An inquiry into New Zealand's mental health and addictions services was established by the Government early in 2018. It consulted with large numbers of New Zealanders during the year and released its report to the public in December 2018. It made 40 recommendations proposing major reform to the sector.
What is the Mental Health and Addiction Inquiry?
The Government Inquiry into Mental Health and Addiction was announced early in 2018. This was in response to widespread concern about mental health services within the mental health sector and the broader community.
The Inquiry’s purpose was to identify unmet needs and develop recommendations for a better mental health and addiction system for Aotearoa New Zealand.
The Inquiry Panel aimed to set a clear direction for the next five to 10 years for the Government, the mental health and addiction sectors and the whole community. It looked at how to prevent mental health and addiction problems, how to intervene early and respond better to people in need and how to promote wellbeing.
The Inquiry began work in February 2018 and released a consultation document in April 2018. During the consultation process, more than 2,000 people attended more than 400 meetings and more than 5,200 submissions were made to the Inquiry.
The Inquiry also undertook a stocktake of government-funded services and programmes and a report was commissioned from the University of Otago, Wellington, on the determinants of mental health and wellbeing, specific populations’ experiences of mental health and wellbeing, and opportunities for service improvements and a move to a wellbeing approach.
Watch an animated video of its findings:
(Te reo Māori)
What is the Mental Health and Addiction Inquiry Report?
The report of the inquiry, He Ara Oranga – Pathways to Wellness, was released on 4 December 2018. It recommends major reform, saying the mental health and addictions system is under pressure and is unsustainable in its current form.
It is the first major report into mental health services since the Mason Inquiry of 1996 which lead to the formation of the Mental Health Commission (disestablished in 2012) and the 1998 Blueprint for Mental Health Services in New Zealand.
What are the recommendations of the Mental Health and Addiction Inquiry Report?
The 40 recommendations in He Ara Oranga – Pathways to Wellness are grouped around the following 12 themes:
- expanding access and choice
- transforming primary healthcare
- strengthening the NGO sector
- taking a whole-of-government approach to wellbeing
- facilitating mental health promotion and prevention
- placing people at the centre
- taking strong action on alcohol and other drugs
- preventing suicide
- reforming the Mental Health Act
- establishing a new Mental Health and Wellbeing Commission
- referring broader structural issues to the Health and Disability Sector Review
- establishing a cross-party working group on mental health and wellbeing.
The 40 recommendations are as follows:
- Agree to significantly increase access to publicly funded mental health and addiction services for people with mild to moderate and moderate to severe mental health and addiction needs.
- Set a new target for access to mental health and addiction services that covers the full spectrum of need.
- Direct the Ministry of Health, with input from the new Mental Health and Wellbeing Commission, to report back on a new target for mental health and addiction services.
- Agree that access to mental health and addiction services should be based on need so:
- access to all services is broad-based and prioritised according to need, as occurs with other core health services
- people with the highest needs continue to be the priority.
Increase choice of services
- Commit to increased choice by broadening the types of mental health and addiction services available.
- Direct the Ministry of Health to urgently develop a proposal for Budget 2019 to make talk therapies, alcohol and other drug services and culturally aligned therapies much more widely available, informed by workforce modelling, the New Zealand context and approaches in other countries.
Facilitate co-design and implementation
- Direct the Ministry of Health, in partnership with the new Mental Health and Wellbeing Commission (or an interim establishment body) to:
- facilitate a national co-designed service transformation process with people with lived experience of mental health and addiction challenges, DHBs, primary care, NGOs, Kaupapa Māori services, Pacific health services, Whānau Ora services, other providers, advocacy and representative organisations, professional bodies, families and whānau, employers and key government agencies
- produce a cross-government investment strategy for mental health and addiction services.
- Commit to adequately fund the national co-design and ongoing change process, including funding for the new Mental Health and Wellbeing Commission to provide backbone support for national, regional and local implementation.
- Direct the State Services Commission to work with the Ministry of Health to establish the most appropriate mechanisms for cross-government involvement and leadership to support the national co-design process for mental health and addiction services.
Enablers to support expanded access and choice
- Agree that the work to support expanded access and choice will include reviewing and establishing:
- workforce development and worker wellbeing priorities
- information, evaluation and monitoring priorities (including monitoring outcomes)
- funding rules and expectations, including DHB and primary mental health service specifications and the mental health and addiction ring fence, to align them with and support the strategic direction of transforming mental health and addiction services.
- Agree to undertake and regularly update a comprehensive mental health and addiction survey.
- Commit to a staged funding path to give effect to the recommendations to improve access and choice, including:
- expanding access to services for significantly more people with mild to moderate and moderate to severe mental health and addiction needs
- more options for talk therapies, alcohol and other drug services and culturally aligned services
- designing and implementing improvements to create more people-centred and integrated services, with significantly increased access and choice.
Transform primary healthcare
- Note that this Inquiry fully supports the focus on primary care in the Health and Disability Sector Review, seeing it as a critical foundation for the development of mental health and addiction responses and for more accessible and affordable health services.
- Agree that future strategies for the primary health care sector have an explicit focus on addressing mental health and addiction needs in primary and community settings, in alignment with the vision and direction set out in this Inquiry.
Strengthen the NGO sector
- Identify a lead agency to:
- provide a stewardship role in relation to the development and sustainability of the NGO sector, including those NGOs and Kaupapa Māori services working in mental health and addiction
- take a lead role in improving commissioning of health and social services with NGOs.
Take a whole-of-government approach to wellbeing, prevention and social determinants
- Establish a clear locus of responsibility for social wellbeing within central government to provide strategic and policy advice and to oversee and coordinate cross-government responses to social wellbeing, including:
- tackling social determinants that impact on multiple outcomes and that lead to inequities within society
- enhancing cross-government investment in prevention and resilience-building activities.
- Direct the State Services Commission to report back with options for a locus of responsibility for social wellbeing, including:
- its form and location (a new social wellbeing agency, a unit within an existing agency or reconfiguring an existing agency)
- its functions (as proposed in Figure 3 in section 7.1.3).
Facilitation mental health promotion and prevention
- Agree that mental health promotion and prevention will be a key area of oversight of the new Mental Health and Wellbeing Commission, including working closely with key agencies and being responsive to community innovation.
- Direct the new Mental Health and Wellbeing Commission to develop an investment and quality assurance strategy for mental health promotion and prevention, working closely with key agencies.
Strengthen consumer voice and experience in mental health and addiction services
- Direct DHBs to report to the Ministry of Health on how they are including people with lived experience and consumer advisory groups in mental health and addiction governance, planning, policy and service development decisions.
- Direct the Ministry of Health to work with people with lived experience, the Health Quality and Safety Commission and DHBs on how the consumer voice and role can be strengthened in DHBs, primary care and NGOs, including through the development of national resources, guidance and support, and accountability requirements.
Support families and whānau to be active participants in the care and treatment of their family member
- Direct the Health and Disability Commissioner to undertake specific initiatives to promote respect for and observance of the Code of Health and Disability Services Consumers’ Rights by providers, and awareness of their rights on the part of consumers, in relation to mental health and addiction services.
- Direct the Ministry of Health to lead the development and communication of consolidated and updated guidance on sharing information and partnering with families and whānau.
- Direct the Ministry of Health to ensure the updated information-sharing and partnering guidance is integrated into:
- training across the mental health and addiction workforce
- all relevant contracts, standards, specifications, guidelines, quality improvement processes and accountability arrangements.
Support the wellbeing of families and whānau
- Direct the Ministry of Health, working with other agencies, including the Ministry of Education, Te Puni Kōkiri and the Ministry of Social Development, to:
- lead a review of the support provided to families and whānau of people with mental health and addiction needs and where gaps exist
- report to the Government with firm proposals to fill any gaps identified in the review with supports that enhance access, affordability and options for families and whānau.
Take strong action on alcohol and other drugs
- Take a stricter regulatory approach to the sale and supply of alcohol, informed by the recommendations from the 2010 Law Commission review, the 2014 Ministerial Forum on Alcohol Advertising and Sponsorship and the 2014 Ministry of Justice report on alcohol pricing.
- Replace criminal sanctions for the possession for personal use of controlled drugs with civil responses (for example, a fine, a referral to a drug awareness session run by a public health body or a referral to a drug treatment programme).
- Support the replacement of criminal sanctions for the possession for personal use of controlled drugs with a full range of treatment and detox services.
- Establish clear cross-sector leadership and coordination within central government for policy in relation to alcohol and other drugs.
- Urgently complete the national suicide prevention strategy and implementation plan and ensure the strategy is supported by significantly increased resources for suicide prevention and postvention.
- Set a target of 20% reduction in suicide rates by 2030.
- Establish a suicide prevention office to provide stronger and sustained leadership on action to prevent suicide.
- Direct the Ministries of Justice and Health, with advice from the Health Quality and Safety Commission and in consultation with families and whānau, to review processes for investigating deaths by suicide, including the interface of the coronial process with DHB and Health and Disability Commissioner reviews.
Reform the Mental Health Act
- Repeal and replace the Mental Health (Compulsory Assessment and Treatment) Act 1992 so that it reflects a human rights–based approach, promotes supported decision-making, aligns with the recovery and wellbeing model of mental health, and provides measures to minimise compulsory or coercive treatment.
- Encourage mental health advocacy groups and sector leaders, people with lived experience, families and whānau, professional colleges, DHB chief executive officers, coroners, the Health and Disability Commissioner, New Zealand Police and the Health Quality and Safety Commission to engage in a national discussion to reconsider beliefs, evidence and attitudes about mental health and risk.
Establish a new Mental Health and Wellbeing Commission
- Establish an independent commission – the Mental Health and Wellbeing Commission (with the functions and powers set out in Figure 4 in section 12.2.2) – to provide leadership and oversight of mental health and addiction in New Zealand.
- Establish a ministerial advisory committee as an interim commission to undertake priority work in key areas (such as the national co-designed service transformation process).
- Direct the Mental Health and Wellbeing Commission (or interim commission) to regularly report publicly on implementation of the Government’s response to the Inquiry’s recommendations, with the first report released one year after the Government’s response.
Wider issues and collective commitment
- Ensure the Health and Disability Sector Review:
- assesses how any of its proposed system, structural or service commissioning changes will improve both mental health and addiction services and mental health and wellbeing
- considers the possible establishment of a Māori health ministry or commission.
- Establish a cross-party working group on mental health and wellbeing in the House of Representatives, supported by a secretariat, as a tangible demonstration of collective and enduring political commitment to improved mental health and wellbeing in New Zealand.
Where can I find out more about the Inquiry’s recommendations?
The executive summary and recommendations of the report have been published in several formats, including audio (MP3), large text, te reo Māori, Samoan and NZ Sign Language. A lending copy of these documents in Braille is available on request.
You can also see the full 200-page report He Ara Oranga – Pathways to Wellness.
What happens now?
The Government will report back on its response to the recommendations in March 2019.
The Mental Health & Addiction Health Sector Leadership Group (MHAHSLG) has been established to provide advice and support to the Ministry of Health as it works to implement the Inquiry recommendations. The Ministry of Health will report its progress regularly to responding to the Inquiry’s recommendations.