Thousands of views were taken in, meetings were held up and down the country, experts were questioned, and it all fed into a massive report on the state of our mental health system. So what does the report say we need to do?
Read more about the mental health inquiry with our edited extract from the report here.
What’s this all about?
You might’ve noticed that New Zealand has a problem with its mental health system. In fact, that’s not quite accurate – there are many complex and overlapping problems that don’t necessarily have any easy solutions, and people are suffering as a result. From the way services are accessed and delivered, all the way through to how our culture deals with mental health issues, we’ve got a lot of problems.
That sounds bad. But what’s a report going to do about it?
For starters, this inquiry has always intended to be different and far more holistic and far-reaching than other mental health reports. One of the clues is in the full name – Report of the Government Inquiry into Mental Health and Addiction. That final word there is crucial as previous inquiries didn’t really consider addiction as part of the wider mental health picture. But that’s not really how it works at all. Drug and alcohol addiction can have an enormous impact on overall mental wellbeing, and the societal impacts are huge – at the extreme end, it’s estimated that 87% of prisoners have or have had a drug or alcohol problem.
In fact, one expert said the report could’ve gone deeper into the concept of addiction. Professor Max Abbott from AUT said alcohol and drugs weren’t necessarily the only addictions that mattered. “While drug addictions are highlighted, behavioural addictions aren’t included. Recent New Zealand research shows the health and social harms associated with gambling disorder alone exceed those of drug abuse and come close to those of major depression.”
The other major change from previous reports is that it isn’t just taking in the mental health sector, but society as a whole. One in five New Zealanders experience some form of mental health issue every year, and up to 80% of the population will have some sort of mental health or addiction issue over the course of their life. Obviously, a huge number of those people aren’t necessarily going to mental health services for counselling or treatment, so to focus only on the mental health system would’ve been to miss the point. There was also a general flavour that approaches to the mental health system needed to be more of a conversation, rather than a top-down approach.
Is the report just outlining problems?
No, it also gave recommendations. The underlying point of the recommendations wasn’t necessarily that we simply spend more money on mental health services (though that wouldn’t hurt) but rather that the system as a whole is reformed so that the system works both better and more cost-effectively. There were 40 in total, broken down into several key areas. A lot of them related to what the new Mental Health and Wellbeing Commission should be doing, in particular, saying it should have a facilitation and oversight role over the whole sector and the outcomes that are being targeted.
But to keep with the theme about this report going beyond the mental health sector itself, a lot of the recommendations were much more around making families as a whole healthier and using other government agencies to do so. But even there, there could be issues. As journalist Jessica McAllen pointed out during her comprehensive wrap of the inquiry process, those in care and their families often have very different ideas about what treatment looks like, with families often much more keen for stricter supervision and more intensive care.
Could any of the recommendations be controversial?
Potentially, the recommendations on addiction will upset some people. Number 27 – ‘replace criminal sanctions for the possession for personal use of controlled drugs with civil responses’ – goes way beyond anything the government has currently committed to in terms of treating drugs as a health issue rather than as a criminal issue. It’s basically decriminalisation that’s being called for. And while these are expert recommendations, it would take an incredibly brave government to actually commit to doing that. About 10% of New Zealand’s prison population are there because of drug offences, with all of the ongoing negative outcomes and consequences that entails. And only a proportion of those people will be in there for possession, rather than manufacture or supply. But it would still mark a huge break if that were to change.
The other aspect of this section that could be controversial is for the complete opposite reason. Number 26 – ‘Take a stricter regulatory approach to the sale and supply of alcohol.’ Whenever there are calls to put more restrictions on the alcohol industry, cries of nanny statism are never far behind.
What does the government have to do now?
They’ve responded in the form of a press release so far, but a more substantive response is coming in March 2019. Health minister David Clark, for whom setting up the inquiry was one of the first jobs of his tenure, said: “The report charts a new direction for mental health and addiction in New Zealand, one that puts people at the centre of our approach.” He described the recommendations as “strong and coherent,” but can’t yet commit to which of them will be implemented or to what degree. But there was a note of caution – he also said there wouldn’t be quick and easy solutions. “I want to be upfront with the public, however, that many of the issues we’re facing, such as workforce shortages, will take years to fix.” The Mental Health Foundation has also responded, saying the time for action has come, particularly on the development of a suicide prevention strategy.
The final word?
One thing the report made clear was that pretty much everyone agreed things had to change. It’s remarkable for such a major report to come back with anything like that sort of consensus, which indicates it was probably a good idea to have it in the first place.