Commissioner letter to Health Committee on mental health
1 August 2017
Simon
O’Connor
Chairperson
Health Committee
House of
Representatives
Dear Mr O’Connor
Petition
2014/89 of Corinda Taylor and others
Thank you
for the opportunity to make an oral submission to the Health
Committee regarding Petition 2014/89 of Corinda Taylor and
others which requests an inquiry by the House of
Representatives into mental health services. This letter is
in support of my submission and, in summary, sets out the
following points.
• An action plan is required to
improve mental health and addiction services. In my opinion
that will be the fastest way to:
(a) develop and improve
services for current consumers; and
(b) ensure services
meet the mental health needs of all New Zealanders now and
in the future.
• Collaborative leadership from a sector
leadership group, which includes people with lived
experience, is essential for the action plan to deliver
results.
• The public needs to be kept informed about
the development of the action plan and see demonstrable
progress.
Mental Health Commissioner’s
Role
As the Mental Health Commissioner, I have a
unique and wide ranging insight into the state of mental
health services in New Zealand and in particular how they
are perceived by consumers of those services.
My role has
two major responsibilities:
• to ensure the rights of
consumers of mental health and addiction services are
upheld. An important aspect of this is making decisions on
complaints about services; and
• to monitor and
advocate for improvements to mental health and addiction
services.
Complaints
I
consider over 200 complaints each year in relation to mental
health and addiction services. The most commonly received
complaints in 2016/17 relate to:
• care and treatment
(60%);
• communication (55%);
• consent and
information (32%);
• facility issues (17%);
• medication (17%); and
• access and funding
(15%).
Those issues of concern have also arisen in the
People‘s Report and recent reports from the
Auditor-General, Ombudsman and Human Rights Commission, and
align with the issues being addressed through the Quality
Improvement Programme led by the Health, Quality and Safety
Commission.
Monitoring and
Advocacy
There are four components of my
monitoring work.
• Identifying the themes and trends
from complaints I receive about services. They are
summarised above and are vitally important because they
reflect the day-to-day reality for consumers and
families/whānau using services.
• Considering other
consumer feedback including from national consumer and
family/whānau advocates, and information from the
Mārama Real Time Feedback survey. The survey
provides consumer and their family/whānau perspectives of
their experiences with services. It is now used by 16 DHBs,
and a number of NGOs. Over 13,000 consumer and family
‘voices’ have been collected since the tool was first
piloted in 2014. Over 80% of respondents have reported
saying that they would recommend their service to friends
and family/whānau in need of similar care or treatment.
Similar numbers report they feel respected, are involved in
decision-making, have a plan that is reviewed regularly and
have the support they need for the future.
• Sector
engagement. I regularly meet with a range of policy makers,
funders, providers, service leaders and professional
groups.
• Analysing a range of information about sector
performance. Developing this aspect of my work is a high
priority for me. It will enable me to provide an on-going
public overview of services based on information from
consumers, HDC complaints and provider information in a way
which has not been done before in New Zealand.
I will be
reporting on my monitoring work publicly from early next
year. The report will include recommendations for actions
to improve services and, in subsequent years, report on
progress with the implementation of those
recommendations.
Monitoring role to date – what
am I seeing?
The main features that emerge from
my monitoring role to date are summarised
below.
• Access – A rapid increase
in access to specialist services over the past ten years
from 96,000 to 168,000. Specialist mental health services
in New Zealand are designed to provide for the 3% of the
population with the most severe disorders and highest needs.
Access has been sitting at 3.5% of the population for a
number of years now following successive annual increases
over the last decade. This is a significant, positive
achievement and reflects the gains that have been made
through investment in mental health and addiction services
following the 1996 ‘Mason Inquiry’. However, increased
access has put pressure on services and is impacting on the
quality of services provided.
• Demand –
Growth in demand for services is partly but not
fully reflected in growth in the number of people accessing
services. That growth is likely to increase considerably in
the future with growing recognition of mental health issues,
growing willingness to access services and increased
expectations of health services. Again that is positive but
requires a better approach to reducing demand and to the
development of new service models to meet people’s needs.
• Variation in service quality –
This is apparent from what I see in complaints and, as noted
above, reinforced by other evidence such as:
o the
People’s Report (access, treatment options and consent
issues);
o the Auditor-General’s report (discharge
planning); and
o the Human Rights Commission report
about seclusion and restraint.
• International
experience – These challenges are not unique to
New Zealand – other countries are facing the same
challenges as reflected in WHO’s focus on depression for
its World Health Day campaign this year.
However, there
are also important indicators of high service
quality and ongoing improvement efforts including
the below.
• The Mārama Real Time Feedback
surveys, with over 13,000 consumer voices so far, reporting
that over 80% of consumers surveyed would recommend their
service to others. It is important that those consumers are
heard.
• Seclusion rates have been reduced. Services
need to continue to reduce restrictive practices but some
DHBs have made substantial progress in this area.
• New
services initiatives, such as recent tele-health
initiatives, have improved access to mental health advice
for both consumers and GPs.
• The quality improvement
programme led by HQSC is focusing on important areas
including medication, coordination of care and reducing
restrictive practices.
A number of the comments above
relate to specialist services, however, the New Zealand
Mental Health Survey, published in 2006, indicates that 20%
of the population will meet the criteria for a mental
disorder in any given year, and that half the population
will meet the criteria for a mental disorder at some point
in their lifetime. Funded treatment and care options for
the approximately 17% of people with mental health needs who
do not qualify for specialist services are limited and there
is no systematic plan in place for addressing these
needs.
Action plan needed to respond to growing
pressures
An action plan is required to respond
to growing demand, gaps in services, variable service
quality and inadequate coordination of sector effort
(including health, education, housing and justice
sectors).
There is a high level of agreement about
current challenges and what needs to change and improve. The
plan should identify and build on the many strengths in the
sector. Some of the things that need to happen
are:
• more emphasis on prevention and early
intervention;
• sharper focus on individuals and
families/whānau with high and complex
needs;
• improved access to evidence-based
services;
• increased primary care support (both access
and options, and improving primary care access to specialist
advice and support); and
• clear progress on
longstanding challenges including:
o enabling health,
education, justice and welfare services to work better
together in a consumer-focused way;
o improving quality
of care (e.g. the HQSC quality improvement
programme);
o improving outcomes for Māori;
and
o coordinating care better – ensuring seamless,
compassionate support.
Progress in those areas also
requires progress in determining:
• the relative
investment in prevention, early intervention, primary and
secondary services (that will require careful assessment to
ensure people experiencing mental illness can access
specialist services to obtain the care they need);
and
• future workforce requirements – ensuring we
have a workforce equipped and supported to deliver services
which best meet consumers’ needs now and in the future.
We also need to build capability in our workforce to
continuously improve services (immediate action to address
pay equity issues is also required to ensure NGO capability
is retained).
Reducing suicide
An
essential component of any action plan to improve mental
health and addiction services is a specific focus on
reducing suicide. I share the widespread community concern
about our high rate of youth and teen suicides, and that we
are not reducing the overall rate of suicides in New
Zealand. We must do more.
Forty percent of people who
committed suicide are known to be receiving specialist
mental heath services at the time. Some ways we can reduce
suicide by people using those services is by addressing
issues which have arisen in complaints I have considered
including improving:
• communication with consumers and
their families/whānau;
• risk assessment and safety
plans and ensuring they are linked to carefully considered
treatment plans; and
• coordination of care amongst
services.
New Zealand also needs a target for our suicide
prevention plan. I understand why some people have concern
about the government being held to account for something
beyond its direct control. However, any target which is
adopted must be seen as our collective responsibility as New
Zealanders. Everyone has a role to play. The target needs
to be considered carefully but I note the World Health
Organisation suggests that countries should be guided by its
Mental Health Action Plan 2013–2020 that aims for a 10%
reduction in the suicide rate over that time (and that some
countries may go further). I support the WHO
target.
Essential components for an action
plan
Four components are important for the
success of an action plan to improve mental health and
addiction services.
• It needs to be
consumer-centred – focused on the needs
of consumers and their families and others who support
them.
• Collaborative leadership is required
from the start. A sector leadership group led by
the Ministry of Health is required. No one part of the
sector can develop or deliver an action plan in this area
alone. A draft plan followed by written feedback will not
achieve the required results. People with lived experience
need to be an integral part of the group as do leaders from
district health boards and NGOs including primary health
organisations. Group composition needs to be based on
people with proven success in achieving sector and service
improvements and achieving results collaboratively with
others including people with lived
experience.
• Delivering results. I
recommend a twelve month timeframe for the action plan to
provide a strong focus on
results.
• Transparency. Good
communication with consumers, the sector and the wider
public is important to ensure people are kept informed about
the pace and progress of the action plan.
Yours sincerely
Kevin Allan
Mental Health
Commissioner