Jacinda Ardern entered government promising to transform a 'broken' system. Critics say there's been progress in some areas, but not nearly enough.
When Hannah*, a teenager in West Auckland, was having difficulty dealing with stressful events earlier this year, a counsellor at her school suggested she get in contact with EaseUp, a community service for young people with mental health and addiction problems.
Hannah was sceptical. It felt weird reaching out to strangers about such intimate problems. But when she visited EaseUp's base in Henderson, the staff immediately put her at ease.
"They were so welcoming," she says.
EaseUp, run by Emerge Aotearoa, a large charity that provides therapeutic and social support for people with mental health difficulties, is one of more than 20 community-based early intervention services for young people that have been funded through Labour's $2 billion investment in mental health-related initiatives since 2019.
The service, which has received government funding to expand to 51 staff across Auckland by October next year and five in Waikato, is designed to provide quick interventions for people between 12 and 18 who are having moderate emotional and mental problems, such as anxiety, self-harm, vaping addiction, and stress about social and family situations. Staff say that providing swift, practical assistance will help stop many of these people spiraling into severe distress or mental illness.
According to its founders, EaseUp has been designed to be as open and accessible as possible to a demographic that historically health and social services have struggled to engage. It accepts walk-ins without referrals and is located in Henderson close to public transport and places that its users tend to spend time: shops, Unitec, a public library, a boxing gym, and youth courts. Its staff are mobile, prepared to travel anywhere a young person who needs their help wants to meet them. And its workforce is an even split between clinicians and people with personal experience of mental illness, so they can provide expert care but also relate to what their users are going through.
"A lot of young people need to feel heard," says one of the counsellors. "That's the number one. Just to listen and not to judge."
EaseUp, which opened in 2019, has seen 325 people this year, and staff say the impact the service has made on their wellbeing has been positive.
"We are seeing some good results," says Barbara Disley, chief executive of Emerge and a former head of the Mental Health Foundation and Mental Health Commission. "We're not seeing miracles. We're seeing good, solid results that help people reconnect and being to dela with the issues."
"They've helped me a lot," Hannah says.
'Huge change'
EaseUp is a potential success story in a sector that desperately needs them.
Even before the Covid-19 outbreak, rates of depression, anxiety, self-harm, distress, and other major psychological problems were rising steadily among children and teenagers, putting enormous pressure on families, communities, schools, mental health providers, and other public services. The pandemic has accelerated the trend.
It was partly because of this troubling rise that Prime Minister Jacinda Ardern identified reforming the mental health system as one of her main policy priorities when Labour entered government in 2017.
In 2018, Ardern's administration ordered a wide-ranging inquiry that produced the landmark He Ara Oranga Report, which set out a damning portrayal of a fragmented, confusing, understaffed mental health system that was failing to provide timely and effective care to vast numbers of people who need it. The report recommended a transformation of the sector, including expanded access to services, more investment in promoting wellbeing, measures to prevent suicide, and stricter regulation of alcohol.
• Resources for parents of children with mental health problems
Labour's response to He Ara Oranga came in the 2019 Wellbeing Budget, which allocated $1.9 billion to mental health-related initiatives across health, housing, and corrections. At the heart of the plan was the "Access and Choice" initiative, a $455 million investment in early interventions for people with milder conditions in primary care settings.
The main plank of Access and Choice is the recruitment of support workers in GPs' surgeries, known as health improvement practitioners and health coaches, but also including youth-oriented services such as EaseUp. Ministers and officials say they are targeting a "missing middle" of people with emerging problems because there were few existing services for them and resolving their needs early will eventually reduce demand on specialist mental health services.
Three years after the Wellbeing Budget, Labour says it has made substantial progress in rebuilding the "broken" mental health system it inherited from National. "There's already been huge change and it's making a real difference," Health Minister Andrew Little said in a tweet earlier this year.
Ardern told the Herald in a statement this week that Labour has "made the largest investment in mental health services of any government".
In a sector that was neglected by successive governments for decades, Labour's commitments have been welcomed as an encouraging start.
Services for young people funded under the primary care programme saw 8733 new people in the three months to March, according to data provided to Ardern in a recent briefing. It is difficult to independently assess the effectiveness of the initiatives to date because of limited publicly available data, but anecdotal feedback from people in the sector is cautiously positive.
Disley, who was on the inquiry panel that produced He Ara Oranga, says the early intervention initiatives have "begun to change the landscape a little bit in terms of where you might be able to go for help in a primary healthcare setting in a better way than you might have ten years ago, five years ago".
Encouraging developments in support for young people in the past few years include the establishment of Piki, a psychological treatment service for young adults in Wellington; the primary school mental health programme Mana Ake; and investments in care for Rainbow youth.
There is also a lot of activity happening across that sector that wasn't initiated by the government. A multitude of digital services have emerged to support young people's wellbeing, such as "Whitu", an app developed during the pandemic by researchers at the University of Auckland that a recent study said could provide a "clinically effective and scalable" way to improve resilience.
Across government and society, Disley says, there is "much greater awareness" of the importance of mental health and the value of providing support — and a lot more support available — than when she chaired the Mental Health Commission three decades ago.
"People are getting help earlier for many of the things that once they'd just have continued to suffer in silence," Disley says. "Those things have shifted, and so have the expectations that we should be able to get help a lot earlier.
"We are more humane, we are more aware, there are a greater number of options. Yes, there are growing needs but if you've got a young person and they've got an anxiety disorder or serious depression or eating disorder, you do know that you can get some help. You might not be able to get it exactly when you want it, but I think the options are a lot broader for accessing some support at some point than they were."
"Am I optimistic?" she says. "Yep. I think we do better. As a community, we recognise each other's pain a bit more."
'Piecemeal policymaking'
Not everyone in the sector is so upbeat.
The counterview is that Labour's investments and policies, while an encouraging start, have not been nearly enough to plug the holes in a system that was badly depleted by years of underinvestment and poor planning by successive governments. The reform has barely started. So much more needs to be done — and Covid-19 has only made the need more pressing.
Critics say the government is moving too slowly to implement its early intervention initiatives, while not doing enough work to promote resilience and wellbeing in young people or to improve acute care for those with the most serious conditions.
National's mental health spokesperson, Matt Doocey, says the flagship $455 million Access and Choice programme is delivering only "two sessions, per counsellor, per day", and has indicated that National will rethink the programme if it gets back into government.
While there are promising initiatives across the sector, they are still in their early stages and only available in some places. They are slow to develop, hampered by severe recruitment challenges, and it is uncertain whether there will be funding provided to expand them.
Piki, for example, has been an "overall success", according to an evaluation by the University of Otago, and could be replicated in other places, but has so far only been funded to operate in Wellington.
Mana Ake, a mental health service for primary schools that started in Christchurch in response to the earthquakes, is being extended to five other regions, but a rollout to the rest of the country is "pending the availability of ongoing funding", according to officials at the Ministry of Education.
Three years into the reforms, critics say, many of the sector's biggest and most pressing problems have yet to be addressed. A series of well-meaning vision documents haven't yet translated into a detailed national plan to rectify the systemic problems plaguing the sector. Services remain disjointed, inconsistent, and hard to navigate.
Workforce shortages across the sector have worsened during the pandemic but policies announced by the government to address these gaps — probably the biggest obstacle to their ambitions succeeding — have so far not shown there is a comprehensive long-term plan to train, recruit, and retain the skilled and experienced professionals that the sector desperately needs, critics say.
In August, Philip Grady, head of mental health at Te Whatu Ora/Health New Zealand, said in an interview that such plans are being formulated as a priority in the new health set-up. The Herald can reveal that Grady is leaving Te Whatu Ora after three months in the role for a bigger job at Oranga Tamariki and has not yet been replaced.
"If you were being sympathetic, you'd say it takes time," says Theresa Fleming, an associate professor in population health at Victoria University of Wellington. "You can't suddenly go from there being zero workforce to there being dozens of people everywhere."
"But it's so ad hoc," she says. "It's just this piecemeal policymaking that fails to bring it all together in a comprehensive, strong way."
There is particular frustration among those who work in specialist public services that treat people with the most serious conditions.
Despite surging numbers of young people with life-altering conditions such as depression, anxiety, and eating disorders, and alarming numbers of children and teenagers presenting to hospital departments in crisis, there has been relatively little investment in bolstering those services.
"All indications are that specialist [mental health services] are not coping with the bow wave of demand," Rees Tapsell, director of mental health clinical services at the Waikato district health board wrote last year in a submission to the Ministry of Health obtained by the Herald. "Inpatient occupancy levels are regularly above 100 per cent (leading to overly coercive, risk averse practices and precipitous discharges to make room for the next admission), crisis services are over-burdened and often unable to respond in a timely fashion, community mental health caseloads are already unmanageable."
Tapsell criticised the lack of national planning and said senior clinicians, managers and community leaders felt "let out of discussions and the future planning of [mental health services], something that would not happen with any other area of health services (eg cancer care)".
In recent months, a series of alarming developments have made the growing problems in specialist services impossible to ignore and Labour's claims of making material progress harder to sustain.
Instead of getting credit for the investments it has made, a narrative has taken hold in some quarters — pushed by a National party that doesn't itself have a good track record in this area — that this government has spent heavily on mental health without achieving anything.
"Where has the $1.9 billion promised in 2019 gone?" says one Auckland mother whose teenager daughter missed two years of school because of mental illness.
"Where has Jacinda's $1.9 billion gone on mental health?" says a businessman who works in the mental health sector.
"$1.9 billion and nothing to show for it," says a GP.
The situation could get worse. The challenges across the sector are complicated and entrenched and will take decades of sustained investment and attention to resolve. In the meantime, the pressures impacting young people's wellbeing are increasing.
"Our emotions are not detached from our world," Fleming says. Economic and social problems have been compounded by the pandemic. The world is increasingly volatile and stressful. The future for our young people is highly uncertain.
Fleming believes the system can be improved. There is an "extraordinary willingness" across government and society — including among young people themselves — to make it better, she says. But we need to move faster.
"We need leadership, we need strong, clear voices," she says. "We need vision. We need prevention. We need skills. We need ways of supporting families. We need the emergency services and police to be well supported. We need all of those things. I actually think if we can get the right people around the table and the right leadership, I think it's possible to tackle this."
*name changed to protect privacy
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 is publishing 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.
For counselling and support
Lifeline: Call 0800 543 354 or text 4357 (HELP)
Suicide Crisis Helpline: Call 0508 828 865 (0508 TAUTOKO)
Need to talk? Call or text 1737
Depression helpline: Call 0800 111 757 or text 4202
For children and young people
Youthline: Call 0800 376 633 or text 234
What's Up: Call 0800 942 8787 (11am to 11pm) or webchat (11am to 10.30pm)
For help with specific issues
Alcohol and Drug Helpline: Call 0800 787 797
Anxiety Helpline: Call 0800 269 4389 (0800 ANXIETY)
OutLine: Call 0800 688 5463 (0800 OUTLINE) (6pm-9pm)
Safe to talk (sexual harm): Call 0800 044 334 or text 4334
All services are free and available 24/7 unless otherwise specified.
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.