The Initial Commission’s interim report, He Ara Oranga - Mānuka Takoto, Kawea Ake / Upholding the Wero Laid in He Ara Oranga, provides a check-in on progress of Government's response to He Ara Oranga, the inquiry into mental health and addictions. It focuses on four initial priority areas, and offers advice to consider in these early days of system transformation.
Ka koke whakamua tonu mahi / We have a unique opportunity to drive change
Overall, what we heard is relatively consistent across all four initial priorities; progress is happening, and communities are leading change from the front. There is strong hope that we can build a wellbeing system with people and whānau at the heart, but there is still a long way to go before people on the ground can see real change.
We acknowledge the commitment from Government to transform the system and appreciate that it will take time. The mental health and wellbeing system is complex and requires a brave and bold shift in culture and new ways of working.
While we don’t yet know the full impact COVID-19 will have on the people of Aotearoa, it presents challenges and opportunities for the mental health and wellbeing system. We would like to encourage the system to pause, reflect and embrace the strengths that emerged in the last few months, such as collaboration, high trust and a shared understanding of need and outcomes. Our response to COVID-19 has shown that together, we can achieve great things.
He whakatū i Te Kōmihana Hauora Hinengaro, Toiora Hoki / Establishing the Mental Health and Wellbeing Commission
- He Ara Oranga called for the establishment of a new Mental Health and Wellbeing Commission to act as a watchdog and provide leadership and oversight of mental health and wellbeing in New Zealand.
- A Mental Health and Wellbeing Commission is being established and expected to be up and running by 2021.
- The Initial Mental Health and Wellbeing Commission is clearing the pathway for the work of the permanent Commission while legislation is progressed.
- There is support the independent leadership and monitoring roles of the Commission and want to see the Commission prioritise genuine partnerships with Māori, Pacific peoples and people with lived experience of mental health and addictions.
He whakaputa i te rautaki ārai mate whakamomori me te whakatū i te Tari Ārai Mate Whakamomori / Publishing the suicide prevention strategy and establishing a Suicide Prevention Office
- He Ara Oranga highlighted that there needs to be more done to prevent suicide, support bereaved families and whānau, and to review the processes for investigating deaths by suicide. The Government agreed and has put the building blocks in place to improve leadership, coordination and resourcing for suicide prevention.
- A suicide prevention strategy – Every Life Matters - was completed and published in September 2019 and a Suicide Prevention Office was established in November 2019.
- A ground-up approach is being taken to improving suicide prevention, with communities leading the way.
He whakahou, he whakakapi i te Ture Hauora 1992 / Repealing and replacing the Mental Health (Compulsory Assessment and Treatment) Act 1992
- He Ara Oranga called for the repeal and replacement of the Mental Health (Compulsory Assessment and Treatment) Act 1992, which people said is out of date and can be traumatising and harmful for those under a compulsory treatment order.
- Cabinet agreed to repeal and replace the Mental Health Act in July 2019. This work is currently underway and is expected to take time. There is hope that this can take a rights-based approach built in partnership with people most affected by the Mental Health Act.
- New legislation won’t be transformative by itself and must be supported by other changes, such as expanding access and increasing choice of services and support.
He kura mahora i ngā ratonga / Expanding access and choice
- He Ara Oranga recommended increasing access to services from 3% of the population, to the ‘missing middle’ of people who cannot access the support and care they need. This is estimated to be around 20% of the population.
- He Ara Oranga also recommended that people should have greater choice in the types of support they receive, such as holistic services, talking therapies, alcohol and other drug services and culturally aligned therapies like kaupapa Māori approaches.
- In 2019, $1.9 billion was allocated over five years to mental health and wellbeing initiatives – to expand access and choice to those with mild to moderate needs and strengthen the services for those with more severe needs.
- Programmes for new frontline services have been launched at pace, such as nearly nationwide services via GPs, and pilot programmes with kaupapa Māori, Pacific and youth focus.
- Work is underway to support and enhance the mental health and wellbeing workforce.
- The way services are funded and designed have not changed enough to allow genuine co-design, where people partner with government to design services that work for them.
- There is concern that new services provided via GPs may not expand services, or increase choice, for those who face barriers accessing GP services (such as costs for seeing a doctor) or want a non-medical entry to health and wellbeing services.
Te mana taurite me ngā whanaungatanga / Equity and Partnership—kotahitanga—need to come first
There are some areas that could be strengthened in these early days of system transformation to achieve equity for all and build strong foundations for the future.
I takea mai i Te Tiriti o Waitangi me te mana taurite / A system grounded in Te Tiriti o Waitangi and equity
The commitment to Te Tiriti o Waitangi needs to be strengthened as the basis for the way the system transforms. This is more likely to improve outcomes and ensure that solutions made for Māori, by Māori are championed and supported.
Ko te whānau me te iwi te iho o te kotahitanga / People and whānau at the centre of a unified and inclusive system
Co-design needs time and meaningful engagement. People need the skills and knowledge to fully utilise co-design approaches and filling this capability gap needs to be a key priority. In addition, there needs to be genuine support and resourcing to enable people to take their seat at the table.
Kia pakari ake, kia kanohi kitea i roto i ngā tini whanaungatanga / Stronger, more visible leadership and genuine partnership
People told us that transformation needs strong, consistent and visible leadership across the system - at a political level, government level, and DHB level, and that more support is needed for emerging community leadership.
He rautaki mauroa ka hua mai i te mahi tahi / A clear, long-term plan we develop together
We heard that achieving this vision will rely on a solid long-term plan that we develop together. Plans need to be transparent so that people know what is happening, when it is happening, and how they can take part in the discussions.
He rautaki takoto mō te whakapakari kaimahi / A strategy that supports and develops our wellbeing workforce
We heard the need for a workforce with atawhai (kindness), aroha (love) and whakarangatira (respect) at their heart. There is no denying that this exists within the system and the passion and dedication of the workforce is strong. Our workforce is critical to transformation and we need to support and enhance it. Our workforce strategies need to be strengthened to align and support a wellbeing approach, with cultural competency and capability a key pillar.
Kia whakangao ki te whakawhānui i ngā huarahi a te Māori me ngā iwi noho pāraerae ki ngā tini kōwhiringa / Investment that expands access and increases choice prioritises Māori and those who need it the most
Investment in expanding access and increasing choice needs to be strengthened to prioritise Māori, Pacific peoples and other diverse communities that have disproportionately lower outcomes. We need greater choice across the spectrum of care so that people who need more support and care have a range of options and can define what works best for them.