cost of caring

The Cost of Caring

Apparently mental health consumers aren’t motivated enough to get back to work, but worry not, private investment funds and profit driven goals are just the stick the chronically lazy nutters need to get them back to the minimum wage grind.

The Government this weekend announced (in a fevered moment of neo-liberal euphoria) that they would be widening the scheme piloted within WINZ to allow for private investment in mental health care.

Early concerns have of course focused on the obvious negative effects such schemes can (and already have) had in creating “perverse incentives.”   In essence there is a high risk for abuse when you shift the goal away from achieving health outcomes, to achieving economic outcomes, for vulnerable people.

There are three obvious problems:

  1. Organizations, under pressure from investors and stakeholders to achieve targets shy away from helping the most difficult, unwell or otherwise needy individuals, because the risk of failure is too high.  This means that those that likely needed less help get it, and those who are more needing of assistance don’t.
  2. The motivation to achieve a simple single dimension (decrease unemployment in mental health consumers) reduces a complex problem down to a single outcome.  It can create situations where people are bullied into unsuitable work, set up to fail and ultimately be worse off, while the financial target is reached.
  3. Organizations simply “game” the system.  We’ve seen this with elective surgery incentives, to achieve percentage targets people were simply removed from the waiting list, again creating a situation where individual health outcomes were made worse, but the target was achieved.


But apart from the practical problems, there are aspects of the underlying philosophy that once you start to think about it, are deeply offensive.  The idea that “work is the definition of health” is one we are familiar with from this governments approach to beneficiaries, and one I have talked about in detail before (see: Back to Work), but in addition to this, utilizing incentives to get mental health consumers back to work of course implies that they need an incentive.

It frames mental health, and it’s associated difficulties, as behavioural and in doing so further stigmatises consumers.

And as we have already seen with WINZ, the approach of putting more pressure on people to achieve “desired outcomes” creates a negative spiral where consumers end up feeling bullied and frightened, and therefore less likely to engage in help.

But by far the biggest concern is that this is the beginning of a long term plan to “privatise by stealth.”  This is being sold as an investment opportunity, because the Government is selling off, contracted chunk by contracted chunk, our publicly funded social support services.

So to be opposed to privatisation; to be opposed to further asset sales; to be opposed to the commodification of the suffering of our fellow New Zealanders: is to be opposed to Social Bonds.

But if you believe the rhetoric, as a nation we simply can’t afford to care anymore.

Leave a Comment

  • graham johnson June 2, 2015, 10:57 pm

    I concur wholeheartedly – after 25 years on an invalids benefit, I took the plunge and took on work. I work as a networker for tangata whaiora/mental health and addiction service users. I am fully supported in my work, not only by my employer, but also by the people with whom I work. This is probably the only environment in which I could sustain the level of effort and energy required to work full time as I now do. I dread to think of the mental stresses on people who are made to seek employment in the general work force with little or no support systems in place for them. Listening to Jonathon coleman on the radio this morning, I was appalled to hear him speak of “good outcomes” only in financial terms as if the health and wellbeing of mentally distressed people had no place in new zealands’ social constructs. One would almost wish for mr coleman to experience chronic mental illness so that he could experience the hopelessness and debilitation caused not only the illness itself, but also the crippling effects of the medical “remedies” that almost always accompany such illnesses – graham johnson

  • Jeff Hickman June 3, 2015, 8:58 am

    There are so many aspects of despair and loss for someone who is mentally ill, brain damaged or other major physical damage, or suffered a stroke etc, that it is just horrific to contemplate what the National Party is suggesting. Each day, a peson in these catagories have different as outcomes. And that’s just trying to do housework, chores and remembering what they’re meant to be doing. I personally often end up in bed, totally hitting the wall and for no known reason. I’d have to be given a job with a bed next to it. It’s hard enough to get work for the unemployed, physically and mentally well people, as we’ve seen historically.

  • Jazmine Bell June 3, 2015, 10:37 am

    I am on the Invalids Benefit because even as the panel set up by Internal Affairs to listen to people who were abused whilst in the care of the system, I have been left disabled by all the abuse I suffered whilst growing up. My labels are D.I.D and PTSD, the idea of putting someone like me with high trauma into that system would re traumatise me and set back all the therapy, the therapy has been about how to live with my symptoms,not about working in a system that is not supportive.

  • Susan St John June 3, 2015, 2:04 pm

    Can someone clarfiy if I have this right.
    Social bonds are issued by Govt and the money is given to private providers to hassle the mentally unwell into work. Investors who provided the money and hold the bonds will only get repaid if goals are acheived and if goals are acheived they will also get interest.
    No one in their right mind would buy the bonds if the capital was not guaranteed unless, maybe, there was an exoribitant rate of interest offered. This makes it a very specualtive asset with all the perverse incentive discussed in the article. If only the captial is guaranteed the risk of a nil return is high so the rate of interest on the face value of the bond will be well above market rates. If the contractis fullfilled the government repays the bonds ( the cost of the service) and a hefty return as well. That is, the price the govenrment pays will be well above the cost of provison. How is this “innovative Financial prodcuct” going to work?? Please help

  • Lila Nixon June 4, 2015, 12:59 pm

    Madness resides in the policy proposal!
    I found this US website. It sets out what employers would need to do to employ autistic people like my very smart grandson; he would love to have a job. The conditions set out do not happen here nor can I see them being required of nz employers.

    [PDF]Employees with Asperger Syndrome Accommodation and ……/accommodationandcomplianceseries-employeeswithaspergersyn…
    The Job Accommodation Network (JAN) is a service of the Office of Disability … AspergerSyndrome is one of several categories of autism spectrum conditions …

  • Liz Manson June 8, 2015, 9:13 am

    From my decade of experience of the current mental health system, there is too little funding is already put into ‘real’ treatment for sick people. In 2011 I was at a public lecture given by an eminent NZ Psychiatrist, he opened his discussion by jokingly saying there are often no beds for the mentally ill person assessed as requiring hospital care. Yeah that’s really funny, especially if it’s you or someone you care about.
    In my experience after 8 years of ‘treatment’ by a community mental heath team I received a letter of apology from the Nurse Manager, acknowledging my ‘years of great suffering’ and apologizing for ‘not offering me any meaningful assistance’.
    My decade of experience of the mental health system involved basically being told to get lost, we’re too busy, go away, we’re too busy for your illness. My Crisis Nurse told me that if I wasn’t prepared to help myself, she couldn’t help me. This from a Crisis Nurse.

TO BUY MY NEW BOOK "Shit Happens: Lessons for Dealing with Life's Ups and Downs"... CLICK HERE