Final report from Mental Health & Addiction Inquiry released
Mon 17 Dec 2018
The Government has released the final report from the Inquiry into Mental Health and Addiction. The report, He Ara Oranga: Report of the Government ...
The Government has released the final report from the Inquiry into Mental Health and Addiction.
The report, He Ara Oranga: Report of the Government Inquiry into Mental Health and Addiction (2018) provides an overview of the Inquiry process and feedback and sets out the 40 recommendations of the Inquiry Panel.
In terms of their approach, the Panel states they chose to be "guided by the needs of people and communities rather than the preferences of the various groups accustomed to the way the system is structured and services are delivered at present." (page 8) They also said "Rather than develop a strategy or lay out a ‘shopping list’ of new services to be funded, we have analysed the underlying reasons why New Zealand’s mental health and addiction system has not really shifted over the past two decades."
The report notes:
"there was a striking degree of consensus, from most parts of New Zealand society about the need for change and a new direction: an emphasis on wellbeing and community, with more prevention and early intervention, expanded access to services, more treatment options, treatment closer to home, whānau- and community based responses and cross-government action." (page 7)
The 40 recommendations are grouped into nine areas, each with a specific chapter in the report:
- Expand access and choice
- Transform primary health care
- Strengthen the NGO sector
- Enhance wellbeing, promotion and prevention
- Place people at the centre
- Take strong action on alcohol and other drugs
- Prevent suicide
- Reform the Mental Health Act
- Establish a new Mental Health and Wellbeing Commission.
- Whakawātea te Ara - discusses pathways to improve health and wellbeing for Māori
- Vai Niu - a vision of Pacific mental health and wellbeing.
The report proposes that a Mental Health and Wellbeing Commission would act as a watchdog and provide leadership. The Panel also recommends repealing and replacing the Mental Health Act 1992, to "reflect a human rights approach, promote supported decision-making and align with a recovery and wellbeing model, and minimise compulsory or coercive treatment." The report calls for urgent development and implementation of a national suicide prevention strategy, with a target of a 20% reduction in the suicide rate by 2030.
The report drew on extensive public consultation. More than 2000 people attended public meetings, more than 5200 submissions were made, and more than 400 meetings with tāngata whaiora ("people seeking wellness" including service users and consumers), their families and whānau, other members of the public, health and other service providers, Iwi and Kaupapa Māori providers, community organisations, researchers and other experts. The inquiry panel also examined a stocktake of services and a report commissioned from the University of Otago.
Considerations of violence and abuse in the report
The Panel and their reports of public feedback discuss the overlap of mental health issues with sources of trauma, deprivation and inequity including family violence and child abuse. The report states:
"Many people referred to over-medicalisation or, simply, medicalisation of mental health responses as inappropriate, inconsistent with holistic world views (particularly Te Ao Māori and Pacific world views), and dismissive of the broad array of social determinants of mental distress. ... There was strong discontent across submissions about the ease with which help-seeking was often met with only a prescription, instead of a breadth of accessible, community-based, timely, holistic options. People sought options and choice: more talk-based therapies, peer-led services, trauma-informed therapy, addiction services that are not wait-listed, early intervention services, maternal mental health services, Kaupapa Māori services, Pacific-led solutions, wrap-around services, and an emergency bed for the night." (page 55)
The Panel notes:
"While evidence exists that trauma is a major factor in the lives of many people with more serious mental distress or addictions, we do not provide comprehensive trauma-informed responses, nor do we offer appropriate psychological and talk therapies." (page 79)
The vision the Panel sets out includes:
"Access to mother and baby services will be widely available so that there is the maximum opportunity to support mothers with mental health and addiction challenges early to minimise the harm to their child. Support will be wrapped around mothers and their children and provided in a way that maximises their ongoing engagement.
... Young people who have experienced abuse or trauma or are in care will have access to a full range of immediate and comprehensive support and interventions, seeking to avert long-term adverse impacts. Trauma-informed responses will underpin all interventions and services." (page 91)
In Chapter 7, the report highlights family violence and child abuse and neglect as one of several major social determinants of health and mental wellbeing. The recommendations in this chapter focus on a whole-of-government approach to wellbeing, prevention and social determinants and facilitating mental health promotion and prevention.
The report, including the executive summary and recommendations, is available in a number of formats and languages. Additional summary documents, commissioned reports and summaries of feedback will be published in the future.
“We are working our way carefully through the 40 recommendations and will formally respond in March. I want to be upfront with the public, however, that many of the issues we’re facing, such as workforce shortages, will take years to fix. Reshaping our approach to mental health and addiction is no small task and will take some time. But I’m confident this report points us in the right direction, and today marks the start of real change for the better."
The media release from the Inquiry noted that the work of the Inquiry panel is now complete and the Chair and Inquiry panel members do not intend to make further public comment on the report.
Media has reported a wide range of responses to the report. Many have welcomed the report; criticisms and concerns have also been raised.
Radio NZ reported that Mental Health Foundation Chief Executive Shaun Robinson warned the government cannot "cherry pick" from the recommendations, saying "The thrust of this report is for a fundamental transformational change, where we move away from thinking of mental health as psychiatric illness, to thinking of it as the well-being of the community."
Lizzie Marvelly called for a sharp and "visionary" response from Government, saying:
"The era of the ambulance at the bottom of the cliff needs to end as quickly as possible. We need to build not only fences to prevent people from falling into the abyss, but also launching pads to help them to flourish. Mental health shouldn't just be the absence of diagnosable illness. It should be living a life in which you can thrive."
Child Poverty Action Group called the report a "comprehensive and substantive response to the wide ranging submissions, with commendable focus on prevention, and notably on the impacts of poverty on children’s mental health."
Māori advocates have criticised the report for failing to adequately address issues for Māori. Academic Dr Waikaremoana Waitoki said while there were some positives, "The 40 recommendations missed an opportunity to promote Maori-led, sustainable solutions that will save, and improve Maori lives. Maori need bold recommendations, not sprinkles of rhetoric." She also said "The report needed to link the structural racism that impacts on Maori mental health and addiction." She highlighted a lack of takataapui and wāhine Māori voices in the report and called for Māori leadership across the recommendations and within the proposed Mental Health and Wellbeing Commission.
Waatea News reported that Chief Executive of Te Rau Matatini Maria Baker also said Māori voices didn't come through in the report, commenting: "If there’s going to be some radical change and improvement of our situation as whānau, hapū, iwi, the crown needs to speak directly with Māori. ... I don't think it's clear in this report that those radical changes need to happen."
Others also criticised the "one-size fit all" approach of the report, including Māori suicide prevention project leader Michael Naera. The Māori Council and National Māori Authority are calling for the Government to establish a Māori Mental Health, Suicide Prevention and Addictions Authority, with National Māori Authority Chair Matthew Tukaki expressing disappointment that the Inquiry "came nowhere close to bringing to the fore the voices of Māori in what is widely recognised as a system that has completely failed our people."
Journalist Indira Stewart has written an investigative report for Radio NZ exploring mental issues health among Pacific people, called Together Alone: New Zealand’s silent Pasifika mental health crisis.
Public feedback during the inquiry indicated that many government agencies can cause or exacerbate trauma such as Oranga Tamariki - Ministry for Children, schools, New Zealand Police, Department of Corrections, Work and Income New Zealand and mental health services. Radio NZ reported that Oranga Tamariki does not collate information on how many children in state care have mental health issues or have attempted suicide. Psychiatrist Siale Foliaki said:
"If we think that we can do it better, then you should see a reduction in those types of statistics going forward. But how can you make those comparisons if you don't have that information? You don't know where you're starting from."
Advocate Paora Crawford Moyle has called on the government to address the mental health and wellbeing of children in state care.
Some families of suicide victims said the report hadn't uncovered anything new and didn't go far enough, but did welcome the proposed establishment of a Mental Health and Wellbeing Commission. Another family criticised the proposed target of reducing suicide rates by 20% when the Prime Minister had previously discussed a target of zero. Hinemoa Elder, a psychiatrist and family member of a suicide victim, questioned why any level of preventable death was acceptable.
A significant focus of the report examines support through primary care and the NGO sector. GP Cathy Stephenson called for a wide focus focused on prevention, early identification and intervention, understanding the links between adverse childhood events, social issues and mental illness.
Research on mental health issues, addictions, trauma, violence and abuse
The Clearinghouse published a reading list on the links between abuse/violence, trauma, mental health issues and addiction.
The Health Quality & Safety Commission has published a new report, Ngā Poutama Oranga Hinengaro: Quality in context (2018), summarising results from a survey of 2500 people working in mental health and addiction services. The survey looked at how tāngata whaiora (consumers in these services) are treated including cultural appropriateness of services for tāngata whaiora Māori, and coordination of care between services.