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More Money, Less Care, More Tragedy

Wednesday 12 May 2004

Heather Roy - Speeches

Mental Health Speech; ACT 'Breakfast at Bellamy's'

The topic I am about to speak on is not what would be called `polite breakfast conversation'. It isn't, what we in politics would call, a sexy story, and you can feel free to groan when I tell you that I'm going to talk about mental illness - I can assure you, however, that it is a subject which improves with acquaintance.

Most New Zealanders only really become interested in mental illness when it affects someone close to them, or when a brutal tragedy occurs as the result of inadequate treatment. Then the headlines reinforce what everyone already thought they knew about the dangerous mentally ill.

Just as an aside, the mentally unwell commit only marginally more crime than the general population.

It is the Labour Government's failure to provide anything that even approaches a reasonable mental health system, which has prompted me to speak out about this today.

The size of the mental health sector is often overlooked, but it is a major area of public spending. . This financial year, the Government will spend around $800 million on mental health. This amount has been rising steadily since 1993 and, at the current rate of increase, we can expect it to pass $1 billion by the end of the next Parliamentary term.

So how do we compare internationally? Well, we currently spend more per capita on mental health than Australia or the US. And this excludes spending by the Corrections Department to create "special units" - which are, in reality, psychiatric wards within the prison system.

But we are not getting value for money. The greater Wellington Region has been plagued with problems since the closing of Kenepuru Hospital's Te Whare O Rangatui psychiatric ward in July 2002. This ward had 22 acute inpatient beds, leaving 28 beds for a population of 250,000 at Wellington Hospitals Newtown site - Ward 27. While the number of beds has risen to 30, the ward is still frequently overpopulated - with patients sleeping in corridors, ward lounge areas and, most recently, the Ward 27 telephone booth. Management is quick to say that these patients always sleep on mattresses - as if that makes it all right. You can imagine the public outcry if a patient in any other part of the hospital were expected to sleep on a mattress on the floor.

The Government is very proud of the `Like Minds' advertising campaign, which features famous New Zealanders - like Ian Mune and John Kirwin - who have suffered from mental illnesses. It is a multi-million dollar campaign aimed at de-stigmatising mental illness. Powerful advertising, yes, but allowing psychiatric patients to sleep on the floor tells them exactly where they are in life's pecking order.

Back to the Wellington Region: overcrowding makes a nonsense of the extra security measures implemented after a patient absconded and climbed into Wellington Zoo's tiger's enclosure. Not long afterwards, Chad Buckle slipped out of the Wellington Hospital Psychiatric ward and was found dead in the grounds of Wellington College. And, only two short weeks ago, a suicidal patient suffered serious injuries after jumping off a six-story building. The response is yet another inquiry, and the bussing of some patients to Palmerston North Hospital. Meanwhile the psychiatric ward at Masterton Hospital has been downgraded (from a six-bed inpatient unit) so that it can no longer take acute patients. Wairarapa patients needing hospital care now come to the already overcrowded Wellington Hospital.

So why, when the budget is rising rapidly, are nursing staff driven to such desperate measures as putting patients in corridors and phone booths? The answer lies in mis-management and systemic failure. Our health professionals dealing directly with patients are well trained and dedicated. But the system they must work in, and which patients have to suffer, is another example of the errors of central planning.

Here's an example: at any given time, a number of patients are in psychiatric wards around the country inappropriately - they just have nowhere else to go, or aren't able to function independently. While sheltered accommodation exists for these patients, the hospital has no authority in this area and cannot require them to take patients. The result is a lack of co-ordination. The Health Ministry also applies the unusual method of reimbursing hospitals, which receive a flat rate per person employed. The more highly qualified the employee, the more unprofitable they are. Being more highly paid, doctors are particularly unprofitable. In "I've Been Thinking", ACT Leader Richard Prebble pointed out that there is a general tendency for commercial enterprises to use small numbers of highly paid professionals, and a general tendency for Government departments to use large numbers of unskilled labour.

These problems are not confined to Wellington. Monday's New Zealand Herald contained an article entitled "Mental Health Access Dips Despite More Funds", showing that access to treatment for serious mental illnesses has grown slightly worse despite more Government spending and plans for expansion.

The Mental Health Commission has also released figures showing that, in the six months to June 2003, 1.6 percent of the population was seen by specialist mental health services compared to 1.7 percent in the first half of the previous year. It is estimated that three percent of the New Zealand population has a severe mental illness. The Health Ministry's Blueprint - the model used to calculate funding - assumes that three percent of New Zealanders will require specialist treatment in any six-month period. We are only treating just over half of those needing treatment. This is appalling.

The reality is that no one has done a good job of mental health. National provided the same type of service as Labour has. The inability to treat all of those with a severe mental illness is no different from the Soviets queuing for bread outside supermarkets.

But ACT has some answers:

Voluntary patients can be treated the same way as anyone with a physical health problem, and there is no reason why the State must provide the care. Health insurance could well cover many psychiatric conditions. We should be looking to treat people where they get the best quality treatment at the best price.

Compulsory patients, however, are more difficult. They frequently refuse to acknowledge that they require treatment. They also often deny that they are a danger either to themselves or others - or sometimes both. Because they must be treated under the Mental Health Act, and the justice system plays a role, State funding for their treatment is appropriate.

What is currently missing from the equation is the priority being placed on the treatment of patients. Increased funding has resulted in less care, and a fragmented and dysfunctional mental health system. If the emphasis were on packages of care for the real problems patients face - rather than bed and staff numbers - we would have a healthier population and patients with dignity. Then, maybe, we could tackle the stigma attached to mental illness.

As Opposition health spokesman in the late 1990's, Annette King was very critical of the then Health Minister and said this of the mental health system:

We see a `cycle of tragedy - followed by investigations - then recommendations which appear to make no difference - then frustration - followed by rounds of people blaming each other - and finally another tragedy to kick-start it all off again'.

In her opinion, this was:

`no way to run a health system. The Minister must make good his statement that mental health is a priority.'

Well, Annette King has had five years to do better. She has poured more money in, but is providing a worse service. Her legacy to mental health in New Zealand will be the promise of fragmented care to just over half of the seriously mentally ill. The lucky ones get to sleep on hospital floors and ward phone booths. The others have to fend for themselves while their families and the rest New Zealand hopes they don't start the `cycle of tragedy' all over again.


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