Social investment approach to mental health

  • Jonathan Coleman

Good morning, it’s great to be here on a beautiful Wellington morning. I’d like to acknowledge Professor Alan Merry, Chair of the Health Quality & Safety Commission. I’d like to also thank the HQSC for hosting us all today.

As you’d expect it is a busy election year. With my Minister of Sport and Recreation hat on I’ve spent part of the Parliamentary recess at the World Masters Games – a pretty interesting and inspiring experience.

But with regards to health, I’m focused on continuing the work of increasing access to health services and delivering better health outcomes for New Zealanders.

As an electorate MP I’m in the community constantly. I talk to a lot of people from all walks of life, and of course just like you, I follow what’s in the news and keep in touch with what’s happening across society generally.

And there’s no question that mental health in New Zealand is a subject that is now top of mind when Kiwis are talking about the serious stuff that matters.

A recent example is the debate around the Netflix show ‘13 Reasons Why,’ and how it depicts teen suicide. These are now topics of family dinner time debate, of lunchtime chat in the workplace, or something that might come up in conversation socially. The subject is hugely concerning for all of us.

But before we get into why people are so mindful of mental health issues, let’s be clear that in general, the sector currently provides high quality mental health services for New Zealanders across the continuum of care from prevention, through to primary care and specialist services.

Yes there are undoubtedly challenges in meeting the demand for mental health services, but the health system and wider social sector is responding.

Increasing demand

In line with international trends here in New Zealand we’ve seen an increase in demand for mental health and addiction services in recent years.

We know that around 47 per cent of New Zealanders will experience a mental health issue during their lifetime – and one in five will meet the criteria for a mental health problem in any given year.

Over the last decade demand for secondary mental health and addiction services has increased from 2.3 per cent to 3.6 per cent of the population, an increase from around 96,000 people, to almost 168,000 people. The numbers of people accessing specialist services are in line with international benchmarks for access to services.

At the same time the number of people treated by services for alcohol and other drugs, including methamphetamine related substance use, has almost doubled since 2008/09.

We know there are many people who might need help for a mental health issue, but who aren’t accessing the services available. For example, around 60 per cent of the people who die by suicide in New Zealand each year have not interacted with a mental health or addiction service in the previous 12 months.

We also know that there are some population groups which are more likely to struggle compared to others. Young men are still more likely than any other age-group to take their own life, and the suicide rates are also disproportionately high for Maori, Pacifica and young people aged 15-24.

Driving the increasing demand

The drivers of mental health and addition are complex, and there is no simple answer as to why across the world we are seeing increased demand.

Our mental health can be impacted by many environmental and social factors. By bullying. By financial pressures. By trauma.

As our understanding of mental health increases so does our willingness to report problems and seek help.

Evolution of care

Over the last few decades and more specifically in recent years our mental health and addiction system has changed dramatically.

It’s not difficult to conjure up images of asylums of the past, desolate and terrifying places where people were locked away and often forgotten.

When I was a medical student working at the old Kingseat Clinic south of Auckland large heavy old keys were used to lock people up. I still have one of those keys, a reminder of how things used to be. Our Dickensian institutions of past years ago are something we never want to go back to.

But we have moved from the institutional model of last century to a recovery model, in which the vast majority of people with mental health issues receive treatment in the community.

It’s fair to say that our mental health and addiction services are on a transformational journey.

To support this transformation there has been a significant investment in mental health services since 2008/09, with funding increasing by 18 per cent from $1.1 billion to $1.4 billion in 2015/16.

Early intervention & access to services is key – that’s where our focus is

What we do know is that across the system and out in the community there needs to be a greater emphasis on promoting wellbeing.

We may not be able to control or prevent those things that trigger mental health problems, but we can work to improve wellbeing and resilience throughout our communities, to equip us for life’s inevitable challenges.

We need to be focused on preventing issues from arising and intervening earlier to stop problems escalating is key.

We need a greater focus on mental health promotion and prevention across the life course and in response to mental distress and illness.

Here in New Zealand we already have the internationally recognised National Depression Initiative, which aims to reduce the impact of depression and anxiety by aiding early recognition, appropriate treatment, and recovery.

The NDI is a good example of utilising technology to ensure people have access to the help and support they need, at a place and time convenient to them. Its services are accessible via social media, text, email and, for young people, a safe online forum.

Another good example is the National Telehealth Service which provides an integrated platform for people to access health information, advice and support from trained health professionals.

In Budget 2016 we announced plans to enhance this system further with an additional $12 million investment, over four years, to help strengthen the response to people who reach out to social and community services at a time of mental health distress and help to identify the appropriate responses and referrals.

This includes a new 24/7 mental health triage service staffed by mental health nurses. This new service is currently in the first phase of implementation, and is on track to be running across the country by the end of the year.

The team will also provide support to the mental health workforce through a dedicated expert advice line.

Future proofing the workforce

Having a workforce with the right mix of skills is crucial to achieving the Government’s vision of sustainable change.

The recently released Mental Health and Addiction Workforce Action Plan 2017-2021 recognises the vital role primary and community care workforce has to play.

It’s important that we harness the skills of our wider workforce. We need to move our thinking beyond GPs and look at the wider picture such as the role of our midwives, nurses, pharmacists, school counsellors and peer support workers.

The plan also recognises the importance of workforce wellbeing – a promising approach that is gaining traction overseas.

Not only are we evolving and changing the way our workforce is seen and utilised, we’re also adding to the workforce.

For example, over the past five years, the number of registered nurses working in mental health and addictions services has increased at a higher rate than for any other area of nursing, from 3,583 to 4,206.

The number of full time equivalent psychiatrists employed across our DHBs has increased by well over 100 in the last eight years.

New Quality Initiative launched today

To help drive further improvements in the quality and safety of our mental health and addiction services, I am pleased to announce today a new national improvement programme.

This new approach is the result of a call for action from a group of psychiatrist leaders and academics.

The Health Quality and Safety Commission subsequently undertook to develop the programme in conjunction with DHBs.

It covers five key areas:

Firstly, we want to address the variation in prescribing of medications for people with mental health conditions, and to do this sector experts will establish national standardised, evidence-based practice for prescribing.

Secondly we need to improve the processes around transferring patients in and out of services.

Thirdly, we need to ensure we learn from serious adverse events and complaints.

Fourthly, we will build on the ‘Equally Well’ programme which looks to improve the overall physical health of people with mental health and addiction issues.

And finally we will continue to minimise restrictive care.

This programme is largely based on the successful Scottish Patient Safety Programme and work undertaken by the Institute for Healthcare Improvement.

It will be run for the next five years at a cost of around $7.5 million which will be funded from within DHB baselines, with a review after the first three years.

The Government’s new approach

To help guide our continued transformation of mental health and addiction services the Government is also adopting a new approach.

You may recall that in 2012 the Government launched ‘Rising to the Challenge’ - a five year service development plan for mental health and addiction services. It was an ambitious plan that included around 100 actions. I am keen to see that we build on these achievements and keep the momentum going.

We realise that mental health and addiction issues do not happen in isolation to an individual. They have a ripple effect which touches family, friends, communities and workplaces, as well as the health, justice and education sectors.

We the Government have moved from looking at mental health and addiction as ‘just’ a health issue to seeing it in a wider context through the Government’s Social Investment approach.

Social Investment will see the Government seeking to better utilise data and information to help inform decision making and our service development. The Prime Minister spoke extensively on this yesterday when he launched the new Better Public Service Targets.

As part of this new approach, there is already a significant cross Government programme of work to improve the mental health of New Zealanders underway.

It covers a continuum of services, including health promotion and prevention, self-help and online support, primary and community care, and specialist high intensity care for complex needs.

We are looking to improve alignment of the Government response across the board. We want our health, justice, education and welfare systems to work in an integrated way to promote mental health and do more to prevent mental illness arising, as well as improving the way we identify, respond to and support people with mental illness or addictions.

It was announced yesterday by the Prime Minister that Budget 2017 will include a $321 million Social Investment Package.

This will include expanding the Family Start programme which provides intensive support to at-risk families. This programme works to ensure mothers who need it can access community-based mental health services.

Also announced yesterday was additional funding to support more children with severe behavioural difficulties, focusing on those aged eight and under.

We know that young children with severe behavioural issues are more likely to be involved in antisocial behaviour later in life. By providing more support earlier, we’re aiming to help steer more young children onto a positive path in life.

I can confirm that Budget 2017 will also include new funding for mental health and addiction services as part of the Social Investment Package.

Further details of this investment will be announced on Budget Day.

What I can say, is that the additional funding for mental health and addiction services will complement the other work being undertaken through the Social Investment Package.

This new approach is being supported by the Government’s Chief Science Advisors.

Collectively we are still consolidating our thinking around this, and I will be taking a paper to Cabinet shortly which will outline the Government’s mental health and addiction strategy.

In part, it will be informed by early feedback received through the public consultation of the draft suicide prevention strategy which is currently underway.

The release of the draft suicide prevention strategy for consultation provides an opportunity for individuals and organisations to give feedback on the priority actions that will help guide suicide prevention activities.

The draft strategy acknowledges the need for input and engagement from right across society. Health services, particularly mental health services, and Government agencies cannot do this work alone.

Mostly this new cross Government approach will be able to operate within existing baselines. However we do recognise that this new approach will take some additional funding to help it bed in, and it will be provided through Budget 2017.

Closing - Building on the gains we’ve already made

In closing, I would just reiterate that all across the world the need for more person-centred mental health and addiction services is rising. The drivers are complex and include a range of societal pressures as well as an increased awareness.

New Zealanders can be confident of how much we have achieved in transforming mental health and addiction services.

There’s no doubt that more still needs to be done, and this Government is committed to continuing this transformation journey.

Kia ora, and thank you.