Mental health response not transformative... yet

It was supposed to be the biggest announcement of the inaugural Wellbeing Budget. Laura Walters reports on why the Government’s mental health response is not all it’s cracked up to be... yet.

Analysis: For those who have been waiting for changes to mental health services and systems, the inquiry into mental health and addiction was a symbol of hope.

In order to create the best services, the Government wanted to know what it was doing well and where it fell short.

So those with experience of mental health issues and their families waited 18 months while the inquiry was conducted. They shared their stories, their hopes and suggestions, and their struggles.

The $6 million inquiry reported back to the Government in November. Then New Zealand was asked to wait a further six months for the Government’s response.

On Wednesday, among the political firestorm of a Budget leak (and potential hack) and the biggest teacher strike in New Zealand history, the Prime Minister and Health Minister released their response to the first national mental health inquiry since the watershed report by retired judge Ken Mason in 1996.

This was supposed to be the moment where Government delivered its vision. Instead, Jacinda Ardern and David Clark spoke in broad terms about accepting 38 out of 40 recommendations from the inquiry.

Those who wanted details about what the promised new services would look like and the ultimate vision for mental health in New Zealand were again asked to wait.

Mental health was a core issue in the 2017 election, and the current Government committed to setting up the inquiry in its first 100 days in office.

“Nobody’s painted the end picture of the transformation, and I think they need to.”

The issue was also labelled the top priority for the Government’s inaugural Wellbeing Budget, to be delivered on Thursday afternoon.

Wednesday’s response was supposed to be about transformational change, instead Ardern used the high-level phrases like “step-change”, “fundamental change”, “laying the foundations” and “significant shift”.

“Fundamentally New Zealand wants to see a different approach to mental health and addiction in this country,” Ardern said, adding that the Government had accepted that challenge.

Along with this came a promise to significantly increase access to publicly funded mental health and addiction services for people with mild to moderate needs. What Clark referred to as the “missing middle”.

There was also a commitment to increasing choice by broadening the types of services available.

Jacinda Ardern and David Clark have announced their response to the national mental health inquiry in broad terms; for more specific details, kiwis will have to wait. Photo: Lynn Grieveson

Other major changes are already underway or have been signalled, including the re-establishment of a mental health commission, a suicide prevention strategy (without the recommended suicide reduction target), and repealing and replacing the Mental Health (Compulsory Assessment and Treatment) Act 1992 (likely with a new piece of proposed legislation called the Mental Health and Wellbeing Bill).

The re-establishment of an independent mental health commission has long been in the pipeline and was part of the Labour-New Zealand First coalition agreement. It is expected to be established before the end of the year, with Clark receiving advice in June.

The suicide prevention strategy is underway, and in the final stages of consultation.

And a repeal of the Mental Health Act has been a long time coming, considering the pretty horrific human rights breaches under the current act. But that work will also be a long time in the making, with Clark signalling getting new legislation right could potentially take years.

The devil is in the detail

As former Mental Health Commissioner Mary O’Hagan said, “the devil’s in the detail”.

It was hard to assess the level of transformation without knowing how much money would be wrapped around initiatives, what types of services would be created, and who would control what, said O'Hagan, who is a member of the Wellbeing Coalition.

“Nobody’s painted the end picture of the transformation, and I think they need to.”

Would more services amount to more pills and psychotherapy? Or would it be something broader, coupled with addressing social determinants?

Ultimately, there needed to be a whole-of-society response, or services would “just be sandbaggers”, O'Hagan said.

“You have to stem the flow of demand by making this a better pace for people to live in.”

Over the past 10 years, demand for services has increased 75 percent, and funding has not kept pace.

"How will this investment of services keep pace with rising numbers of people who need support? Demand has been steadily increasing year on year, and the specific recommendations the inquiry made to address this and start preventing mental health problems have been kicked for touch – the Government has delayed making a decision on these."

So while the promise of more funding for services, and new and broader services was positive, more detail was needed before the Government claimed transformation, she said.

Mental Health Foundation chief executive Shaun Robinson had a similar take, saying the response was not truly transformative... yet. And would not be until all 38 promises were actioned.

Robinson cautioned that a response so heavily-weighted on service delivery would not create lasting change.

“How will this investment of services keep pace with rising numbers of people who need support? Demand has been steadily increasing year on year, and the specific recommendations the inquiry made to address this and start preventing mental health problems have been kicked for touch – the Government has delayed making a decision on these,” he said.

Public health responses, mental health education and initiatives that built and sustained the wellbeing of individuals, whānau and communities were essential to achieving long-term improvement to the mental health of New Zealanders, he said.

Along with Māori health providers, the Foundation also expressed concern over a lack of detail on culturally appropriate services.

While the Government has agreed in principle to address these things, it has delayed making any definitive announcement or commitments.

One more sleep

So far, those in the sector have articulated cautious optimism, but there is a widespread view that more detail and funding commitments are needed.

Ardern has promised many questions will be answered in the Budget, including clarification of the Government’s specific vision.

The split of the mental health announcement – into general policy on Wednesday and funding on Thursday – makes it difficult to fully assess the response.

This does not mean the Government will not deliver transformational response, but it does mean more waiting for people who have been waiting a long time for a system that is properly designed to support and care for them.

Former Mental Health Commissioner Mary O'Hagan is supportive of the re-establishment of an independent mental health commission, but wider than that says the devil will be in the detail. Photo: Lynn Grieveson

National Party spokesperson for mental health Matt Doocey said he would work with the Government, adding the focus should be on frontline services.

A total of $1.9 billion of new funding over four years was needed for the Government to increase access to the inquiry’s indicative target of 20 percent of the population having access to mental health services over five years.

“Tomorrow’s Budget will show if the Government are taking these targets seriously or whether it will be another underwhelming response to an important issue for so many Kiwis,” he said.

The Budget will need to be big and it will need to be specific in terms of mental health.

Service users, those with lived experience and families have waited too long for more promises of change, without concrete action.

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