One good way to improve mental health
Re-establishing the Mental Health Commission will give a much-needed lifeline to New Zealand’s seriously overstretched mental health care sector. Once it is in place, the Government would do well to run it on the model tried and tested by the old commission, with good strong leadership and committed financial support. If this happens, I am confident that the present failings inside this sector will be remedied.
It was at a time of serious need in mental health that the first commission was set up, as a short-term body, in 1996. We were still in the wake of de-institutionalisation from the old-style psychiatric hospitals and the country had been dogged by mental health inquiries – probably 40 or more in the decades leading up to the commission.
Then we had the Mason Inquiry which was run by Judge Ken Mason. He conducted an overall inquiry into mental health and the Mental Health Commission was set up as a result. After it was set up there just weren’t any more inquiries because there was now a mechanism for looking at what was happening in mental health services from an independent body that reported directly to the Minister of Health, and worked directly with the Ministry of Health on service improvements.
To summarise some of the commission’s achievements: it established a blueprint for mental health services which focused on recovery and took into account the needs of all service users, including specific needs of Māori and Pasifika, and of the families of people with mental illness; it monitored services and funding ring-fenced by the government; it extended existing services and oversaw development of new community and non-government services.
It really was a success story.
And that brings us to where we are today. Sadly, we seem to have returned to a situation where we have a mental health service plagued with complaints. People often cannot access services in a timely way or access quality services at all, and for some this has meant things have gone badly wrong. Last year there was a People’s Mental Health Report carried out by ActionStation, a crowd-funded campaigning community. This report showed widespread discontent from service users and their families and confirmed mental health staff were overworked and under-resourced.
Although the system has moved on leaps and bounds from more than two decades ago, service provision is failing and so it is time to bring the commission back.
But while there are similarities to the pre-commission days of the 1990s, the situation today is very different. Community services are now very well established, including those provided through a large voluntary sector, and we have many more specialised services that offer support across a really wide spectrum. As well, there has been such a lot of work done to remove the stigma of mental illness that people now want to use the services whereas in the past they were more often compelled to use them.
These changes, and the fact that so much more can be done for people now, have all contributed to demand for services doubling from when I was first involved with the commission. We now have over three percent of New Zealanders accessing mental health services – and more service provision is clearly needed. In a sense, the mental health service of today has been a victim of its own success and that is a very different situation to that of 20 years ago when the service was simply a mess.
So although the system has moved on leaps and bounds from more than two decades ago, service provision is failing and so it is time to bring the commission back. In fact, it is crucial. There are very serious questions that need to be asked about why there is such a hugely increased demand for services; why our youth suicide rate is so high; what is the effect of growing social inequity on mental health? There is a lot of work to be done to find out what exactly is going on, but one factor is very clear – the demand for services is overwhelming. A new commission, dedicated to recovery-oriented mental health services, could sort it out.
A good starting point for this new body would be to produce another blueprint for mental health services alongside, once again, ring-fencing and prioritising spending and keep a close eye on the quality of the services to stop things from slipping and present some hard arguments. This new commission would also need to address a number of additional concerns such as an ageing population which means a steep rise in dementia disorders and the exclusion of mental health care workers in the recent equal pay case. It may also want to look at improving the integration of services dealing with drugs and alcohol and providing seamless support in other areas that affect the lives of service consumers, such as homelessness.
Historically, mental health service improvements have often been cyclical, with too much demand sinking advances in quality. A commission has the opportunity to bed in parameters for mental health services that enable delivery of good and equitable services to those who need them, as well as attending to the bigger picture of how changes in society can impact on the mental health of New Zealanders.
* Dr Hilary Lapsley was research director of the former Mental Health Commission.