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Taking mental health and addiction seriously

Rt Hon Jacinda Ardern
Prime Minister
Hon Dr David Clark
Minister of Health
EMBARGOED UNTIL MIDDAY

29 May 2019 PĀNUI PĀPĀHO
MEDIA STATEMENT
Taking mental health and addiction seriously

The Government’s response to He Ara Oranga (the report of the Inquiry into Mental Health and Addiction) shows just how seriously the Government is taking mental health and addiction says Prime Minister Jacinda Ardern.

The Government has accepted, accepted in principle, or agreed to further consideration of 38 of the 40 recommendations of the Inquiry Panel.

“The Inquiry into Mental Health and Addiction laid down a challenge to the Government and to all New Zealanders. We need to transform our thinking and approach to mental health and addiction – and that is what we are committing to today,” Jacinda Ardern said.

“We all know people who have lived with mental health and addiction challenges. This touches every community and every family and we must do better.”

Inquiry recommendations accepted include:

• Significantly increase access to publicly funded mental health and addiction services for people with mild to moderate needs
• Commit to increase choice by broadening the types of services available
• Urgently complete the national suicide prevention strategy
• Establish an independent commission to provide leadership and oversight of mental health and addiction
• Repeal and replace the Mental Health (Compulsory Assessment and Treatment) Act 1992

“The recommendations of He Ara Oranga are wide-ranging and comprehensive. Delivering on the Panel’s vision of a people-centred approach to mental health and addiction that meets the full range of need will be a major undertaking.

“Just delivering on the first recommendation around services to meet mild to moderate mental health and addiction needs will be transformational.

“We will need to build entirely new services, train hundreds of new staff and build new facilities across Aotearoa.

“All this will take significant and sustained investment. That begins with tomorrow’s Wellbeing Budget but will take years,” Jacinda Ardern said.

Health Minister David Clark says for too long mental health has been considered somehow less important than physical health and that has to change.

“It has been said before, but there really is no health without mental health.

“Supporting and maintaining people’s mental wellbeing must become part of the daily routine of our health services. When New Zealanders are in distress they need to know there is appropriate support available and it has to be easily accessible.”

The Government rejected two of the Inquiry’s recommendations:

• Directing the State Services Commission to report on options for creating a ‘locus of responsibility’ for social wellbeing within Government
• Set a target of 20% reduction in suicide rates by 2030

Health Minister Dr David Clark said all of Government needs to be focused on social wellbeing and it does not need its own separate agency.

He said the question of a suicide target was considered at length, and as acknowledged in He Ara Oranga, views are mixed about establishing a target.

“We’re not prepared to sign up to a suicide target because every life matters, and one death by suicide is one death too many.

“This Government is committed to tackling our terrible record on suicide. The Ministry of Health is in the process of finalising a draft suicide prevention strategy and is working on options for an office of suicide prevention.
“There are no quick-fixes for these issues. The drivers of mental health and addiction issues are deep seated and long standing, but as a Government we are committed to tackling them.

“New Zealanders in distress deserve our support, plain and simple,” said David Clark.



#Theme / recommendationResponseRationale for response
Expand access and choice
Expand Access
1Agree to significantly increase access to publicly funded mental health and addiction services for people with mild to moderate and moderate to severe mental health and addiction needs.Accept• The Government supports expanding both access and choice of mental health and addiction responses that are appropriate across the needs spectrum and the life course.
• Measuring increases in access will be important to track progress; however, while this can tell us how many people are accessing treatment, it will not capture how well services are delivered and whether anyone is better off.
• Longer-term transformation planning will consider a mix of measures to improve both access and outcomes.
• The involvement of a new Mental Health and Wellbeing Commission is contingent on decisions around its establishment, timing and scope.
• The Government supports broad access to mental health and addiction services appropriate to people’s levels of need, and acknowledges the importance of simultaneously maintaining services for those with the highest need.
2Set a new target for access to mental health and addiction services that covers the full spectrum of need.Accept in principle
3Direct the Ministry of Health, with input from the new Mental Health and Wellbeing Commission, to report back on a new target for mental health and addiction services.Accept in principle
4Agree that access to mental health and addiction services should be based on need so:
• access to all services is broad-based and prioritised according to need, as occurs with other core health services
• people with the highest needs continue to be the priority.
Accept
Increase choice of services
5Commit to increased choice by broadening the types of mental health and addiction services available.Accept• Current services do not work well for all New Zealanders. The Government supports expanding both access and choice of mental health and addiction responses that are appropriate across the needs spectrum and the life course.
• The Government is committed to the expansion of talk therapies, alcohol and other drug (AOD) services and culturally-aligned therapies. These types of services are supported by a strong evidence base and will be crucial to improving equity for Māori, as well as Pacific peoples and other population groups that continue to experience poor outcomes.
6Direct the Ministry of Health to urgently develop a proposal for Budget 2019 to make talk therapies, alcohol and other drug services and culturally aligned therapies much more widely available, informed by workforce modelling, the New Zealand context and approaches in other countries.Accept
Facilitate co-design and implementation
7Direct the Ministry of Health, in partnership with the new Mental Health and Wellbeing Commission (or an interim establishment body) to:
• facilitate a national co-designed service transformation process with people with lived experience of mental health and addiction challenges, DHBs, primary care, NGOs, Kaupapa Māori services, Pacific health services, Whānau Ora services, other providers, advocacy and representative organisations, professional bodies, families and whānau, employers and key government agencies
• produce a cross-government investment strategy for mental health and addiction services.
Accept in principle

Accept

• Co-design can be an effective approach for incorporating the voices of stakeholders into transformation; however, a one-off co-design process may not be sufficient to deliver the change that is envisioned.
• Meaningful partnership and ongoing participation with stakeholders to design and implement change is fundamental to a transformed approach. This must be supported by sufficient funding, communication and engagement planning, and strong leadership.
• A cross-government investment strategy is necessary for a cohesive whole-of-government response, and will support a coordinated approach to prioritisation, phasing and implementation.
• The involvement of a new Mental Health and Wellbeing Commission is contingent on decisions around its establishment, timing and scope.


8Commit to adequately fund the national co-design and ongoing change process, including funding for the new Mental Health and Wellbeing Commission to provide backbone support for national, regional and local implementation.Accept in principle
9Direct the State Services Commission to work with the Ministry of Health to establish the most appropriate mechanisms for cross-government involvement and leadership to support the national co-design process for mental health and addiction services.Accept in principle
Enablers to support expanded access and choice
10Agree that the work to support expanded access and choice will include reviewing and establishing:
• workforce development and worker wellbeing priorities
• information, evaluation and monitoring priorities (including monitoring outcomes)
• funding rules and expectations, including DHB and primary mental health service specifications and the mental health ring fence, to align them with and support the strategic direction of transforming mental health and addiction services.


Accept

Accept


Accept in principle

• Workforce development is critical to enable expanded access and choice of services. Currently, workforces are under considerable pressure and will ultimately be both a key enabler and constraint for transformation.
• Monitoring and evaluation of outcomes is essential to ensure transformation is increasing access and choice and improving outcomes, and must be supported by fit-for-purpose, real-time information collection and sharing.
• Funding rules and expectations should enable more integrated planning and support more balanced funding across the spectrum of need.
• These elements have been prioritised for consideration through longer-term transformation planning.
11Agree to undertake and regularly update a comprehensive mental health and addiction survey.Accept in principle• The Government acknowledges the importance of having accurate, comprehensive, up-to-date data on the prevalence, population need and impact of mental health and addiction issues, and on the access to and effectiveness of services. This data is crucial to inform the optimal mix and balance of responses, and to establish a baseline from which to measure progress.
• Further consideration is needed about other ways, in addition to a regular national mental health and addiction survey, to achieve the intent of this recommendation, including opportunities to better share and leverage existing surveys and data sets.
12
Commit to a staged funding path to give effect to the recommendations to improve access and choice, including:
• expanding access to services for significantly more people with mild to moderate and moderate to severe mental health and addiction needs
• more options for talk therapies, alcohol and other drug services and culturally aligned services
• designing and implementing improvements to create more people-centred and integrated services, with significantly increased access and choice.


Accept


Accept


Accept

• Realising the vision of mental wellbeing for all will require bold funding commitments, which will need to be phased over multiple years.
• Commitment to a staged funding path will embed the long-term view needed to give effect to the transformation called for by He Ara Oranga.
• Phasing of investment and implementation will need to take into account current system constraints, including workforce capacity and capability, and the system’s capacity for change, as well as financial constraints. These will be considered in the longer-term transformation planning.
Transform primary health care
13Note that this Inquiry fully supports the focus on primary care in the Health and Disability Sector Review, seeing it as a critical foundation for the development of mental health and addiction responses and for more accessible and affordable health services.Accept• The Government is committed to expanding and enhancing mental health and addiction responses in primary and community settings, enabling broad access to services appropriate to people’s levels of need.
• The system settings, including funding arrangements, needed to give effect to broad-based access to mental health and addiction support (prioritised by need) will be considered as part of the current Health and Disability System Review.
• Future primary health care strategies will be informed by the outcomes of the Health and Disability System Review.
14Agree that future strategies for the primary health care sector have an explicit focus on addressing mental health and addiction needs in primary and community settings, in alignment with the vision and direction set out in this Inquiry.Accept in principle
Strengthen the NGO sector
15Identify a lead agency to:
• provide a stewardship role in relation to the development and sustainability of the NGO sector, including those NGOs and Kaupapa Māori services working in mental health and addiction
• take a lead role in improving commissioning of health and social services with NGOs.
Accept in principle• Several agencies across Government play a role in supporting and guiding improvements in the commissioning of social services, however no single agency currently has stewardship responsibility for the non-government organisation (NGO) sector.
• There are opportunities to improve commissioning and have a more joined up cross-government approach for NGO services through enhancing work currently underway by the Social Wellbeing Board.
• This includes the Ministry of Business, Innovation and Employment’s tools to support streamlined contracting with NGOs, and opportunities for the Ministry of Health to work more closely with the NGO-district health board Partnership Group.
Enhance wellbeing, promotion and prevention
Take a whole-of-government approach to wellbeing, prevention and social determinants
16Establish a clear locus of responsibility for social wellbeing within central government to provide strategic and policy advice and to oversee and coordinate cross-government responses to social wellbeing, including:
• tackling social determinants that impact on multiple outcomes and that lead to inequities within society
• enhancing cross-government investment in prevention and resilience-building activities.
Accept in principle• The Government as a whole has a responsibility for social wellbeing and addressing the social determinants of mental health and wellbeing. We have committed to embedding a wellbeing approach in the way we operate.
• The Government does not support introducing a new specific locus of responsibility for social wellbeing at this stage, as improving wellbeing should underpin all Government activities, as demonstrated by our approach to the 2019 Wellbeing Budget.
• Existing mechanisms and infrastructure can be used to facilitate improved agency and ministerial collaboration. For example, the Social Investment Agency uses data and insights to support strategic cross-government advice on how we can better support people’s wellbeing. These existing options should be exhausted ahead of any machinery of government changes.
• Longer-term transformation planning will consider how best to measure and incentivise cross-government efforts and investment to support social wellbeing and cross-sector outcomes.
17Direct the State Services Commission to report back with options for a locus of responsibility for social wellbeing, including:
• its form and location (a new social wellbeing agency, a unit within an existing agency or reconfiguring an existing agency)
• its functions.
Do not accept
Facilitate mental health promotion and prevention
18Agree that mental health promotion and prevention will be a key area of oversight of the new Mental Health and Wellbeing Commission, including working closely with key agencies and being responsive to community innovation.Accept in principle• The Government acknowledges that there are missing components in the continuum of care, as highlighted in He Ara Oranga, and supports a greater focus on mental health promotion and prevention.
• Taking a strategic approach to improve coordination and quality of health promotion and preventive activities will maximise positive long-term outcomes across health and social sectors. This will be considered alongside recommendation 7 to produce a cross-government investment strategy and related work, for example the development of the Child and Youth Wellbeing Strategy.
• The implementation of these activities as recommended arecontingent on decisions around establishment, timing and scope of a Mental Health and Wellbeing Commission.
19Direct the new Mental Health and Wellbeing Commission to develop an investment and quality assurance strategy for mental health promotion and prevention, working closely with key agencies.Accept in principle
Place people at the centre
Strengthen consumer voice and experience in mental health and addiction services
20Direct DHBs to report to the Ministry of Health on how they are including people with lived experience and consumer advisory groups in mental health and addiction governance, planning, policy and service development decisions.Accept in principle• The Government is committed to placing people at the centre of mental health and addiction services.
• Inclusion of consumer voice in services and resource development is currently inconsistent (eg, variation exists in how DHBs resource consumer advisors). Addressing this will provide clarity and consistency across agencies and will be crucial to understanding progress in transforming our approach.
• Renewed prominence of consumers’ rights, including the rights to be treated with respect, to dignity and independence, and to be fully informed, will raise awareness and embed people’s rights in their care. This is aligned with the New Zealand Disability Strategy 2016–2026.
21Direct the Ministry of Health to work with people with lived experience, the Health Quality and Safety Commission and DHBs on how the consumer voice and role can be strengthened in DHBs, primary care and NGOs, including through the development of national resources, guidance and support, and accountability requirements.Accept
22Direct the Health and Disability Commissioner to undertake specific initiatives to promote respect for and observance of the Code of Health and Disability Services Consumers’ Rights by providers, and awareness of their rights on the part of consumers, in relation to mental health and addiction services.Accept in principle
Support families and whānau to be active participants in the care and treatment of their family member
23Direct the Ministry of Health to lead the development and communication of consolidated and updated guidance on sharing information and partnering with families and whānau.Accept• Family and whānau form an important support network for people with mental health and addiction needs. Evidence suggests people who stay connected to their supports have better outcomes.
• Guidance on sharing information and partnering with families and whānau will enable health care providers to communicate appropriately whilst upholding the rights (including privacy rights) of the person with mental health or addiction needs.
• The Government acknowledges the importance of the roles of the Privacy Commissioner and the current Mental Health Commissioner in this area, and other key stakeholders, and will continue to involve them in ongoing work in this area.
24Direct the Ministry of Health to ensure the updated information-sharing and partnering guidance is integrated into:
• training across the mental health and addiction workforce
• all relevant contracts, standards, specifications, guidelines, quality improvement processes and accountability arrangements.
Accept
Support the wellbeing of families and whānau
25Direct the Ministry of Health, working with other agencies, including the Ministry of Education, Te Puni Kōkiri and the Ministry of Social Development, to:
• lead a review of the support provided to families and whānau of people with mental health and addiction needs and where gaps exist
• report to the Government with firm proposals to fill any gaps identified in the review with supports that enhance access, affordability and options for families and whānau.
Accept in principle• Family inclusive practices aim to collaboratively support people seeking mental wellness, and have a growing evidence base. There are opportunities to partner with providers of Whānau Ora services, Kaupapa Māori services and Pacific-led services to expand whānau-centred approaches.
• Longer-term transformation planning will consider the existing landscape of support provided to families and whānau of people with mental health and addiction needs and gaps.
Take strong action on alcohol and other drugs
26Take a stricter regulatory approach to the sale and supply of alcohol, informed by the recommendations from the 2010 Law Commission review, the 2014 Ministerial Forum on Alcohol Advertising and Sponsorship and the 2014 Ministry of Justice report on alcohol pricing.Further consideration needed• Harmful use of alcohol and other drugs has significant, widespread impacts on individuals, families, whānau and communities.
• The Government agrees with the intent of reducing harm from alcohol and other drugs; however, further consideration is needed as to how best to give effect to this, building on work already underway.
• The Government has committed to shift to a health-based approach and supporting Police discretion in prosecution for possession for personal use; to hold a binding referendum on Cannabis Legalisation; and to increase funding for drug and alcohol responses.
• Given the significant role that alcohol and other drugs play in people’s wellbeing, a strong cross-sector forum dedicated to the advancing AOD policy is critical.
• There are existing mechanisms and arrangements that can be enhanced to provide cross-sector leadership and collaboration in relation to AOD policy.
27Replace criminal sanctions for the possession for personal use of controlled drugs with civil responses (for example, a fine, a referral to a drug awareness session run by a public health body or a referral to a drug treatment programme).Further consideration needed
28Support the replacement of criminal sanctions for the possession for personal use of controlled drugs with a full range of treatment and detox services.Further consideration needed
29Establish clear cross-sector leadership and coordination within central government for policy in relation to alcohol and other drugs.Accept
Prevent suicide
30Urgently complete the national suicide prevention strategy and implementation plan and ensure the strategy is supported by significantly increased resources for suicide prevention and postvention.Accept• A new suicide prevention strategy and implementation plan is needed to drive a reduction in suicide rates, particularly for population groups such as Māori, men, and youth, who currently experience substantially higher suicide rates.
• The Minister of Health will report back to the Cabinet Social Wellbeing Committee with a draft strategy and plan later this year.
• The strategy will outline our proposed approach to preventing suicide in New Zealand and the implementation plan will set out concrete actions to contribute to achieving this.
• Following Cabinet agreement, the strategy and implementation plan will be publicly released. Implementation of the strategy and plan will begin following this.
31Set a target of 20% reduction in suicide rates by 2030.Do not accept
• No suicide is acceptable. To date, there has been a failure to achieve a meaningful reduction in New Zealand’s persistently high suicide rates.
• While a number of countries have set targets and seen reductions in their suicide rates, meaningful reductions have been achieved in other countries without a target.
• A well-resourced, suicide prevention strategy and action plan that emphasises that ‘every death by suicide is unacceptable’ is expected to drive a reduction in New Zealand’s suicide rate.
• Targets can produce unintended outcomes, for example:
o an assumption that the remaining number of deaths by suicide are ‘acceptable’
o a focus on meeting the target rather than implementing sustainable change
o increased inequity
• deliberate inaccurate reporting of deaths by suicide
32Establish a suicide prevention office to provide stronger and sustained leadership on action to prevent suicide.Accept• There is Government and sector agreement on the need to strengthen the governance and leadership of suicide prevention in New Zealand.
• The Government will establish a suicide prevention office to enhance leadership of suicide prevention.
• There is potential for the suicide prevention office to be based within a new Mental Health and Wellbeing Commission.
• The suicide prevention office will initially be housed within the Ministry of Health to lead the development of the suicide prevention strategy and implementation plan. Further work to design the functions, size and location of the office is required and will be considered alongside the development of advice on the form and functions of a Mental Health and Wellbeing Commission.
33Direct the Ministries of Justice and Health, with advice from the Health Quality and Safety Commission and in consultation with families and whānau, to review processes for investigating deaths by suicide, including the interface of the coronial process with DHB and Health and Disability Commissioner reviews.Accept• The Government acknowledges that changing processes for investigating suspected self-inflicted deaths could help reduce the burden and re-traumatisation of families and whānau who have lost their loved ones.
• The current process is lengthy, and there are missed opportunities for better integration of reviews, to better support bereaved families and to prevent suicide.
Reform the Mental Health Act
34Repeal and replace the Mental Health (Compulsory Assessment and Treatment) Act 1992 so that it reflects a human rights-based approach, promotes supported decision-making, aligns with the recovery and wellbeing model of mental health, and provides measures to minimise compulsory or coercive treatment.Accept• New Zealand’s Mental Health (Compulsory Assessment and Treatment) Act 1992 has not kept pace with shifts towards a recovery and social wellbeing model of care, and has never been comprehensively reviewed.
• The legislative process for a complete repeal and replace will take multiple years. While legislative change is underway, the Government will continue to improve services and address issues with applying the current legislation.
• The Minister of Health will report back to the Cabinet Social Wellbeing Committee with the proposed scope, timeframes and resource needed to repeal and replace the Mental Health Act.
35Encourage mental health advocacy groups and sector leaders, people with lived experience, families and whānau, professional colleges, DHB chief executive officers, coroners, the Health and Disability Commissioner, New Zealand Police and the Health Quality and Safety Commission to engage in a national discussion to reconsider beliefs, evidence and attitudes about mental health and risk.Accept
36Establish an independent commission to provide leadership and oversight of mental health and addiction in New Zealand.

Establish the Mental Health and Wellbeing Commission (with the functions and powers set out in Figure 4 in section 12.2.2).

Accept


Further consideration needed

• The Government intends to establish an independent Mental Health and Wellbeing Commission to enhance cross-agency oversight, monitoring and accountability, including providing oversight of the implementation of Government’s response to the Inquiry, and to drive transformation of our approach to mental health, addiction and wellbeing.
• Interim arrangements will likely be needed while the Commission is being established.
• The Minister of Health and Minister of State Services will report back to the Cabinet Social Wellbeing Committee with advice on the functions, powers, form and financial implications for establishing a Commission, including any interim arrangements and a proposed locus for implementation support and options.
• Regular reporting on the progress of Government’s response to the Inquiry will support transparency and help to drive progress. Longer-term transformation planning will consider an appropriate monitoring and reporting mechanism for the Government’s response.
37Establish a ministerial advisory committee as an interim commission to undertake priority work in key areas (such as the national co-designed service transformation process).Accept in principle
38Direct the Mental Health and Wellbeing Commission (or interim commission) to regularly report publicly on implementation of the Government’s response to the Inquiry’s recommendations, with the first report released one year after the Government’s response.Accept in principle
Wider issues and collective commitment
39Ensure the Health and Disability Sector Review:
• assesses how any of its proposed system, structural or service commissioning changes will improve both mental health and addiction services and mental health and wellbeing
• considers the possible establishment of a Māori health ministry or commission.
Accept• The Health and Disability System Review will identify opportunities to improve the performance, structure, and sustainability of the system with a goal of achieving equity of outcomes, and contributing to wellness for all, particularly Māori and Pacific peoples.
• The recommendations for explicit consideration of mental health and addiction, as well as mechanisms for improving equity for Māori, align with the intent of the Health and Disability System Review and the Government’s wider priorities.
40Establish a cross-party working group on mental health and wellbeing in the House of Representatives, supported by a secretariat, as a tangible demonstration of collective and enduring political commitment to improved mental health and wellbeing in New Zealand.Accept in principle• The Government acknowledges the need for cross-party collaboration and collective commitment to deliver on the vision of mental health and wellbeing for all, but considers there are opportunities to enhance existing arrangements to achieve this.
• The Health Select Committee includes cross-party membership and will maintain oversight of significant health topics, including the transformation of our approach to mental health and addiction.
• Cross-party groups have historically proven most effective where they operate outside structures supported by secretariats.


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