Specialist mental health services for children and teenagers treated fewer patients last year than they did in the previous year because of disruption from Covid-19 and severe recruitment challenges, health officials have told Prime Minister Jacinda Ardern.
In private briefings to the prime minister, obtained by the Herald as part of an eight-month investigation into mental health care, the Ministry of Health gave a stark assessment of the ability of child and adolescent mental health services (known as "CAMHS" or "ICAMHS") to cope with a rising tide of psychological problems among young Kiwis.
Officials told Ardern the pandemic has disproportionately impacted young people and that the psychological consequences are "likely to be extensive and enduring". More children and teens are experiencing serious distress, self-harm, eating disorders, and other potentially devastating problems, they said.
But "significant issues" in the public mental health services which treat people with the most serious conditions have worsened during the pandemic, limiting their ability to keep up with the growing need.
"Specialist mental health and addiction services for children and youth have been under pressure for some time," a senior official wrote in May, and "data suggest[s] that the Covid-19 pandemic has increased this pressure since our September 2021 advice."
Data provided to the Prime Minister in that document showed that, across the country, CAMHS saw 49,562 people last year, down from 49,819 in 2020 and 50,207 in 2019.
"This probably reflects the combined pressures of the pandemic and workforce issues, as services have likely balanced accepting new referrals with their ability to provide services," a senior official said.
Ardern told the Herald in an emailed statement she is concerned about the impact Covid-19 has had on the public's mental health, particularly among young people, and added: "I don't want New Zealanders' mental wellbeing to be the price of Covid."
But she stopped short of saying whether Labour is prepared to commit more money to expanding specialist services for the most acutely unwell children.
The Herald obtained four briefings provided to Ardern on the topic in the past year. They reveal that the Prime Minister has on several occasions asked for more information about the performance of youth mental health initiatives and for officials to look at ways to improve the capacity of CAMHS.
In May, she asked the ministry to examine how much it would cost to make funding for children's services equitable with those for adults. Officials calculate that CAMHS get $3600 per patient, compared to $5800 spent per head on adult patients, even though their work can be more intensive than that of their counterparts.
It is not known whether officials have carried out an analysis of the cost of closing the gap after the prime minister's request.
In response to questions about it, Ardern said: "The rate at which mental health services are funded is a contracting decision for Te Whatu Ora/Health New Zealand.
"However, I have queried why there is a disparity between the funding rate for youth and adult services and have been advised that, as the health reforms are finalised, there will be an opportunity in the future to re-look at the current funding formulas with a particular focus on equity and priority groups."
Ardern said Labour has "made the largest investment in mental health services of any Government and are in the middle of rolling out a new universal health service, of which youth is one of four priority streams of work".
Labour made mental health one of its top priorities when it took office in 2017, and it was central to its Wellbeing Budget two years later. It has so far committed around $2 billion to mental health-related initiatives, with a focus on early intervention in primary care for people with milder conditions.
Services for young people funded under that programme – which include the Mana Ake school programme that is available in some regions, and Piki, a psychological therapy initiative for young adults in Wellington – saw 8773 new people in the three months to March, according to data provided to the prime minister.
But while these initiatives have been welcomed in the sector as an encouraging start, critics say they have been slow to roll out, are not universally available, and are not targeted at people with serious, acute conditions who need a lot more treatment and support.
Clinicians and researchers say there has been a startling rise in the number of young people experiencing such acute distress that they become a danger to themselves. According to the ministry's briefings to Ardern, CAMHS services saw 8919 young people in "crisis" last year, a figure that has nearly tripled in a decade.
The number of children and youths seen for mental health problems in emergency departments has increased by more than 400 per cent in that period.
The young people being referred to CAMHS are tending to be more acutely unwell and to have more complex conditions than in the past, which puts them at higher risk of harm and makes them harder to treat, officials said.
One of the most striking trends since the pandemic is a startling increase in the number of teens with eating disorders. Admissions to the specialist eating disorders service at Starship children's hospital in Auckland jumped by 48 per cent in the past two years.
However, decades of underinvestment have left CAMHS badly depleted and unable to handle the increasing demand.
In one analysis, officials said the number of people seen by CAMHS rose by 35 per cent in a decade but funding rose by only 25 per cent. Historic shortages of psychiatrists, psychologists, nurses, and other skilled and experienced staff have become critical, forcing services to raise thresholds for admission and limit the care they provide.
Staff are handling bigger caseloads and burning out. Turnover is high. Vacancies are hard to fill. Families of children with serious mental health problems say it is increasingly hard to get into CAMHS, and those who are accepted can face long waits for treatment.
According to Ministry of Health data presented to the prime minister, only 39 per of CAMHS patients were seen within 48 hours, compared to 63 per cent of patients in adult services. Nearly a third of young people waited more than three weeks for an initial assessment, while only 14 per cent of adults waited that long.
In May, Labour committed an additional $4.7 million a year in its latest budget to CAMHS so the services can see another 1300 people annually by 2026. In a briefing to Health Minister Andrew Little at the time, officials said: "It is important to note that further sustained investment will be required in the future to fully address pressures on specialist mental health and addiction services."
About this series
In April, the Herald and NZME launched a major editorial project, Great Minds, to examine the state of New Zealand's mental health and solutions for improving wellbeing in the aftermath of the Covid-19 pandemic. As part of this, Investigations editor Alex Spence examined the state of services for people with the most urgent and severe problems.
In the past eight months, we spoke to dozens of people at all levels of the system, including service users, their families, clinicians, researchers, and officials; obtained data from more than 25 public bodies; and examined thousands of pages of government and health authority documents, many of which have not previously been made public.
This week, the Herald will publish several stories examining the worsening mental health of our children and young people, the government's policies in this area, and potential actions that could help to resolve the crisis.
Where to get help
If it is an emergency and you or someone else is at risk, call 111.
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Lifeline: Call 0800 543 354 or text 4357 (HELP)
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For more information and support, talk to your local doctor, hauora, community mental health team, or counselling service. The Mental Health Foundation has more helplines and service contacts on its website.