Taking Mental Health Seriously
Key Budget initiatives:
Record $1.9 billion total Mental Health package, including:
- New universal frontline mental health service established, expected to help 325,000 people with mild to moderate mental health and addiction needs by 2023/24
- $200 million extra for new and existing mental health and addiction facilities
- Expanding the nurses in schools programme to decile 5 secondary schools – reaching an extra 5,600 students
- $128.3 million for Department of Corrections to spend on mental health and addiction services
- $197 million to tackle homelessness through Housing First
- Funding for the Te Ara Oranga programme in Northland to help up to 500 people a year who are addicted to methamphetamine.
Budget 2019 delivers on many of the recommendations contained in the Inquiry into Mental Health and Addiction, He Ara Oranga.
The Inquiry revealed that a new approach to mental health and addiction is needed in New Zealand which the Government is starting to deliver.
Current data suggests one-in-five New Zealanders experience mental health and addiction challenges at any given time.
This comes at huge social cost. To individuals, families – and to the economy. It’s estimated that in 2014 the economic cost of serious mental illness alone was $12 billion, or five per cent of Gross Domestic Product (GDP).
A new universal frontline service for mental health
A new universal mental health services will be rolled out nationwide over five years (recognising the need to train more qualified mental health workers and build new facilities). The new service will place trained mental health workers in doctors’ clinics, iwi health providers and other health services so that when people seek help it is easy to access and immediately available for those suffering mental health issues.
For example, when a GP identifies a mental health or addiction issue they can physically walk with their patient to a trained mental health worker to talk. The mental health worker will have an ongoing relationship with the person in distress, helping to guide and support their recovery.
Health Minister David Clark says it needs to be easier for people to get help early, before small issues become major problems.
“The Coalition Government is taking mental health seriously. We want to make it as easy as possible for people to get support when they need it, which is why we are intergrating this new initiaitve into the health services people use most often like GPs.
“By the end of the rollout we expect up to 325,000 people a year will be able to access this new model of primary mental health care – these are the people He Ara Oranga identified as the ‘missing middle’,” David Clark says.
Making mental health advice available at a primary care level will also promote early intervention. Over time, that should mean more people stay well, which will reduce demand on expensive acute services.
To make this transformation possible it will take sustained investment over a number of years.
In 2019/20, $48.1 million will be invested in expanding access and choice in primary mental health and addiction support, ramping up as workforce and sector capacity increases to $455.1 million over four years.
Suicide prevention and response
Tackling New Zealand’s stubbornly high rate of suicide won’t be easy, but the Wellbeing Budget is the start of transforming our entire approach to mental health and addiction.
The Ministry of Health is working on a new suicide prevention strategy in response to the recommendation of He Ara Oranga.
To support that work the Government is investing $40 million over four years into suicide prevention services, to give people at risk intensive support. This includes better recognition and support for people who have self-harmed or experienced suicidal distress.
The Associate Health Minister Jenny Salesa says the Government knows there is particular need in Māori and Pacific communities.
“To recognise the need in Māori and Pacific communities the Wellbeing Budget will fund up to eight programmes designed to strengthen personal identity and connection to the community.
“It is also important that we do more to support those who are bereaved by suicide, so provision has been made for free counselling for up to 2,500 people (four sessions per person) who have lost a loved one to suicide,” Jenny Salesa says.
Expanding access to addiction treatment
Demand for addiction treatment services has grown steadily over the last decade, and we need to do more to support people struggling with alcohol and drugs.
The Wellbeing Budget will make it easier for an estimated 5,000 people a year to get early support through primary care for alcohol and drug issues, at a cost of $14 million over four years.
This will include increased availability of counselling and group therapies in up to four regions, based on community need.
Budget 2019 also provides $44 million extra over four years to improve existing drug addiction services, with a focus on residential care, detoxification services and ongoing support for more than 2,000 people who are currently receiving assistance.
We also need to upgrade current facilities and add capacity by building new facilities. That’s why we’re ring-fencing $200 million of District Health Board capital investments into new and existing mental health and addiction facilities.
One of the first regions to benefit from this will be Tairawhiti, which will get a new facility pioneering a different model of care, combining both mental health and addiction services on the same site.
The Government is also providing $4 million over four years for Te Ara Oranga in Northland, which provides support for up to 500 people a year who are addicted to methamphetamine, and their families. This is a joint initiative with the New Zealand Police.
Most existing mental health and addiction services are delivered through District Health Boards, either directly or via contracts with non-government and community providers. As part of the overall four-year funding boost to DHBs of $2.3 billion dollars, a total of $213.1 million will go into mental health and addiction services.
As an immediate measure to help people in crisis we are also investing an additional $8 million over four years in improving responses for the up to 15,000 people a year who turn up at hospital emergency departments needing mental health support.
Supporting young people’s mental wellbeing
Budget 2019 extends the nurses in schools programme to a further 5,600 students by commencing the rollout to decile five secondary schools at a cost of $19.6 million over four years. (The programme currently covers decile 1-4 secondary schools, and funding is also provided to enhance these current services).
Prime Minister Jacinda Ardern says evidence shows that when students have more time with on-site professionals there is significantly less depression and suicide risk.
“Early intervention works. We want to provide our young people with support and early intervention as they learn to cope with the pressures that come with becoming a young adult.”
2.2 million dollars over four years will provide resources for teachers to encourage mental resilience in primary and intermediate schools. This will help children and young people talk about and promote positive mental health.
The Budget also allocates $10 million to the creation of a nurse-family partnership programme at an initial three sites. The programme will provide enhanced support to parents and whānau who have mental health or addiction needs during pregnancy and for the first two years of a child’s life or following a still birth. Supporting parents through this programme will also play an important part in keeping at-risk children safe.
Hāpaitia Te Oranga Tangata
This programme is made up of four initiatives across three Budget priorities – with two in this mental health priority.
The first provides $128.3 million over four years to expand mental health and Alcohol and Other Drug (AOD) services for offenders.
Corrections Minister Kelvin Davis says 91 per cent of people in prison have a lifetime diagnosis of a mental health or substance use disorders.
“Investing in mental health and addiction services in prisons will help break the cycle of crime and offending. These services delivered in prisons will help people re-enter society and help keep our communities safer.
“Current mental health services help 8,000 people a year through the Corrections service. We need to grow those services to reach even more people in our prisons,” Kelvin Davis says.
The expansion of services for offenders will be rolled out over four years and will deliver the additional services:
- Mental health services for up to 2,310 offenders per year with a mental health need. Enabling national coverage of mental health services across prisons and community Corrections sites.
- A family/whānau service for the family/whānau of offenders who need mental health services. Up to 275 families will be supported per year.
- Supported living accommodation for offenders with intensive mental health needs who are transitioning to the community. Up to 30 offenders will be supported in total each year.
- Expanded social worker and trauma counselling services to help offenders reconnect with their whānau/children, address personal trauma, and transition back into the community. Up to 800 prisoners will be supported each year.
- AOD intensive treatment in prisons. Up to four additional treatment programmes will be established and the 11 existing programmes will be enhanced, enabling up to 204 participants to access treatment per year.
- Expanding AOD testing and harm reduction support interventions in the community will provide AOD tests and alcohol detection anklets to ensure they avoid drink driving.
- AOD aftercare support services. Offenders will be able to access the relapse support prevention they need.
An additional $6.2 million has been provided to support the families of homicide victims to make their mental health a priority.
The Justice Minister Andrew Little says the aim is to ensure the justice system responds safely and effectively to victims while providing mental health support to their families as well.
This will be done through funding victim support to improve their capabilities so they can manage mental health services.
“The new plan includes employing specialist caseworkers with mental health experience to support victims’ families bereaved by homicide in their recovery and help them navigate the criminal justice system,” Andrew Little says.
Families of victims will get constant support from the same person. To limit confusion a single, consistent professional point of contact will be appointed to manage their needs until they no longer need it or their engagement with the criminal justice system ends.
A solution to homelessness
The Wellbeing Budget will mean the internationally-acclaimed Housing First programme will be able to reach 2,700 homeless people and help get them into permanent homes.
Research by the University of Otago found that chronically homeless people have high mental health needs. It found that in the five years before being housed, 390 people seen by the People's Project in Hamilton had spent a total of 10,000 bed nights in mental health facilities – that’s about a month per person. They were also given 55,000 prescriptions, most commonly for anti-psychotic and anti-depressant medicines.
The Housing First programme understands that it is easier for people to address their issues once they have a home. That’s why they house them, then support them to address their issues by connecting them with services, such as counselling and addiction treatment, helping them to keep their homes and avoid ending up back on the streets.
As announced before Budget Day the Wellbeing Budget invests $197 million over four years into Housing First, which will fund 1,044 new places. This is the largest government investment in addressing chronic homelessness.
Housing and Urban Development Minister Phil Twyford says Housing First has housed 720 households, including 431 children in Auckland alone, since 2017.
“It is now helping house long-term homeless people in Auckland, Hamilton, Christchurch, Tauranga and Rotorua and will launch in Northland, Hawke’s Bay, Nelson/Blenheim and Wellington later this year.”