This is my recent column in the New Zealand Herald, which is published in the digital “Premium” edition every Thursday…
“Transformational” has become a loaded word with this government. It has been turned from an election promise into a sneering accusation in the mouths of the opposition, writes Kyle MacDonald.
How does the Wellbeing Budget measure up, in terms of mental health?
Transformational might be a stretch, as with mental health we are just getting started. What is clear is when you look past the numbers – an impressive $1.9 billion dollars allocated for mental health and addictions – this is a road map for transforming how mental health support is funded and delivered in New Zealand.
In fact, you can go further and make the argument that it is redefining how we treat mental health.
In health we talk about “primary” services: largely, GP practices, where individuals can directly access the service, and secondary services, where the level of care is more acute, or you need to be referred by a clinician for services. Hospitals, largely.
Since the last major review of mental health in the late 90s, dubbed the “Mason Report”, mental health services have largely been the focus of secondary services, via the District Health Boards (DHBs). Primary, or community services, which have been a patchwork of charitable services such as Youthline, Lifeline and others, or private practice. There have been some attempts to fund access to psychological support via GPs, but these haven’t been nationally – or even regionally – consistent. NGOs have, over the last decade grown in the gap, but with short contracts and competition for funding they have done the best with what little they have been able to get.
The Wellbeing Budget has turned this on its head, by committing nearly half a billion dollars to primary mental health care over the next five years. In doing so, they have provided much needed direction and commitment. It will also enable people to commit to train, or retrain, as we will need to grow the workforce to provide services at this level. By 2023/ 2024 it’s projected this will allow around 325,000 Kiwis to access free, easily accessible mental health support.
By placing the service in “primary” health care – GP’s clinics, community services and Kaupapa Māori providers – hopefully it will be much clearer how to access help, and where to go to get it.
Some of course have expressed concern about the level of DHB funding, and it’s not clear yet how much is “enough”, at least with regards to DHB mental health services. But the good news is we are now explicitly talking about a “ring-fence” – meaning a specific amount of money that has to be allocated to mental health services by DHBs as part of their funding.
There is of course more money for suicide prevention – although we are still without a plan – and attempts to address the pressures on staff responding to acute mental distress in emergency departments and increased funding across the board for addiction services.
And of course, more access to support earlier should, at least in theory, take pressure off acute mental health services.
So is $1.9 billion impressive? Yes.
Is it transformational? That remains to be seen.
But at last we now have a plan. And more importantly a clear commitment to listen to the needs and concerns of advocates, professionals, clients and the public.
Let’s hope in five years time we all can look back and see that this is where the transformation started.