Mental health workers will be put in GP clinics as part of a service to treat 325,000 Kiwis every year - but there are warnings the current workforce could need to nearly triple.
The 2019 Budget allocates $1.9 billion of new spending over five years to mental health initiatives, including a new service that Health Minister David Clark promises will help the "missing middle" with mild or moderate needs.
It will place trained mental health workers in doctors' clinics, iwi health providers and other health services. The idea is that a GP can walk with a patient down the corridor to get specialist help.
The service is expected to treat 325,000 people every year by 2023/24, but Clark told the Herald there's no target as to how many GP clinics will have a worker on-site.
"It's our intention that every GP clinic will have access to mental health support for its patients, but not every clinic will require a worker permanently on-site.
"From July next year we expect an average of 81,250 additional people per year will be able to access these free services until it's fully rolled out."
Clark said the mental health workers would be a mix of clinical and allied health workers, likely including psychologists, counsellors, nurses and peer support workers. It's estimated 1600 full-time positions will be needed by the end of the rollout.
Dr Dougal Sutherland, who works in the clinical psychology training programme at Victoria University of Wellington, said the psychology workforce sees about 200,000 people a year, and another 200,000 are seen by counsellors, social workers and other professionals.
That workforce would need to almost triple by 2023 to meet the service targets, he said.
"Three years. It's not long ... I'm unclear how they're going to address that shortage in the workforce."
Professor Harvey White, deputy chairman of the New Zealand Medical Association, said expanding the workforce would be the main hurdle, but the investment was "transformative" and badly needed.
"I think it's all do-able. And GPs would welcome this ... our mental health services are terrible. You phone up, get told to write a referral letter, then they say it's a three-week waiting list or something. This is not at the bottom of the cliff - this is at the top of the cliff or even back from that."
The mental health funding announcement came a day after the Government revealed it would be adopting 38 of the 40 recommendations in the He Ara Oranga report on mental health.
New spending also included $40m over four years on suicide prevention services, and four free counselling sessions for up to 2500 people who have lost a loved one to suicide. Another $197m over four years will go towards the Housing First programme which aims to get the homeless into permanent homes.
National's mental health spokesman, Matt Doocey, said his party was prepared to work with the Government, but "there's a lot not being said", including on where the workforce would come from.
"There is also a key issue around people with mental health issues not accessing GPs in the first place ... Labour campaigned on free GP visits for people with mental health issues, and they haven't actioned that."
Doocey said that when the new Government came to power it cancelled 17 mental health initiatives, and half had since been re-announced: "That has delayed that work by 18 months, which could have made a real difference to people."
The NZ Taxpayers' Union lobby group said given the complexities of mental health it was "foolish for politicians to assume they can fix issues like suicide simply by burning taxpayer cash", and the effectiveness of initiatives had to be tracked.
'Fewer people will get to the crisis stage'
Putting mental health workers in GP clinics is a world-leading step that will provide support at what is the first port of call for many in distress.
That's the view of Tatiana Hotere, who works at mental health not-for-profit Changing Minds and has battled depression and anxiety herself.
"A lot of people can't self-refer. And when you are going through mental distress, for many people your GP is your first port of call," the 44-year-old Aucklander said of the Budget announcement.
"If your GP doesn't know what to do, it is amazing that they will soon have somebody in a clinic that the GP can actually go and take that person to."
A centrepiece of the 2019 Budget is $1.9 billion of new spending for mental health over five years. That includes a new service to place trained mental health workers in doctors' clinics, iwi health providers and other services.
As a teenager and in her early 20s, Hotere had depression and anxiety, as well as suicide ideation. She said getting support and help to people early would create huge savings for society.
"Of course we are going to have a healthier individual, but also a healthier family, a healthier community. So much of the money we have been spending, an incredible amount, is on people when they are really unwell.
"Making looking after your mental health and wellbeing the norm, then fewer people will get to the crisis stage. And that's good for everybody."