This includes a new frontline service for mental health, with a NZ$455 million programme and a goal of reaching 325,000 people by 2024. The package also includes a NZ$40 million boost to suicide prevention services and extra nurses in schools to reach 5,600 more secondary students.
Other initiatives are to strengthen existing services and to re-establish a Mental Health and Wellbeing Commission. The government has also shown a willingness to tackle social determinants of mental health, including poverty and homelessness. Together these initiatives are a bold step forward, although questions remain about whether the goals are achievable in a short timeframe.
Going backwards to go forwards
The resurrection of the Mental Health and Wellbeing Commission represents a step back in time for the mental health sector. While the return of the commission to provide leadership and accountability for the sector is welcomed, the fact that it is needed shows just how far the sector hasn’t come and that district health boards have largely failed to address the mental health needs of most New Zealanders.
The commission will need to lead the development of new models of delivering mental health services to release these from the grip of district health boards, which are focused on helping those people with acute and severe issues while at the same time trying to endlessly save money. Mental health services must be integrated into primary health care and moved closer to communities that need them.
We need a holistic approach to health rather than the current mind/body split that treats mental health as a leperous outsider. Today’s budget recognised this need, with the announcement of a new universal frontline mental health service linked to GPs and iwi (tribal) providers.
But with the government boldly aiming to reach 325,000 New Zealanders within three to four years, who will staff this service? Current estimates are that the psychology workforce sees about 200,000 people per year and another 200,000 are being seen by counsellors or social workers. In order to meet the government’s target, this workforce would need to be doubled by 2023. The budget provides no details on how this will happen. Instead we are told we need to wait till later in the year.
Yesterday, the government also accepted most of the recommendations made by the recent Inquiry into Mental Health and Addiction. The inquiry repeatedly called for an increase in talking therapies. They are ideal for people with mild to moderate mental health issues and psychologists are experts in developing and delivering them.
But current Ministry of Education funding rates for clinical psychology training are so low that courses typically run at a loss. Clinical psychology training is funded at substantially lower rates than all other health disciplines including medicine, dentistry, dietetics and even acupuncture and osteopathy. The government cannot claim to take the mental health inquiry’s recommendations seriously, nor is it likely to achieve its ambitious 2023 goal, without stumping up the cash for training.
The government must also think about how to fundamentally reshape the delivery of mental health services. Even if the current psychology workforce were doubled overnight it would still not reach all who need access to services. Innovative initiatives will need to be considered, including e-therapies and prevention programmes targeted at children and teens.
In this regard the expansion of nurses into secondary schools for a further 5,600 students is a good start but unlikely to be enough. It may be that the soon to be re-established mental health commission will be given the task of considering how to expand services outside the current one-to-one intensive, in-person model.
Shot in the arm for existing services
The well-being budget has allocated $200 million for existing mental health services. Anybody who has worked in or used current services will know that they are frequently placed in less-than-fit-for-purpose facilities hidden away in the back-blocks of hospital grounds. The budget announcement will go some way to addressing this inequity of treatment.
It remains to be seen whether the government’s response to the mental health inquiry will go deep enough to fundamentally alter how mental health services are delivered in the public sector. Urgent change is needed in how mental health services in the public sector are managed and delivered in order to stop the exodus of psychologists from district health boards which, in some areas, is reaching epidemic proportions.
The 2019 budget was labelled the “well-being budget”. From a mental health perspective, this involves thinking more widely than just providing individuals with treatment. It also needs to address societal factors that influence mental health, such as poverty and homelessness. The government seems keen to address these broader issues with plans to reduce child poverty, increase benefit levels, and tackle homelessness. If successful, then today’s budget may yet live up to its name.
Authors: Dougal Sutherland, Clinical Psychologist, Victoria University of Wellington