The Aotearoa New Zealand Association of Social Workers (ANZASW) broadly supports the findings and recommendations of the newly-released Report of the Government Inquiry into Mental Health and Addiction - He Ara Oranga.
The publication of this report, following months of extensive consultations with the public and input from service users, organisations and other interested parties- including ANZASW- marks an opportunity to make lasting changes to an overburdened and under-funded system which has too often been failing consumers and staff; despite the dedication, hard work and professionalism of the latter.
The Association is pleased to see that many of the recommendations of the report are in line with our submission and address the concerns of members providing mental health and addiction services.
Reform is overdue. As we stated in our submission, there has been a long-standing need to increase equitable access to services for persons experiencing mental health or addictions issues at an earlier stage, as a means of supporting early recovery and preventing crisis, especially for children / tamariki and young adults. This is particularly so for those from minority communities and / or lower socioeconomic groups, which experience higher than average statistical rates of addiction and poor mental health.
As we also observed, there is an urgent need to increase levels of cultural competency and understanding from professionals in the mental health and addiction system, to ensure that minority groups are satisfactorily consulted, respected, listened to and informed about their own, or their family / whānau’s, treatment in full knowledge of their options, rights and obligations. The means to realise this are not limited to professional development: for example, magnifying the voice of consumers with a depth of lived experience within the system, particularly those from minority communities, would be an important step.
The inability of the system to provide some of the above, as we noted in our submission, is a reflection of the fact that services are under-resourced and under-staffed. The consequences of this lack of capacity are witnessed by our members on a regular basis, who report that people experiencing moderate to severe mental health or addictions issues are often deprioritised by a system that is struggling to cater to their needs, many of whom only get the support they require when they reach breaking point. This has obvious implications for suicide prevention.
We strongly believe that to reduce the high suicide rate in Aotearoa New Zealand, the availability of
community and health resources needs to be expanded, particularly for marginalised groups and / or those in isolated regions of the country. For this to be achieved there will need to be increased coordination between individuals, families, whānau, communities, employers, the media and Government agencies in developing localised services, alongside efforts to promote connectedness and awareness of risk / protective factors across society.
We are satisfied that many of the points we raised in our submission appear to have been acknowledged by the report; for example, we are pleased to see that our view that addiction should be primarily be treated as a healthcare, rather than a criminal issue, adopting a “treatment first” approach, is echoed in the paper and that it recognises the need for a greater understanding of the social determinates of health within the system.
However, we regret that our recommendation that more social workers should be present in the system, particularly in primary health care, has not been explicitly endorsed. Similarly, we feel that greater preparedness for upscaling services in the event of natural disaster appears not to have been sufficiently considered by the authors.
Other concerns include the need to improve services to those living in rural communities, or who are socially isolated, and providing culturally responsive interventions to service users from a diverse range of communities. While one can infer from some of the findings and recommendations that capacities in these areas might be strengthened on implementation, few concrete measures have been proposed.
We regret that the report appears not to have fully explored the value of funding programmes such as the proposed "youth hub" in Christchurch / Otautahi, which can increase connection and help to end isolation among young people and children while providing important social services. Such measures would help to address the levels of reported loneliness for young persons, which is likely to be contributing to the high rates of youth suicide in this country, particularly for those experiencing social exclusion.
On the subject of suicide, while the report notes the troublingly high numbers of attempted and actual suicides annually, little is said in detail about how exactly these trends can be reversed; as a result it is difficult to anticipate what government measures may be forthcoming or the implications this will have on our profession and those we work with.
In general, the Association feels that the report could have spent more time exploring the over-reliance on medical models of treating mental health and addictions issues. As social workers we understand that social determinates such as inequality and poverty are very often of equal significance in producing poor physical and mental health outcomes.,
While social factors are acknowledged by the report authors as playing a role in driving demand for services, we feel that specific proposals about how to mitigate the effects of structural disadvantage on consumers would have complemented the other recommendations contained in the paper.
In addition to this, we take the view that a comprehensive road map outlining priorities and possible sequencing for further action was lacking from the report, which leaves open the possibility that speedy implementation will be hampered by debates over how precisely to apply the recommendations.
ANZASW member and PhD social work researcher Eileen Joy commented that “I am pleased to see that the overall tone of the report is to stop with the disinvestment in mental health that has been going on for the past decade.”
“As a volunteer counsellor with Youthline I have personally witnessed the toll such disinvestment has had on employed and volunteer staff. I am especially looking forward to renewed investment in the mental health of our young people so that young people get the help they need and organisations do not have to rely on the goodwill of staff and volunteers to continue their valuable work long past the hours they are either contracted to, or able to, provide,” she added.
Natana Taare, an experienced social worker in Community Mental Health for Ngāti Porou Hauora, reflecting on the paper, told ANZASW: “I’m happy with much of the report. I’ve seen many reviews in my career which simply ticked boxes and did not promote serious reform, but I’m hopeful about this one.”
However, he noted: “I still think there needed to be greater emphasis on improving services for those in rural areas, such as providing a 24 hour crisis service with rapid response capacity in places like Ngāti Porou and the rest of the East Coast on the North Island.”
“Staff retention in these areas is a huge issue, we rely heavily on people from out of town and need to recruit more from the local community [in order to improve response times],” he continued.
“I’m particularly interested to see how the recommendations on cultural competency will be realised and how this will improve relations between professionals and consumers, in particular Tangata Whenua,” he added.
On the subject of cultural competency, the Association is disappointed that, while the report has rightly considered Māori and Pacific concerns and perspectives, it has neglected to focus adequately the needs of the diverse and growing Asian communities within Aotearoa New Zealand and the importance of being able to engage effectively with them so as to tailor services to improve outcomes.
Finally, we agree that “mental health and addiction problems cannot be fixed by government alone, nor solely by the health system,” and that there is a need for all New Zealanders as a society to be more responsive to the signs of declining mental health and / or addiction issues in their communities.
It is up to all of us to embody the changes we wish to see in our society.