He Ara Oranga : Report of the government inquiry into mental health and addiction
Background
The Government Inquiry into Mental Health and Addiction was announced early in 2018. The catalyst for the inquiry was widespread concern about mental health services, within the mental health sector and the broader community, and calls for a wide-ranging inquiry from service users, their families and whānau, people afected by suicide, people working in health, media, Iwi and advocacy groups.
Purpose of Inquiry
The purpose of this Inquiry is to:
• hear the voices of the community, people with lived experience of mental health and addiction problems, people afected by suicide, and people involved in preventing and responding to mental health and addiction problems, on New Zealand’s current approach to mental health and addiction and what needs to change
• report on how New Zealand is preventing mental health and addiction problems and responding to the needs of people with those problems
• recommend specifc changes to improve New Zealand’s approach to mental health, with a particular focus on equity of access, community confdence in the mental health system and better outcomes, particularly for Māori and other groups with disproportionately poorer outcomes.
The full Terms of Reference are set out in Appendix A.
Conclusions
New Zealand’s mental health and addiction problems cannot be fxed by government alone, nor solely by the health system. We can’t medicate or treat our way out of the epidemic of mental distress and addiction afecting all layers of our society. We need to ensure practical help and support in the community are available when people need it, and government has a key role to play here. But some solutions lie in our own hands. We can do more to help each other.
Wellbeing has been a theme during this Inquiry and in national conversation in recent years. It’s hard for people struggling with poverty, abuse and deprivation to take steps to become well – yet, every day, people recover from distress, overcome addictions and fnd strength in their lives. Sleep, nutrition, exercise and time outdoors help recovery. So too does strengthening one’s cultural identity and helping others.
We have a solid foundation to build on: New Zealand’s mental health and addiction system has valuable strengths. Many people in the system receive good care and we have a skilled and committed workforce. But the system is under pressure and unsustainable in its current form. Signs include escalating demand for specialist services, limited support for people in the community and difculties recruiting and retaining staff.
Despite the current level of investment, we’re not getting the outcomes we want for our people. The outcomes for Māori are worse than for the overall population, and Māori are subject to much greater use of compulsory treatment and seclusion. There are also unmet mental health needs for Pacifc peoples, disabled people, Rainbow communities, the prison population, and refugees and migrants. The estimated reduction in life expectancy of people with severe mental health or addiction challenges is 25 years. Our persistently high suicide rates are of major concern.
Our mental health system is set up to respond to people with a diagnosed mental illness. It does not respond well to other people who are seriously distressed. Even when it responds to people with a mental illness, it does so through too narrow a lens. People may be ofered medication, but not other appropriate support and therapies to recover. The quality of services and facilities is variable. Too many people are treated with a lack of dignity, respect and empathy.
We do not have a continuum of care – key components of the system are missing. The system does not respond adequately to people in serious distress, to prevent them from ‘tipping over’ into crisis situations. Many people with common, disabling problems such as stress, depression, anxiety, trauma and substance abuse have few options available through the public system. By failing to provide support early to people under the current threshold for specialist services, we’re losing opportunities to improve outcomes for individuals, communities and the country.
We also fail to address people’s wider social needs. Initial expansion of culturally appropriate services has stalled, and there has been little investment in respite and crisis support options, forensic step-down services in the community, and earlier access to a broader range of peer, cultural and talk therapies.
Despite a lot of consensus about the need for reform, we are yet to take a bold, healthoriented approach to the harmful use of alcohol and other drugs and to provide a wider range of community-based services to help people recover from addiction. Our approach to suicide prevention and the support available to people after a suicide is patchy and under-resourced. Tackling the social and economic determinants of mental health and wellbeing requires a coordinated, integrated approach from social services.
It’s time to build a new mental health and addiction system on the existing foundations to provide a continuum of care and support. We will always have a special responsibility to those most in need. They must remain the priority. But we need to expand access so that people in serious distress – the ‘missing middle’ who currently miss out – can get the care and support they need to manage and recover.
The new system should have a vision of mental health and wellbeing for all at its heart: where a good level of mental wellbeing is attainable for everyone, outcomes are equitable across the whole of society, and people who experience mental illness and distress have the resilience, tools and support they need to regain their wellbeing.
We set out Whakawātea te Ara, clearing the pathways that will lead to improved Māori health and wellbeing. We outline Vai Niu, a vision of Pacifc mental health and wellbeing. We believe that many dimensions of the aspirations of Māori and Pacifc peoples, especially the call for a holistic approach, point the way for all New Zealanders.
We describe a vision for mental health and addiction services, with people at the centre; responsive to diferent ages, backgrounds and perspectives; centred on community-based support and local hubs, using a mix of peer, cultural, support and clinical workforces; providing support for people in crisis; a comprehensive harm-minimisation approach to alcohol and other drug use; more community-based addiction services to help people recover; and a broader range of therapies for people who are detained and support for their transition back to the community. Psychiatrists and appropriate medications will continue to be important – but they are only part of the picture.
Honouring the voices of the people who shared their stories with the Inquiry means there must now be decisive action. Our approach is to focus on a few critical changes to shift the system. In addition to the gains in health and wellbeing, a strong economic case exists for further investment in mental health and addiction. The key principles that underpin our recommendations are a commitment to equity and the Treaty of Waitangi; putting people with lived experience and consumers at the centre of the system; recognising a shared responsibility for improving mental health and wellbeing in our society; and building on the foundations already in place, with mental health and addiction services remaining part of the health system.