New Zealand's 'Once-in-a-Generation' Chance to Fix its Mental Health Services

For a lot of people who have dealt with New Zealand’s mental health system, it being labelled as “outdated and inadequate” will hardly come as a surprise. The new Government report, titled ‘He Ara Oranga’, reveals just how far our country’s mental health system falls short and what needs to change.

In January, Health Minister David Clark announced the launch of a Mental Health and Addiction Inquiry that would hear the voices of New Zealanders being treated by, or working in, a system in crisis. Today, the Government released this report in full, less than a week after receiving it.

The report aims to point the country in a new direction in how we deal with mental health and addiction, one that puts people first, not politics. It estimates the annual cost of serious mental illness and addiction in Aotearoa is $12 billion, and states that those who live with severe mental health or addiction challenges have a life expectancy of 25 years less than average.

In a statement, Clark said the inquiry was a “once-in-a-generation opportunity to rethink how we handle some of the biggest challenges we face as a country… It is clear we need to do more to support people as they deal with these issues.”

“The Inquiry heard many stories of people who did not get the help they needed and deserved. We must listen to these voices of people with lived experience,” said Clark.

And it could not have come soon enough. This year, more New Zealanders took their own life than in any other recorded year. Young New Zealanders are waiting longer than two months to see support services, and our biggest helpline is missing one in four calls.

Here are some of the key recommendations the inquiry has suggested to rescue a system at breaking point.

The report acknowledges that the criminalisation of drugs has failed to decrease drug use and its harmful effects. In fact, it argues, it has contributed to social issues like prison overcrowding, unemployment, family separations and gang involvement in the drug trade.

Instead, the inquiry advocates for drug-law reform that will shift the focus and resources onto the health and social impacts of drug use. Possible transformative recommendations include removing prison sentences for low-level drug dealing, repealing and replacing the Misuse of Drugs Act 1975 with legislature that has a health-based approach, and introducing mandatory cautionary schemes for personal drug use and possession.

Alcohol is cheap, normalised and everywhere—and all of this ties into why one in three Kiwis are drinking to hazardous levels their entire lives. New Zealand’s harmful drinking culture was a key focus and the inquiry insists more action needs to be taken.

The recommendations include increasing the price of alcohol through tax increases, and regulating alcohol advertising and sponsorship—especially promotions that encourage us to buy more alcohol. It also proposes increasing the purchasing age limit from 18 to 20 and reducing the hours licensed premises are allowed to open.

Professor of Psychiatry and Addiction Medicine at University of Otago Doug Sellman welcomes a bolder approach to alcohol reform—a move, he says, the last three Governments have virtually ignored. “This is arguably the easiest and most effective intervention the government could enact in order to improve the well-being of New Zealanders… He Ara Oranga recommends the present government finally takes action on these matters.”

This year, the coroner revealed that 668 people died by suspected suicide between July 2017 and June 2018. This marked a 10 percent increase on the previous year’s total and was the fourth year in a row the number had increased. “Every year, an estimated 150,000 people think about taking their own life, 50,000 make a suicide plan and 20,000 attempt to take their own life,” the report reads.

The inquiry suggests an urgent national suicide prevention strategy, to be supported by more resources for suicide prevention and postvention. It recommends establishing a suicide prevention office to provide stronger leadership, and to set a suicide reduction target of 20 percent by 2030.

Because New Zealand’s mental health services are so stretched, there has been a deliberate focus on providing help for those most at risk first—this is at least three percent of the population in a given year. But this has left those who are less severe, but still significantly distressed, without much help beyond a packet of pills.

The inquiry suggests a drastic increase in publicly funded services for people with mild to severe needs. The inquiry insists a new access target must be set, supported by a wider range of therapies, talk therapies, alcohol and other drug services, and culturally aligned services in particular.

The report described the Mental Health Act 1992 as “out of date” and “inadequate” and stressed a vital need for reform. The inquiry recommends replacing the act with one that reflects a human-rights-based approach, falls in line with modern and international models for mental health treatment and reduces the use of compulsion, seclusion and restraint, especially among Māori and Pasifika.

A common theme among the voices in the inquiry revealed there was a lack of trust and confidence in leadership in the mental health and addiction sector. The report suggests establishing a new Mental Health and Wellbeing Commission to act as a watchdog to hold decision-makers to account, provide leadership and publicly report on progress.

Professor Sunny Collings, consultant psychiatrist and director of Suicide and Mental Health Research Group at the University of Otago, says the report's single most important theme is leadership. “Mental health and suicide prevention in New Zealand have suffered badly from a lack of coherent leadership with the ability to influence. This has been a major contributor to where we now find ourselves.”

“Mental health is too important to be a political football,” the report reads. It suggests establishing a cross-party working group that would enable politicians to collaborate and strive towards a shared plan for mental health care, without politics slowing things down.