In November 2018 the Government Inquiry into Mental Health and Addiction published He Ara Oranga (Pathways to Wellness) – Report of the Government Inquiry into Mental Health and Addiction.
It has been 22 years since the previous national level mental health inquiry in New Zealand. Major differences are noted between these two inquiries, with the current inquiry looking beyond simply the health sector for understanding socio-economic determinants of mental health and addiction (MH&A); broadening the conceptualisation of mental health to acknowledge the place of mental distress on the spectrum; shifting away from the current treatment heavy focus towards more of a prevention and early intervention focus; and recognizing the need for a wider variety of mental health support options that are more easily accessible in terms of both geography and affordability.
A key objective of the inquiry was to provide a platform for the everyday New Zealander, particularly those who have been touched directly or indirectly by MH&A, to voice their opinions. Further aims were to outline the existing prevention and response approach and to recommend changes that give special consideration to equal access and improved outcomes especially for populations with disproportionately poorer outcomes.
The inquiry resulted in a 12 chapter report, commissioned from the University of Otago, spread across 214 pages and divided into two parts: a review of our current MH&A status, and recommendations for the future.
In part two, 40 recommendations are laid out. These recommendations are a direct reflection of feedback received from thousands of New Zealanders who participated in this process to share their views on the current system. The inquiry process itself involved over 2,000 people attending public meetings at 26 locations, over 5,200 submissions made, and over 400 meetings held across the country.
The resounding message was a call for a major paradigm shift when it comes to the classification and treatment of mental health - the system as it is was felt to leave significant gaps which, if not addressed, will lead to ever decreasing mental health in New Zealand.
The current state of MH&A in New Zealand is dire, as demonstrated by the following statistics:
There has been a 73% increase in the number of people accessing MH&A services over the past 10 years
Between 50–80% of New Zealanders will experience mental distress/ addiction challenges during their lifetime
The 2017/18 suicide rate is the highest since 1999 at 668. On average there are 50,000 annual suicide plans made and 20,000 suicide attempts. Our youth suicide rate is among the worst in the OECD.
The cost to the economy is estimated at $12 billion annually.
Clearly, there is a need for reform. Following is a summary of the 12 unique domains captured across the report recommendations (for further information access the report here - chapters for each recommendation are indicated below):
Extending access and choice to the 'missing middle' – the population of people with mental illness or significant mental distress. The current target of specialist services available to the 3% of people with most severe needs should be increased to 20% of the population able to access specialist services. Recommendations (R) 1 - 12, Chapter 4. This domain expresses the growing urgency to develop the psychologist workforce, and to increase access for those with mild to moderate distress (such as those experiencing significant ongoing job stress) to evidence based therapies.
Transformation of primary health care – this includes, for example, training for general practitioners, practice nurses and community health workers. R 13 & 14, Chapter 5.
Strengthening the NGO sector to support the crucial role it plays (including Kaupapa Māori services) and will play with the shift to more community-based MH&A services. R 15, Chapter 6.
Supporting a more coordinated, whole-of-government approach to wellbeing to address social predictors and encourage prevention activities that impact on multiple outcomes, in addition to MH&A. R 16 - 17, Chapter 7.
Establishing a new commission to facilitate mental health promotion and prevention, including an investment and a quality assurance strategy. R 18 & 19, Chapter 7.
Validating and leveraging the lived experiences of Whānau and families of MH&A suffers. There needs to be more consideration for them in both the care and treatment options of family members, as well as support offered for their own continued mental wellbeing. R 20 - 25, Chapter 8.
Taking stronger action on alcohol and other drugs. R 26 - 29, Chapter 9.
Suicide prevention: A national suicide prevention strategy is required with a target of 20% reduction of suicide rates by 2030. Families and whānau of suicide victims need more support, and the processes for investigation of deaths by suicide need to be reviewed. R 30 - 33, Chapter 10.
Reforming the Mental Health Act to be more aligned with the times and reflect better practices. R 34 & 35, Chapter 11.
Establishing a new Mental Health and Wellbeing Commission to act as an independent entity, providing leadership and oversight of mental health and wellbeing in New Zealand. R 36 - 38, Chapter 12.
Refer to the Health and Disability Sector Review: The Health and Disability Sector Review is better placed to consider structural and system issues, including the transformation required in the primary health care sector. R 39, pages 204-206.
Establishing a cross-party working group on mental health that demonstrates a shared commitment across parties to improve mental health and wellbeing in New Zealand. R 40, pages 204-206.
There are so many reasons to care about the state of our MH&A services. The effects of living with a mental health or addiction challenge is devastating to the sufferer and their loved ones. In addition to the negative impact on quality of life, there is an estimated reduction in life expectancy of 25 years for people with severe mental health or addiction challenges. As the report acknowledges, the narrow focus on supporting only the most severe 3% has led to a detrimental decline in the mental wellbeing of our people.
This inquiry could not come too soon. Perhaps most encouraging to us is the call for a mental wellbeing approach where wellbeing, a state of flourishing, is actively promoted, giving a tip of the hat to service workers such as ourselves who recognize the value of equipping people with the mental tools and skill sets to boost their resilience and buffer them against everyday mental health risks. Outcomes are so much better when we focus on prevention and early intervention, a direct contrast to the reactive ambulance at the bottom of the cliff approach.
At The Effect we are excited to see such public commitment to advance the mental wellbeing of our nation, and proud to be a part of the solution.
From the team at The Effect