The Government will still have much to do after the Budget. Photo / Getty Images
ANALYSIS:
Health Minister Andrew Little on Tuesday announced a "pretty targeted" $100 million Budget package for specialist mental health services that are struggling to cope with rising numbers of people in psychological distress and crippling workforce shortages.
The new investment will be cautiously welcomed by people on the front lines but won't come close to resolving the crisis in the sector – an assessment that is becoming a theme of this Government's record on mental health.
Three years ago, Prime Minister Jacinda Ardern stood before a group of health professionals at a clinic in Māngere, Auckland, to announce her Government's first major policy move in the area.
It was still nine months before the coronavirus outbreak consumed her administration and mental health was top of the Prime Minister's policy agenda. Labour had inherited a "broken" system, it claimed, and Ardern was personally committed to improving it.
After commissioning a national inquiry, He Ara Oranga, that delivered a damning assessment of the state of mental health, Ardern's Government set aside $1.9 billion for mental health in its 2019 Wellbeing Budget.
As the Prime Minister explained to the attendees that day, the centrepiece of that investment was Access and Choice, a new $455 million frontline service intended to provide early intervention for people with mild and moderate mental health difficulties in primary settings.
"This will change lives, I absolutely believe that," Ardern told the group, visibly excited.
Today, though, Labour position on mental health seems much less upbeat.
In recent months, a succession of troubling data points has prompted renewed concern about the state of New Zealand's mental wellbeing and pushed the issue back to the top of the political agenda.
As the Herald has reported, the problems that Labour inherited haven't disappeared. Covid has magnified the crisis, pushing more people into psychological distress and compounding the challenges facing the public services for people with mental illness.
Eager to be seen as "the first government to take mental health seriously", Labour has found itself on the defensive, accused of losing focus on a policy priority and responding to a chorus of critics asking why its $1.9 billion investment hasn't resolved the crisis.
Some of the criticism is unfair.
The money didn't just disappear into a black hole. Talk to people across the sector and you'll hear plenty of nuanced critiques of Access and Choice, but few experts say it's a poor use of money. Early intervention for people with mild conditions is an important gap that needed filling.
Frontline staff in primary care say Access and Care is making a positive difference in the places where it has been rolled out so far.
But even its supporters acknowledge that improving early intervention in primary care could only ever be part of the solution.
In its 2019 Budget, Labour chose to give relatively little money to address the enormous strain on specialist services operated by District Health Boards that are meant to care for people with moderate and severe mental health problems.
These services, which saw about 191,000 people last year, have experienced a sharp rise in demand in recent years but are struggling to cope with the need after years of underinvestment and poor planning.
Last week, a major investigation by the Herald exposed a host of serious challenges preventing thousands of Kiwis getting timely and effective care, based on interviews with dozens of service users, carers, frontline staff, and health officials.
Staff are burning out and leaving, forcing DHBs to ration care and restrict access. Police and emergency departments are inundated by people in crisis. Inpatient facilities are so overcrowded that psychiatrists dread being on call after hours because there are no beds for people who urgently need them.
It was these pressures the Health Minister was seeking to address with Tuesday's announcement.
Speaking at a residential mental health facility run by a charity in Christchurch, Little said the biggest portion of this year's Budget allocation is $27 million for boosting services for adults with serious needs.
No specific initiatives have been approved yet, but the Government anticipates funding a range of providers to deliver community-based services including residential respite facilities run by people with experience of mental illness in partnership with clinicians.
In his remarks at the announcement, the Minister said he envisaged several new facilities that would give people recovering from acute episodes of mental illness who are currently languishing in psychiatric units a safe, supportive place to transition back to life in the community.
As the Herald reported last year, almost a third of inpatient beds are taken up by people who are no longer acutely unwell but haven't been discharged because there aren't enough "step-down" facilities in the community for them to go to.
In a press release accompanying the announcement, however, officials emphasised providing more services for people in crisis. Both are massive problems. A $27 million pot spread over four years will only go so far.
The Government is also setting aside $19 million to boost child and adolescent services, and $10 million for workforce development – two of the biggest problems facing the sector. Another announcement will come later in the week about an increase in funding for treating eating disorders, which is also causing huge concern.
Funding has also been secured in this year's budget to pay for a couple of initiatives that were already in process. Mana Ake, a school-based counselling programme that started in Christchurch, is being rolled out to five other DHBs. Te Ara Oranga, a promising drug treatment initiative, is being extended to the Bay of Plenty.
The Government is expected to provide more detail on the specific plans in the coming days.
People in the sector will, publicly at least, cautiously welcome these announcements. Any new investment is gladly received when you work in a field that has been neglected for decades. But there's a lot of scepticism, too.
Nobody is under the illusion that another $100 million is anywhere near sufficient to rectify the multitude of challenges confronting the sector.
It won't remedy the systemic problems that make services so complicated and confusing to navigate.
There still doesn't seem to be a long-term plan to remedy the crippling shortages of psychiatrists, psychologists and other specialist staff.
And there's growing frustration at the slow rate of change.
Shaun Robinson, chief executive of the Mental Health Foundation, one of the sector's most outspoken advocates, welcomed the announcement but hinted at frustration with the piecemeal approach to reform: "One service there, one clinic there, one pilot somewhere else, without a clear direction and without any goals, any targets, any accountability."
This is not a partisan point. The crisis wasn't created by Labour and it will take years of investment and reform by administrations led by both major parties to remedy.
"We still have plenty to do," Little acknowledged in a recent interview with the Herald. It was true then and will still be true after this week's Budget.
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