According to Mental Health and Wellness Commission statistics, one in ten New Zealanders made use of the website www.depression.org.nz in 2020/21. At the same time, just over 191,000 people (3.7% of the population) accessed mental health services directly and 9,392 were admitted to acute inpatient care. Our annual suicide rate rose to just over 600 cases, with our youth suicide rate remaining one of the highest amongst the world’s developed nations.
By any measure, these statistics portray a serious mental health crisis in New Zealand. While differences in the way statistics are collected makes direct comparison with earlier years difficult, it is a more than reasonable assumption that the overall position has been getting worse over the last twenty years or so. The Mental Health and Wellness Commission reports that the percentage of young people seeking mental health services help has risen by a third since 2016.
Following its Mental Health Inquiry in 2018 the government allocated $1.9 billion in the 2019 Budget to dramatically improve the delivery of mental health services. The announcement was widely acclaimed at the time and long overdue. In August last year the Minister of Health was proclaiming “This government is transforming Aotearoa - New Zealand’s approach to mental wellbeing with greater focus on care in the community, and more emphasis on prevention and early intervention.”
However, in its report this week, the Mental Health and Wellness Commission has painted a somewhat different picture about the $1.9 billion new spending. Its conclusion that “improvements in services have not materialised as we had hoped for over this time” was simply damning. Even the Minister now concedes the Ministry of Health has “struggled to achieve as much as we would have liked them to,” on mental health, a far cry from his bold rhetoric of just seven months ago.
The 191,000 people who accessed mental health services directly last year are but the tip of the iceberg. When family, friends and workmates associated with them are taken into account, the real figure is probably four, maybe five, times higher. It could well that around at least 10% of our population are affected directly or otherwise by mental health issues.
It is likely to get worse before it gets better. I recall as a Health Minister being advised by mental health officials after the Christchurch earthquakes that typically the mental health crises following traumatic events can take up to four years to surface in the community. In the aftermath of an immediate crisis people are too busy getting their own lives back in order, they told me, it is only after time has settled that the mental health impacts become apparent. On that basis, the full impact of the social and economic impacts of the pandemic on the mental health of New Zealanders may yet be two to three years away, further highlighting the desperate need to improve services in the meantime.
The point which the Minister made in his too gung-ho statement last August about the need to “focus on care in the community” is correct. But the problem is care in the community cannot be delivered by a centralised agency like the Ministry of Health, or even district health boards. The service base needs to be broadened dramatically, so it can be delivered in a way that is non-threatening to patients, without the cold walls of bureaucracy around it. That should go without saying in a country as culturally, ethnically and gender diverse as New Zealand, but it still seems the point is not getting through.
When I was the Minister responsible for mental health, about a decade ago, I was stunned to find that, the prevailing view at the time notwithstanding, there was no shortage of mental health resources in the community. On the contrary, there were literally hundreds of agencies, big and small, up and down the country serving the mental health needs of local communities. Some were better than others, some were more well-meaning than they were well-informed, but there was no doubt about their dedication to meeting the mental health needs of their communities.
The problem was then, and I suspect remains the case today, that access to funding for the improvement of service delivery and better training for mental health workers was strictly controlled by autonomous district health boards, who were legally not subject to Ministerial direction, and the Ministry of Health. Their joint attitude was that if a service could not be provided by a district health board it was probably not required or worth providing at all. So, many of these community health agencies have therefore been left largely to their own devices, over the years, while district health boards either tried to replicate what they were doing, or just ignored them altogether. Many patients almost certainly fell through the cracks because of that.
The fact that $1.9 billion of funding allocated to the Ministry of Health almost three years ago has led to no improvements in services will come as no surprise to anyone working diligently in the field, but it is a scandal of serious proportions, raising many questions. What has the money been spent on so far, or is it just still sitting there? Where was the plan for its utilisation at the time the original Budget bid was made, and how was that to be monitored? The impression is left there was no plan, let alone any monitoring, and it was all just left to struggling officials who have achieved very little.
Mental health consumers will be both furious and frustrated that the promise of so much has led to so little. At the very least, there needs to be an urgent inquiry, by the Auditor-General maybe, into what has happened.
The almost 200,000 New Zealanders accessing mental health services each
year, and those close to them, deserve so much better.