Health Minister Andrew Little will today announce a new initiative to "get more boots on the ground" in public mental health services that are struggling to cope with a rising tide of psychological distress, the Herald can reveal.
In one of several "innovative" measures being pursued by the Government to alleviate a staffing crisis in the sector, hundreds of counsellors who provide talk therapies in settings such as schools, workplaces, helplines and private clinics will be able for the first time to work in clinical roles in public mental health services.
According to ministerial briefings obtained by the Herald, health officials have told Little the "right-touch" regulatory change could "open up a large workforce" that will ease strain on publicly funded mental health services that are facing critical shortages of psychiatrists, psychologists, nurses and other skilled staff.
In one briefing in March, officials told the minister "there is no silver bullet" to rectifying the workforce crisis – which has been years in the making and was amplified by Covid-19 – and "ongoing and sustained effort and investment" will be needed.
Several "innovative solutions" including the counselling initiative are under consideration, the officials said, in what they hope will be a "demonstration case or early prototype" for workforce development in the new national health structure under Te Whatu Ora/Health New Zealand.
"Even with these initiatives, it will be difficult to grow sufficient workforce, quickly enough, to fill the current gaps," the briefing said.
Little's announcement comes amid growing dissatisfaction among the frontline clinicians who treat people with the most serious mental health conditions.
In recent months, a Herald investigation has exposed how Covid-19 magnified an already grave staffing situation, forcing DHBs to increase thresholds for admission and to ration the care they provide. Across the country, people facing life-altering mental health conditions are facing long waits for treatment, getting substandard care, or missing out entirely.
Many staff are fatigued and demoralised and some have opted to leave for better-paid and less-stressful jobs elsewhere. Health authorities have struggled to replace those who have left.
On Thursday, the Herald reported a call by the Royal Australian and New Zealand College of Psychiatrists for urgent investment to increase the number of frontline doctors to treat children and teenagers with serious mental illnesses.
In a new development, it can also be revealed that another branch of the mental health workforce – psychologists – are preparing for a showdown with the Government over concerns that their working conditions have "gone from bad to worse".
Apex, the union that represents psychologists in the public sector, has written to its members recommending a new approach to negotiating with the government after three years of strikes failed to address the shortages.
Psychologists, who deliver evidence-based talk therapies for complex mental health conditions, are a crucial component of specialist mental health services but, like psychiatrists, they are in short supply. Training a clinical psychologist takes at least six years and the pathway to employment in the public sector is complicated.
Historically, DHBs have filled gaps by recruiting overseas but this has become increasingly hard during the pandemic. The Government has committed to developing more in New Zealand, but in the past three years the number of training positions available in DHBs has increased from 12 to only 28.
Apex told members it will push for a collective agreement governing psychologists across all public services to eliminate pay disparities and increase their collective bargaining leverage. That would push up starting pay for psychologists in mental health services from $77,478 to $100,000, in line with their counterparts at Oranga Tamariki. The union also wants an overhaul of the training system to produce more homegrown recruits.
Health officials say they understand the strain on mental health services and are pursuing numerous options in the short- and long-term to expand the workforce. Developments in the past few years have included the recruitment of about 990 mental health-related staff in primary care settings and the entry of about 710 newly trained nurses to specialist roles.
The Ministry of Health has been in talks for months with the New Zealand Association of Counsellors about a new "accreditation pathway" that will allow around 3000 counsellors to apply to work in mental health services if they meet criteria such as holding a degree in counselling and completing at least 300 hours of practice.
At present, the counselling workforce is self-regulated and practitioners can vary widely in qualifications and experience. While many are skilled and reputable, there are no entry requirements and practitioners do not have to be registered or undergo continuing professional development.
Those who are accredited could work in a variety of frontline roles in mental health, Little says. "They could join a therapeutic multidisciplinary mental health team in a specialist hospital environment which could free up other specialists, such as psychologists and psychiatrists, to focus on the most acute cases and presentations."
Correction: An earlier version of this article said there have been about 240 newly trained nurses entering specialist roles. Te Whatu Ora has since clarified that 710 nurses have gone through the new entry to specialist practice programme in the past few years. The 240 figure refers to those funded by money set aside for workforce development in the 2019 Budget.
Help us investigate
This story is part of a series examining the state of mental health services and how to improve them. We need your help to continue our reporting.
If you have experience of child and adolescent mental health services, as a patient, caregiver or staff, and have information that would help us understand the pressures on services, please contact investigations editor Alex Spence at firstname.lastname@example.org. We will not publish your name or identify you as a source unless you want us to.
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
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For help with specific issues
Alcohol and Drug Helpline: Call 0800 787 797
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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.