The Government’s new mental health strategy was announced last week and if you missed it click here for a link to the full document.
In many respects, it is saying the right things. There is no question that a system that relies less on crisis, less on coercion, and ultimately eliminates seclusion is something we should all want.
But it is hard to greet yet another mental health strategy with uncomplicated optimism. Not because the goals are wrong. Quite the opposite. The problem is that these goals arrive in a system already stretched past what is reasonable, with too little money, too few staff, and too many people waiting too long for help.
A mental health strategy is not care
Strategies matter. They can set direction, create accountability, and remind large systems what they are meant to be for. But a strategy is not a therapy session, a hospital bed, a community support worker, a crisis team, or a safe place for someone to be when they are terrified, suicidal, psychotic, withdrawing, overwhelmed, or alone.
That distinction matters because mental health policy in New Zealand has too often been very good at producing aspiration, and much less good at producing access. We have become used to worthy language about wellbeing, early intervention, lived experience, integration, prevention and recovery. None of these words are wrong. In fact, they are often exactly right.
Yet if the person who needs help cannot get an appointment, or the family trying to keep someone safe is told there is no service available unless things get worse, the language starts to feel hollow.
Eliminating seclusion is the right goal
The commitment to eliminate seclusion is important. Seclusion is not a neutral clinical tool. It can be frightening, humiliating and traumatic, particularly for people who have already experienced violence, neglect, racism, institutional harm or loss of control over their own lives.
At the same time, simply declaring an end to seclusion does not make the conditions that lead to it disappear. Seclusion often happens at the sharpest edge of an under-resourced system: acute distress, fear, staff trying to manage risk, too few options, too much pressure, and not enough time or support to do the careful relational work that prevents escalation.
To be clear, this is not an argument for keeping seclusion. It is an argument for being honest about what it takes to stop using it. Services need enough trained staff, decent environments, strong clinical leadership, community alternatives, culturally safe care, and the time to build trust with people who may have every reason not to trust the system.
If those things are not funded and staffed, the risk is that coercion changes shape rather than disappears.
Trying to do too much with too little
One of the difficulties with broad mental health strategies is that they can become a container for almost every hope we have for society. Better prevention. Better addiction treatment. Better crisis care. Better workforce planning. Better support for children and young people. Better support for Māori, Pacific peoples, rural communities, rainbow communities, older people, families and whānau.
Again, none of these priorities are wrong. The problem is that when everything is a priority, the hardest choices can be avoided. And when those choices are avoided, frontline services are left to absorb the contradiction.
Clinicians and support workers are then asked to provide more responsive, more humane, more culturally appropriate and more accessible care while also carrying impossible caseloads, covering vacancies, managing risk, and coping with the moral distress of knowing what people need but being unable to provide it.
I have written before about the way institutions can fail without needing to imagine bad intent from every person inside them. The issue is often the culture and incentives of the system itself, something I explored in this earlier piece on institutional denial. Mental health services are full of people doing their best. That does not make the system adequate.
Good policy needs enough people to carry it
Workforce is not a side issue. It is the service. Without psychiatrists, psychologists, psychotherapists, nurses, peer workers, addiction practitioners, social workers, cultural workers, support workers and community organisations, a strategy remains a document.
And workforce cannot be conjured quickly. People need to be trained, supervised, retained and paid properly. Services need to be workplaces people can survive in, not just places sustained by goodwill and exhaustion.
So yes, we need a national mental health strategy. We need the ambition to end seclusion. We need a system that is more humane, more accessible and less dependent on crisis. But we also need the honesty to say that ambition without investment is not reform. It is another way of asking already stretched people to make the impossible look manageable.
That is why my response is not cynicism, exactly. It is concern, and disappointment. The direction may be right. But for the people waiting, the families frightened, and the workers exhausted, the question is not whether the strategy says the right things. It is whether anyone will give the system what it needs to actually do them.
