonymously, while it could not be directed by him as minister.

National leader Bill English criticised the decision to launch an inquiry, describing it as “a replacement for action”.

"This inquiry will take most of the year, the recommendations will flow into the 2019 budget so nothing will happen until 2020. I think they're playing for time, just kicking it down the road."

English argued the Government should instead back the 17 “proven” initiatives given $100m in funding by his government last year — a suggestion dismissed by Clark, who said he would support the initiatives which had merit and ditch those which didn’t.

“What [the Mental Health Commission] enables is an independent body outside of the party political process to actually ensure these plans are put in place and enacted."

One change already confirmed by the Government is the re-establishment of the Mental Health Commission, among the commitments made to New Zealand First in its coalition deal with Labour.

The commission was disestablished by the previous government in 2012, with its main functions transferred to the Office of the Health and Disability Commissioner.

All three coalition parties called during the election campaign for a standalone commission to be revived, and Clark said the inquiry would be a way to inform its terms of reference and mandate as an organisation.

“It is is a pledge that we’ve made and that our partners have made, we all want to see it happen but we want to see it given a clear task, and so again with an inquiry that is until the end of October it means we won’t be too far away.”

MacDonald said re-establishing the commission was “incredibly significant”, given the need to ensure the Government was held to account following the inquiry.

“What it enables is an independent body outside of the party political process to actually ensure these plans are put in place and enacted, but it also provides a watchdog function to ensure that even inside the ministry or the political parties, and hopefully that’s where the independence lies.”

Jacinda Ardern and Grant Robertson speak at a mental health rally before the election. Photo by Lynn Grieveson.

Where to get help

Need to talk? Free call or text 1737 any time for support from a trained counsellor.
Lifeline – 0800 543 354 (0800 LIFELINE).
Youthline – 0800 376 633, free text 234 or email talk@youthline.co.nz or online chat.
Samaritans – 0800 726 666.

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