New Zealand’s mental health system is “in crisis” and in worse shape now than four years ago, practitioners say – despite much-heralded government efforts to reform it and prioritise national wellbeing.
A commitment to improving New Zealand’s mental health record has been at the heart of the progressive, Jacinda Ardern-led Labour government. The country has enduring challenges with mental health, including the highest rate of youth suicide in the developed world. When Ardern was leading her first election campaign in 2017, she made it a central election issue.
“It is time for us to move from grief and loss, to love and hope for our next generation,” Ardern said at the time, in a tearful speech to families who had lost members to suicide. “If I was going to give you any commitment here today it’s that … I’ll think about the people, the lives, and do everything practically we can to make a difference for those families who have already experienced loss.” After about a year in power, the government unveiled its “world-first” wellbeing budget in 2019, which drew international attention for its focus on support for New Zealand’s most vulnerable. That year, mental health was given the biggest funding and investment boost on record, receiving NZ$1.9bn (£980m).
Despite those investments, substantial reform of New Zealand’s mental health system has proven difficult. The country’s overall suicide rate has remained relatively static, dropping slightly last year after an all-time high in 2019. The latest annual reports from the Office of Mental Health and Addiction Services were finally released on Wednesday, with data from 2018 and 2019. Their release had been repeatedly delayed, so until now the most recent data was for 2017, when the previous National party government was in power. This new data represents one of the first wide-reaching assessments of the mental health system under the current government – and social service agencies say it’s failing.
“It’s hard to find much that’s positive,” said Mental Health Foundation chief executive Shaun Robinson. He said the report showed the mental health system was in worse shape now than four years ago. “It’s not surprising, unfortunately – the mental health crisis in New Zealand just continues to grow. With the best intentions in the world, the response from government to date is just not adequate. It’s not working.”
In particular, the report found the practice of locking mental health patients alone in rooms – known as “seclusion” – had grown significantly since 2017, rising 10% in 2018, and another 9% in 2019. Patients were also spending more time locked in: the average time that seclusion lasted for rose from around 24 hours to more than 27 hours. The report also revealed significant racial disparities: Māori were five times more likely to be locked up in seclusion rooms than other New Zealanders.
Seclusion is supposed to be used only as a last resort, to avoid patients harming themselves or others. Its widespread use in New Zealand was slammed by the United Nations committee against torture and commission on human rights, and five years ago government launched a project that aimed to end the practice by 2020. But New Zealand nurses have pointed out that reducing seclusion requires more resources to deal with complex patients. In the past, some seclusion rooms have been scrapped, then reinstated by district health boards who find they don’t have the resources to find alternatives.
Sarah Dalton, the executive director of the Association of Salaried Medical Specialists, a union representing doctors, said earlier this month that “acute and community psychiatric services [are] completely overwhelmed and in crisis”.
The union’s mental health workers released a statement saying they were “overwhelmed by skyrocketing demand and have seen no meaningful progress despite the promises of the 2018 mental health inquiry”.
“There just aren’t enough staff, not enough resources,” a psychiatrist member said. “There is huge demand, really, really high need and we’ve been significantly impacted not just by high rates of severe mental illness but significant deprivation, homelessness, poverty, substance abuse issues.”
Robinson was also concerned at the way this week’s report had been delayed, and now published without all the same data and analysis as previous years. The ministry blamed the delays on Covid-19. Particularly notable was the missing data on how many people were engaging with specialist mental health services – a statistic he said was “the centrepiece” of the government’s mental health plan. While the government had commissioned a national mental health inquiry in 2018, he said there still wasn’t a clear implementation plan.
“One of the things that’s most concerning is the overall lack of transparency and accountability,” he said. “We all know the changes required are big, complex, and long-term, and no one was expecting a magic wand,” he said. “But we still don’t have a plan that says how that’s going to happen.”
“It’s frankly an abysmal situation and cannot be allowed to continue.”
Toni Gutschlag, the ministry’s acting deputy director general for mental health and addiction, said in a statement: “We don’t agree that the mental health system is in worse shape than it was before the current government came in. There are always natural variations in data indicators and we need to make sure we look at trends over a longer time frame, not just year to year.”
She said working to decrease seclusion rates “will take time”. She also said the ministry was “building parts of the system that have not previously existed and put in place the foundations for transformation”.
Mental health and addictions director Dr John Crawshaw said that while the data did show increases in both seclusion incidents and times, things had been improving in the year since. In a written statement, he said “the very early ‘tests of change’ (ideas to reduce seclusion) only started during 2019 and have gathered pace during 2020”. Over the course of 2020, he said that across district health boards, the length of time each patient spent in seclusion had been decreasing.
He also noted that while seclusion had trended substantially upwards from 2017-19, it was still significantly lower than the previous high point a decade earlier, in 2009. “While some of the increase can be explained by better reporting methods and an overall increase in people accessing mental health services, the ministry and the commission are aware that this does not cover all situations,” he said.
Need to talk? In New Zealand, free call or text 1737 any time for support from a trained counsellor. Lifeline – 0800 543 354 (0800 LIFELINE) or free text 4357 (HELP). In Australia, the crisis support service Lifeline is 13 11 14. In the UK and Ireland, Samaritans can be contacted on 116 123 or email firstname.lastname@example.org or email@example.com. Other international helplines can be found at www.befrienders.org