Mental health gets long-overdue cash injection
Mental health has been given a long overdue funding injection, following a national inquiry. Laura Walters reports on why this fundamental change in service delivery might just turn the tide on the country’s horrific record on mental health and addiction.
The Government’s plan to change the way the country responds to mental health will take time to flow through into measurable change, but it had to start somewhere.
When the Government announced its response to the national Inquiry into Mental Health and Addictions on the eve of the Budget, those with lived experience and sector experts were not convinced of the transformative change the Prime Minister had promised.
Former mental health commissioner, service user, and member of the Wellbeing Coalition Mary O’Hagan said the devil would be in the detail, others were cautiously optimistic.
Now, the coalition Government can rightly claim it is on the path to meaningful change in an area that’s been plaguing New Zealand for far too long.
Government has pumped a total of $1.9 billion of additional money into the mental health and addiction sector as the showpiece of its inaugural Wellbeing Budget.
On Wednesday, Prime Minister Jacinda Ardern and Health Minister David Clark told New Zealand the coalition has accepted 38 out of 40 of the recommendations of the national Inquiry into Mental Health and Addiction.
Now New Zealand gets to see how those changes will be rolled out across the country.
Early intervention and prevention
A total of $823 million– the biggest chunk of the money – will go into meeting growing demand for services, and creating new services, including ones designed to support what Clark refers to as “the missing middle” (those with mild to moderate mental health issues).
More detail will need to come on the exact design of services, especially those responding to Māori and Pasifika needs, and growing and upskilling the workforce will take significant investment and time.
But there is no doubt this will make an impact on both the growing number of people accessing services for high levels of distress, and the country’s stubbornly high suicide rate.
As it stands, mental health and addiction services are weighted towards those with the highest needs, and demand is increasing for these services.
People with emerging issues, or mild to moderate needs, have largely been left on their own, or have had to wait too long to get help.
Demand for services have grown by 75 percent in the past 10 years and funding has not kept pace. The focus on more money and responsive services at the lower end will serve to intervene before Kiwis are facing highly complex, or life or death situations.
Essentially, this rethink shifts the focus away from simply growing the number of ambulances at the bottom of the cliff.
A total of $455m will go into placing trained mental health workers in every doctors’ clinic, iwi health provider and other health services, to help people easily and immediately access expert help.
"For too long we've treated issues of mental health and addiction only when they become a crisis. That's no longer acceptable – in fact it never was,” Clark said.
The universal frontline service would allow all New Zealanders to access mental health support if, when and how they needed it.
Investing in mental health was also the economically sensible thing to do, he said, adding that serious mental illness could cost up to $12b or 5 percent of annual GDP.
“We have so often heard New Zealanders calling for early intervention and investment in challenging issues to save both money and lives in the long run. This is exactly what this Budget delivers,” Ardern said.
After five years, 325,000 people with mild to moderate mental health and addiction needs are expected to access the new frontline services.
The Government will also continue to ring-fence money within DHBs to meet mental health demands and expand services, to the tune of $213m in operating and $200m in capital expenditure.
Focus on youth
The mental health initiatives focus on those aged under 24, in an effort to intervene early and build resilience.
New Zealand has one of the highest suicide rates in the OECD, with those aged 19-24 worst affected.
The Budget allows for the expansion of school-based health services, to improve the health and wellbeing services in decile 1-4 secondary schools, and start the rollout in decile 5 schools ($19.6m total). The expansion of the nurses in schools programme will reach an extra 5600 students.
There is also $2.2m allocated to promoting positive mental health and wellbeing in primary and intermediate schools.
Other service initiatives include extra money for telehealth and e-health services ($20.8m), a further $8m for those experiencing mental health crisis or at risk of suicide, and extra funding to expand the pregnancy and parenting service ($7m).
In the short-to-medium term, it will be important not to forget middle-aged Kiwis, including men aged 45-55, who have the second highest rate of suicide, and still struggle with the stigma surrounding mental health.
The Ministry of Health is in the final stages of creating a new suicide prevention strategy, and the Government has put aside $40m for suicide prevention services.
This includes tailored Māori and Pacific suicide prevention interventions; enhanced follow-up support; increased access to bereavement counselling; and improvements to information services for whānau and the media.
The Government has refused to adopt the 20 percent suicide reduction target recommended by the inquiry, saying it sends the wrong message, especially to suicide bereaved.
Currently, 50 percent of those who kill themselves have never accessed mental health services, so significant change is needed to respond and fight stigma, to ensure those who do access services do not then slip through the cracks, and that the other 50 percent are able to easily access services when and how they need it.
The Government has also put $8m into re-establishing an independent Mental Health and Wellbeing Commission – something committed to as part of the Labour-NZ First coalition agreement, and also recommended by the inquiry.
Drug and addiction services
Mental health and addiction are inextricably linked, and the coalition has committed to treating addiction as a health issue. Part of that work has already begun with the Misuse of Drugs Amendment Bill currently before select committee.
In order to support that step-change, a further $14m over four years had been put into making it easier for people to access early support through primary care for drug and alcohol issues, along with $44m over four years to improve existing services.
The much-lauded meth pilot in Northland will also continue, with $4m over four years.
More than 90 percent of people in prison have a lifetime diagnosis of a mental health or addiction issue, so a group of four initiatives, aimed at supporting offenders with mental health and addiction issues, has also be created.
Part of the support for prisoners comes in the expansion of alcohol and other drug services, at a cost of $128.3m over four years.
As announced prior to the Budget, part of the mental health priority spending also includes the expansion of the Housing First scheme, which includes $197m in funding over four years for more than 1000 new places.
Job not done yet
This is an ambitious amount of money to inject into mental health and addiction services.
However, it will take time for the spending to lead to meaningful change, as acknowledged by Finance Minister Grant Robertson on Budget Day.
The mental health workforce has faced significant issues in recent years, and it will take years to create a fully skilled workforce that’s able to deliver the level of services needed.
But the Government has taken the first step in correcting the historical underspend in mental health.
In the past, the issue has been used as a political football, but this is set to end with National’s mental health spokesman Matt Doocey committing to working with the coalition on mental health.
Throughout the Budget leak saga, Doocey stayed away from politicising what he knew was the Government’s Wellbeing Budget highlight.
In a statement on Monday, he said $1.9b in mental health investment was needed to address New Zealand’s issues – he obviously knew the numbers and decided to take the high road.
Perhaps the tide truly is turning on mental health.
Budget 2019: Read more
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