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Social Experiments No Solution For Mental Health Care

Social Experiments No Solution For Mental Health Care

By Mark Henrickson, Shirley Jülich and Ksenija Napan

Recently the public was quietly exposed to the concept of ‘social bonds’. According to the Ministry of Health, social bonds partner private and not-for-profit organisations in order to fund and deliver services to improve social outcomes. If they achieve agreed results, the Government will pay investors back their investment plus a return. This concept has been floating around New Zealand since 2013. We have yet to see the full plan, but we are deeply concerned by what we have heard so far.

Mental health disorders are the third leading cause of health loss for all New Zealanders. Women are 1.6 times more likely to have been diagnosed with a mental health disorder than men. Clearly mental health disorders require careful policy attention.

According to the Ministry of Health’s own data, Māori and Pasifika account for nearly half of people with mental health disorders in New Zealand. It appears that the New Zealand Government is proposing to carry out a very large social experiment on already vulnerable and marginalised communities.

Social bonds are an extension of a neoliberal agenda that holds government should get out of providing care for people, and that the private sector provides more efficient solutions and more effective incentives. Treatment success, for this government, means putting people in work.

While we do not dispute the value of meaningful work, this measure assumes not only that there is adequate meaningful work to do, but that employers are willing to take on individuals with mental health histories. There are some excellent programmes in New Zealand that return people with mental health histories to work, but such programmes ensure that there is adequate training and support for both employee and employer.

If employment is government’s outcome measure of success, resources would be better spent identifying best practice models of preparation for work, expanding and replicating them, addressing stigma, and incentivising employers to hire and retain employees with mental health histories.

The proposed $28.8 million social bonds initiative assumes that mental health care agencies are somehow insufficiently motivated by caring for clients, and require the threat of financial penalty in order to ‘sharpen their minds’. But outcomes and success are difficult to measure in mental health care. What is the measure of success for a high-needs client whose weekly goal is to take a shower, or to use the toilet rather than soil their clothes or the floor? There are many high-needs clients—not only with chronic mental health disorders, but also with accompanying challenges of substance misuse, brain injury, other physical health conditions, or with complicated legal and forensic histories perhaps due in part to their mental health issues.

Social workers, counsellors, nurses, psychologists, psychiatrists, physicians and other care and support staff work daily with such clients to achieve small, barely measurable successes because they are committed to the work of caring — not financial profit. If the Government wants mental health agencies to prove that they are efficient and effective, then resources could be better spent matching technical assistance to agencies to help them develop evaluation plans and measures that will appropriately demonstrate the incremental successes that occur.

If New Zealand wants to be a world leader in effective and efficient mental health care, we need to commit resources where they will be most effective: assisting mental health agencies to develop evaluation models, addressing stigma, incentivising employers, and above all consulting with sector stakeholders about ways to improve services. Social experiments are not the solution.

Dr Mark Henrickson, Dr Shirley Jülich and Dr Ksenija Napan teach and research in the School of Social Work at Massey University in Auckland.


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