In a major ongoing investigation, the Herald has exposed how a disjointed, underfunded and understaffed public mental health system that was already stretched before Covid-19 has been pushed to the brink by the pandemic.
A tide of mental illness and distress that was already rising steadily for a decade - particularly among children and teenagers - has been amplified by the coronavirus outbreak, overwhelming not only specialist mental health services, but also GPs, schools, charities, police, and hospital emergency departments.
New data from the Ministry of Health reveals there were 5,855 people under the age of 25 seen in emergency departments for a mental health crisis last year, a figure that has increased 140 per cent in ten years.
While there are initiatives under way in some parts of the country to improve crisis response - including embedding mental health clinicians around-the-clock in some EDs and establishing facilities run by people with experience of mental illness that people in distress can go to instead of hospitals - these services are not universally available. Until now, the various DHBs pursued their own policies and none were resourced to keep up with the rising need.
However, Grady said a streamlined structure under Te Whatu Ora will allow the government to expand these intiatives so there's a consistent approach to treating people in crisis across the country.
"I agree with you that, up until now, there hasn't been a coherent view around what we are doing nationally around our crisis response," Grady said. "But there is now the opportunity with Te Whatu Ora around how we scale up those things."
"Essentially, we want to have consistent responses up and down the country. We want to have the right responses, and we want those responses to be as early as possible."
The plans are still at a formative stage. In May, Labour set aside about $27 million in its latest Budget, spread over four years, to develop up to eight community-based crisis services in different parts of the country. Officials are currently examining the need for crisis services in different areas before beginning a selection and procurement process. Those initiatives are expected to be at capacity by the end of the 2025-26 financial year.
Grady and Culver acknowledged complaints from service users, carers, clinicians, DHB managers, and campaigners that the government hasn't done enough to relieve the growing pressure on specialist mental health services that treat people with the most debilitating conditions.
Although Labour made mental health one of its top policy priorities when it returned to power in 2017 and has invested about $2 billion in mental health-related policies, it chose to focus on early intervention for people with mild conditions in primary care settings. While that was a gap that needed addressing, people across the sector say there is an urgent need for more attention and investment in other parts of the system, ranging from prevention programmes to specialist hospital-based services.
Grady and Culver defended the government's flagship $455 million primary care initiative, the "Access and Choice" programme, arguing that they are creating from scratch a much-needed free service that will eventually help to improve the population's wellbeing and reduce the number of people who develop severe problems. But they also said they recognise the frustrations across other parts of the system and are working to address them.
Asked whether $19 million set aside in the latest budget to expand child and adolescent services - which are at "crisis point" across the country - is enough to rectify a long-standing gap in funding relative to adult services and to relieve the pressure they're facing, Culver said: "It's a good start. Would we like more? Absolutely."
Culver said the Ministry is preparing to publish a new system and service framework by October that will detail its vision for mental health services and bring greater clarity and consistency to the sector. Officials are also working on a range of initiatives to expand the mental health workforce, across specialist, primary and peer-led services.
"We absolutely acknowledge there is a lot of concern out there," Culver said. "There's also a lot of really good care that is happening... It is not a hopeless situation."
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.
