Government’s response to He Ara Oranga – Expert Reaction

The Government has responded to the recommendations from the Mental Health and Addiction Inquiry report, He Ara Oranga.

All but two of the 40 recommendations have been accepted, accepted in principle, or agreed to further consideration. The Government has rejected a recommendation to set a target of 20 per cent reduction in suicide rates by 2030, with Health Minister Dr David Clark saying “every life matters, and one death by suicide is one death too many”.

A recommendation to repeal and replace the Mental Health (Compulsory Assessment and Treatment) Act 1992 has been accepted, as has the recommendation to re-establish a Mental Health Commission.

The SMC gathered expert reaction to the Government’s response – previous comments are available here.

Dr Ruth Cunningham, Senior Research Fellow and Public Health Physician, University of Otago, Wellington, comments:

“It is good to see the long-awaited response from the Government to the Mental Health and Addiction Inquiry recommendations and pleasing to see that almost all of the recommendations have been accepted or will be given further consideration.

“In particular the move towards re-establishing an independent Mental Health Commission, with a broadened focus on wellbeing, is positive, as is the plan to move on with the stalled suicide prevention strategy. It is disappointing that a stronger stance has not been taken on alcohol policy. It is good to see a focus on equity in various parts of the response. However, a more explicit focus on Māori mental health in the Government’s response could have gone some way to addressing some of the public concerns about the Inquiry report.

“It remains to be seen what access to a broader range of mental health services and a more joined-up sector including DHB primary care and NGO services will look like in practice. Hopefully, the Budget announcement will tell us more about what the sector can expect.”

Conflict of interest statement: I led the team that provided two of the background reports to the Inquiry; I am the epidemiologist for the Suicide Mortality Review Committee.

Dr Dougal Sutherland, Clinical Psychologist, Victoria University of Wellington, comments:

“The resurrection of the Mental Health & Wellbeing Commission represents a step back in time for the Mental Health sector. Whilst the return of the Commission to provide leadership and accountability for the sector is welcomed, the fact that it is needed shows just how far the sector hasn’t come and that DHBs have largely failed to address the mental health needs of most New Zealanders.

“The Commission will need to lead the development of new models of delivering mental health services to release these from the grip of DHBs who are focused on helping those people with high acuity and severity whilst at the same time trying to endlessly save money.

“Mental Health services must be integrated into primary health care and moved closer to communities that need them. We need a holistic approach to health rather than the current mind/body spilt which treats mental health as a leperous outsider.

“The Commission has a strong track record of making significant changes in the sector and many were saddened when the government of the time decided not to prolong its life. Without the Commission, the sector took a step backwards and the Commission has a steep road ahead of it to bring about meaningful change.

“It remains to be seen whether the government’s response to the Mental Health and Addiction Inquiry will go deep enough to fundamentally alter how mental health services are delivered in the public sector. Urgent change is needed in how mental health services in the public sector are managed and delivered in order to stop the exodus of psychologists from DHBs which, in some areas, is reaching epidemic proportions.

“The Government has accepted the need for more talking-therapies as opposed to medical interventions. To fully implement this recommendation there will need to be significant investment in the psychology workforce. Currently, clinical psychology training programmes are funded at rates so low that they run at a loss or at best break even. Training of more Clinical Psychologists in crucial given their expertise in talking-therapies which the Mental Health and Addiction Inquiry highlighted as being in high demand but short supply.”

Conflict of interest statement: I was involved in preparing two separate submissions to the Mental Health Inquiry. I am Clinical Practice manager in the Clinical Psychology Training Programme at VUW.

Dr Fiona Hutton, senior lecturer in criminology, Victoria University of Wellington, comments:

“It is excellent to see that the government has accepted, accepted in principle or agreed to further consideration of 38 of the 40 recommendations of the Mental Health and Addiction Inquiry, as well as their commitment to increasing the services available for those with mental health and addiction needs. It will be great to see a wellbeing budget that supports these commitments as well as the other recommendations of the Inquiry.

“As noted in the latest Government announcement, the issues related to mental health and addiction are deep seated and longstanding, and a holistic and non-stigmatising approach to these complex issues is urgently needed. It is also excellent to see that the Government has not rejected the recommendation to remove the criminalisation of personal possession and use of drugs that are currently illegal. This signals that the Government is serious about reforming our drug laws, not least to address some of the pressing issues related to addiction and mental health that the Inquiry noted.

“Removing penalties for personal use and possession of illegal drugs would be truly transformative and if the Government is indeed serious about addressing the often inseparable issues of mental health and addiction then this is what it will take, alongside the many other recommendations of this thorough report. The commitment to increasing and funding services is urgently needed, although there is no ‘quick fix’ to the deep-rooted issues such as stigma, marginalisation, racism and poverty that affect both mental health and addiction.”

No conflict of interest.

Professor Doug Sellman, Professor of Psychiatry & Addiction Medicine, University of Otago, Christchurch, comments:

“The Government appears to be completely ignoring the following recommendation of the Mental Health and Addiction Inquiry: ‘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.’

“Alcohol is the drug that is doing the most damage to New Zealanders’ well-being by far; the cost of which has been recently estimated at $7.85 billion per year. Alcohol law reform is one of the most obvious and most effective single ways of improving New Zealanders’ well-being.

“Raising the excise tax on alcohol is the easiest and most effective evidence-based measures a government can undertake to reduce alcohol-related problems; and has been shown to be supported by a majority of New Zealanders.

“To not act at this time with robust alcohol law reform, in particular substantially raising the excise tax on alcohol, risks reducing this Wellbeing Budget to a set of platitudes.

“But even more concerning is that because rationality, international evidence, formal recommendations and majority public support is being ignored, the power of alcohol industry lobbying of our government becomes apparent. This power to subvert alcohol law reform risks making a mockery of democracy and continues to undermine the reduction of alcohol-related misery and suffering in favour of the greed of powerful vested interests.”

Professor Warren Brookbanks, Professor of Criminal Law and Justice Studies, AUT, comments:

“The Government has released its response to He Ara Oranga (the Report of the Inquiry into Mental Health and Addiction). The Government is to be congratulated for the robust and positive response to the report, especially in its agreement to further consideration of 38 of 40 recommendations.

“The recommendations it does not accept include the suggestion that the State Services Commission should report back with options for a locus of responsibility for social well-being. In this regard the Government’s response was that existing mechanisms and infrastructure are able to be used to facilitate better agency and ministerial collaboration. The other recommendation not accepted was to set a target of 20 per cent reduction in suicide rates by 2030. Acknowledging that no suicide is acceptable, and that there had been a failure to achieve meaningful reduction in New Zealand’s high suicide rates, the Government’s response was that a well resourced suicide prevention strategy and action plan emphasising that every death by suicide is unacceptable was
expected to drive a reduction in New Zealand’s suicide rate.

“Nevertheless, the issue of suicide was a clear focus of the Government’s response to the Report, including a commitment to strengthening governance and leadership of suicide prevention in New Zealand and establishing a suicide prevention office within the Ministry of Health to lead development of suicide prevention strategy and implementation plan.

“Other than the two rejected recommendations, the whole Government’s response effectively endorses all the substance of the He Ara Oranga report. This necessarily implies very far-reaching and comprehensive reforms to New Zealand’s mental health system. The response recognises a need for a transformation of thinking in relation to mental health and addiction, including a significant increase in access to publicly funded mental health and addiction services for people with mild to moderate needs, who have been largely ignored under existing mental health policy. This, as the official response acknowledges, will have major implications for the provision of new services, new staff and new facilities across the country. The Government recognises, realistically, that this will take significant and sustained investment rolled out over many years to achieve the desired transformation. There will not be, as is also acknowledged, any quick fixes.

“Support for expanding both the access and choice of mental health and addiction responses appropriate to the needs spectrum and life course of mental health consumers, including the expansion of talk therapies, alcohol and other drug services and culturally-aligned therapies, is visionary. It is a recognition that previous models of mental health services and care provision have failed to adequately address the needs of the whole community, and particularly Māori, Pacific peoples and other population groups who have experienced poor mental health outcomes.

“The Government’s support for the establishment of a Mental Health and Wellbeing Commission, intended to facilitate service transformation and meaningful partnership with stakeholders, including those with lived experience of mental health and addiction, will be instrumental in removing the uncertainty surrounding the question of which agency should oversee the national, regional and local implementation of new mental health policy.

“The approach of making the improvement of well-being a matter underpinning all government activities rather than a specific locus of responsibility within central government is appropriate. It is also consistent with the Government’s commitment is to placing people at the centre of mental health and addiction services and supporting a renewed commitment to consumer’s rights and support and enablement of family and whānau.

“The Government’s commitment to taking strong action on alcohol and other drugs is commendable, given the widespread harm caused by alcohol and drug abuse in this country. However, how it will implement these good intentions is an open question and will no doubt require strong cross party support in the creation of new and effective health-based strategies.

“Finally, the expressed intention to repeal and replace the Mental Health (Compulsory Assessment and Treatment) Act 1992 with legislation that better encompasses models of recovery and social well-being, while appropriate, will be a significant challenge. The legislative process for complete repeal, as the Government rightly acknowledges, is likely to take many years to effect and will require wide consultation and input from the community. However, the aim of minimising compulsory and coercive treatment is to be applauded and aligns with the wider collective commitments to achieving equality of outcomes and enhanced wellness for all citizens, in particular Māori and Pacific peoples.”

No conflict of interest.