After spending 10 months last year as a member of the Mental Health and Addictions Inquiry Panel, it was heartening to see the Government's substantial investment in mental health and addictions in the Wellbeing Budget.
The Government noted the inquiry's findings with the Treasurer stating: "He Ara Oranga (the report of the Inquiry into Mental Health and Addictions) revealed that we need a whole new approach to mental health and addictions in New Zealand … It is time to finally take mental health seriously."
It can be argued that $1.9 billion over the next five years does just that. The Minister of Finance's Budget Speech emphasised the aim of "transforming" our approach over the next five years, by providing universal access to free services that support and maintain mental health and wellbeing.
There will be new frontline services available that will put mental health and addiction workers into doctors' clinics, iwi health providers and other health services, so people have immediate access to trained mental health workers. Who will shape these services and how they will be rolled out is one of the major challenges for the Government. If the wrong choices are made, the potential for real change in some areas could be lost.
The test of whether this budget will be transformational or not will come when we look at who is around the table when funding is being allocated, who determines the shape of the programmes and services and how they will be rolled out.
It is pleasing to see that DHBs have been allocated a total of $213 million of ring-fenced mental health funding to enhance mental health and addiction services; $65m has been tagged for Māori initiatives; and $40m has been allocated for suicide prevention services for those at risk. In the addiction areas, an estimated 5000 people a year will receive early support through primary care for alcohol and drug issues. More than $40m over four years will be provided to improve residential and detox services and $200m has been allocated for mental health and addictions capital investments, to upgrade and build new inpatient facilities, in several places across the country.
While not part of the mental health funding, $197m has been allocated to Housing First to fund 1044 assertive housing support pathways for people who are homeless. Many of these people will have mental health and addiction challenges.
Linked to the priority to promote child wellbeing were a range of initiatives aimed to reduce sexual violence, including specific funding to support Māori initiatives. There has been a substantial injection into Oranga Tamariki, to give better support to children already in care, as well as provide more places for intensive support for children who are at risk of being placed in State care.
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For Māori and Pasifika aspirations, the Government has put an additional $80m into supporting whānau through Whānau Ora programmes, as well as investing another $45m to reduce inequities and support Māori and Pacific health workforces. Within Corrections settings, $98m has been allocated to a new kaupapa-based Corrections pathway. This programme has been co-designed by Whānau Ora, Department of Corrections, Ministry of Social Development and iwi. It is heralded as a system and cultural change for prisons.
There is real potential to provide innovative new services that truly meet the needs of young people, Māori, Pasifika, new settlers, and the Rainbow communities. They need to be co-constructed with the communities that they will be serving. Health has not generally been good at this and primary health care is no exception. We are talking about moving from a medicalised/health focus to one that is firmly based in community and acknowledges the impact of social and contextual determinants.
There have been some specific allocations for alcohol and drug services but the amounts fall short of what is really required to meet the significant number of people who need these services. We are a long way from having an infrastructure that would allow us to truly take a harm minimisation approach and one that responds in a deep and competent way to trauma. There is currently no programme available for people who have lived experience of mental health or addiction challenges to easily access a training pathway that would enable them to move smoothly into the workforce, therefore the workforces to provide these services, and mental health ones, must be developed and supported.
The test of whether this budget will be transformational or not will come when we look at who is around the table when funding is being allocated, who is engaged in determining the shape of the programmes and services that will be funded and how they will be rolled out. If key decisions are centralised and made by people who carry unconscious biases with them the potential for real change could be lost.
A transformation requires those who have had the decision-making power to share it and to do so quickly.
• Dr Barbara Disley, OMNZ, is group chief executive of Emerge Aotearoa and a member of the Mental Health and Addictions Inquiry Panel