welcomed the Initial Mental Health and Wellbeing Commission’s assessment that transformation of New Zealand’s approach to mental health and addiction is under way.
“This is an important step in the Government’s work to provide better and equitable mental health and wellbeing outcomes for all people in New Zealand after years of underfunding,” Andrew Little said.
His statement didn’t mention how many millions are being devoted to mental health and wellbeing to remedy this under-funding. The report does provide that information and (no surprises here, surely) it makes the case for more money.
The report (again, no surprises because it has become common practice for the state sector) has been published in a bizarre and formidable blend of English and te reo.
More than formidable, it can be almost impenetrable in places:
To assess progress, a Poutama was collaboratively developed. The Poutama outlines five key steps of progress, from Te Kākano (Potential) through to Puāwaitanga (Realisation). The Poutama is designed to reflect the journey towards system transformation, recognising that we are working together – Tu tangata mauri ora, flourishing together. The steps of the Poutama demonstrate that system transformation is a journey and an opportunity for us.
Has nobody figured it would be smarter to publish
- An English-language version of reports such as this for the big majority of the population who don’t speak Te Reo (whose ranks include significant numbers of Maori, by the way); and
- A Te Reo version for the Maori who don’t speak English (how many of them are there?) or who prefer to read reports in Te Reo?
Mā Te Rongo Ake: Through Listening and Hearing, looks at the Government’s progress on implementing recommendations made in He Ara Oranga: Report of the Government Inquiry into Mental Health and Addiction.
He Ara Oranga, by the way, does not mean Report of the Government Inquiry into Mental Health and Addiction. The document published in 2018 says it translates as “pathways to wellness”.
Little’s press statement says the latest report finds that, after only 18 months, progress is visible, particularly for the areas initially prioritised by the Government, despite the transformation of the mental health and addiction sector being significant and needing time.
“The transformation envisioned by He Ara Oranga is bold and extensive and we are making progress. We have invested heavily to enable much-needed and significant shifts to occur,” Andrew Little said.
Point of Order found the report further says:
While there is hope, there is also frustration. When He Ara Oranga was launched, the Government prioritised action and we held firmly to the belief that this was a once in a generation opportunity to transform the mental health and wellbeing system and eliminate inequities.
However, while progress is visible, other areas prioritised in He Ara Oranga have had little progress. There is concern that services for people that need them the most are taking more time to roll out, and that this will lead to increased inequities.
The commitment to transform needs to be put into action. This call to action is backed up through the Mental Health Commissioner’s Monitoring and Advocacy Report of 2020, the Health and Disability System Review, Hauora, Report on Stage One of the Health Services and Outcomes Kaupapa Inquiry, and COVID-19 Kia Kaha, Kia Māia, Kia Ora Aotearoa.
But hey – let the Minister have his moment.
“Mā Te Rongo Ake confirms meaningful change is underway, especially in the priority areas of establishing the Mental Health and Wellbeing Commission, repealing and replacing the Mental Health (Compulsory Assessment and Treatment) Act 1992, expanding access and choice of primary mental health and addiction support, developing a national suicide prevention strategy, and establishing a Suicide Prevention Office.
“Despite the challenges of the global Covid-19 pandemic, progress is continuing to be made with considerable vigour to improve mental health and wellbeing in New Zealand, and we are seeing new services and activities every month.
“The Government has expanded access and choice of primary mental health and addiction supports, built community supports, boosted crisis services, developed initiatives to prevent suicide and support people bereaved by suicide, strengthened specialist alcohol and other drug services, and expanded and enhanced school based health services.
“There are new or enhanced services in every district health board area across New Zealand and thousands of people every month are now accessing services that were previously not available,” Andrew Little said.
Fair to say, further down in the press statement he does acknowledge …
“The Initial Commission has also highlighted areas for improvement. This includes stakeholder frustration that progress is not faster, and a perception of insufficient engagement with priority population groups.”
“I recognise the high expectations for transformation. This transformation will take time, given the historic systemic issues and resource constraints of many years that need to be addressed. But I am heartened by the progress and the difference it has already made to the lives of so many New Zealanders,” Andrew Little said.
The Initial Mental Health and Wellbeing Commission recommended the development of a long-term action plan to clearly articulate the pathway for the transformation of New Zealand’s approach to mental health and addiction.
“We have a plan in place, Kia Kaha, Kia Māia, Kia Ora Aotearoa: the Psychosocial and Mental Wellbeing Recovery Plan (Kia Kaha), which was released by the Ministry of Health last year. Kia Kaha ensures we are on track right now, and work on developing the long-term pathway is underway,” Andrew Little said.
And the cost?
The report says the Government is investing $455 million over four years to expand access to services and choice of services, to enable up to 325,000 people a year (6.5% of the total population) to access new models of primary mental health and addiction care. This has been allocated to service delivery ($339 million), workforce development ($77 million), and enablers ($39 million).
There is a time lag between new services being commissioned and getting up and running in the primary and NGO sector, with full roll-out expected after five years (i.e. by the end of 2023/24).
Budget 2019 invested a further $255 million over four years in specialist, forensic and crisis mental health and addiction initiatives to help alleviate these pressures.
By the end of 30 June 2021, as a result of procurement processes currently under way, the Ministry of Health expects to have committed dedicated investment streams from service delivery funding of up to:
- $13 million per annum ongoing for kaupapa Māori services
- $5.2 million per annum ongoing for Pacific services
- approximately $15 million per annum ongoing for youth-specific services.
Further investment was allocated within Budget 2020 and as a result of the response to COVID-19, with $25 million over four years to build on and accelerate the roll-out of youth-specific primary mental health, wellbeing and addiction initiatives to tertiary students.
But (brace for it) more is needed.
People have told us that expanding access to funded mental health and addiction services has not been consistent, and areas such as addiction services have been overlooked.
Priority groups, such as disabled peoples and Rainbow communities, have said that despite intentions stated by Government to target and include these specific groups, they do not see themselves in the development and delivery of options, and are not confident their voices have been heard.
Veterans have described how poorly served they are by existing mainstream agencies and organisations when they seek help to transition from military life back to everyday life and feel coerced by a culture of silence that takes their stories and agency away from them.
Despite increased Government commitment for support of wider choice in services, the report says changes are small and continue to be under-resourced. Despite funding announcements and funding being delivered on the ground, some people working with communities note that it takes too long for funding announcements to translate into services.
In particular, providers and communities feel like they aren’t consulted or engaged in design or delivery of new approaches and services in ways that are meaningful for them. There is also an expectation for increased investment in culturally specific services as well as to primary care-based services.
For example, some groups who provide the only culturally specific services in their region have not seen any support. Government was asked to contribute to and enable work of kaupapa Māori organisations in accordance with the intent of He Ara Oranga – five of whom have updated us on their views about Government progress.
At Point of Order, our needs are more modest. In the name of accountability, we would simply like to be able to read government reports in the language that pretty well all New Zealanders understand.
Maori readers should be given their Te Reo version unimpeded by English chapters, too.
User-unfriendly linguistic hybrids are not the best way to inform the public about what is going on and are unlikely to serve whatever purpose Little imagines he must serve under the Crown’s treaty obligations.
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5 MARCH 2021