Bottom line for mental health services

"This scenario is about the selling off, chunk by chunk, of a public asset that's taken decades of New Zealand taxpayer graft to build." Illustration / Getty Images

The most vulnerable are likely to suffer with the introduction of ‘social bonds’ for the private sector.

In the United States, about $2 billion each year is shaved off community mental healthcare funding and funnelled straight into the pockets of the private sector, one way or another.

That's the model New Zealand wants to emulate, as revealed this week with a tiny taster in the shape of "social bonds" for mental health services. It's the shape of things to come, as private companies continue to lobby for unfettered access to public monies earmarked for health, education, prisons, and so forth.

In the US, acute mental health care is a costly business, but it's harder to access when private providers have to chase revenue streams. Consequently, the number of beds available for psychiatric treatment reduces by thousands annually. And at the same time prisons and homeless populations swell. Those with the most acute mental health issues simply cycle through emergency rooms, homeless shelters, jails and police cells, sometimes ending their personal circle of hell in the morgue.

Nothing has stopped the privatisation freight train for mental health (or any health) services in the US, not even dire "performance indicators". In North Carolina, according to the state's Child Mental Health Network, highly trained mental health care workers have left the field as private providers took control, decimating the professional public-sector workforce. Service quality suffered as private providers "cherry-picked" the least difficult patients and focused on the most profitable services, including that which could be performed by low-paid, unlicensed workers.

Most critically, North Carolina wasted at least $400 million in privately provided services that were unnecessary for the client - or not even performed.

Meanwhile, in Britain cuts to the National Health Service (NHS) have hit mental health particularly hard (some patients are discharged into B&Bs to free up acute beds). Moves to slash NHS mental health services have gone hand in hand with the privatisation of these services, with companies such as Virgin Care (owned by Richard Branson), Serco (a multi-billion dollar concern that also runs some New Zealand prisons) and others lining up for lucrative contracts, despite little experience in acute mental health management.

The countries that have followed this path are what we are supposed to aspire to, despite variable outcomes (to put it kindly).

Certainly we've adopted the lingo of "care pathways" and "payment by results", with funding (or "support") only needed until "normality" or "recovery" is reached - at which point patients are pushed through the process of "re-ablement" - getting off benefits and into work - which is what it's all about.

It doesn't seem at all to be about life-long treatment or, at least, management of often debilitating mental health issues. They're too expensive. Especially when there are dividend payments to make.

Despite the rosy language about compassion, and caring for the most vulnerable, this scenario is about the selling off, chunk by chunk, of a public asset that's taken decades of New Zealand taxpayer graft to build, and follows a well-worn roll-out. It starts with the underfunding of existing services, which leads to the perception the Government is "incapable" of running said service, leaving the way clear for private operators to swoop in and extract profits.

If only the Government would be honest about its true agenda for social services. Take for instance Dr Jonathan Coleman, telling us that social bonds are not about profit, "and there's no sense the Government's making a profit". In fact, the complaint is about the private sector making a profit from years of taxpayer investment and expenditure, Dr C. - but nice straw man anyhow.

Bill English, supposedly the most compassionate Cabinet member God ever put a skin around, has said "social bonds" would become "another tool in the Government's investment approach, which aim[s] to improve the lives and prospects of the most vulnerable New Zealanders". So far, the most vulnerable New Zealanders have had their state houses sold to property investors, their Relationships and Rape Crisis lines and other support services slashed and now their mental health services shuffled off to heartless multi-nationals. If that's compassion, I'd hate to think what contempt looked like.